PAIN ASSESSMENT TYPES OF NOXIOUS STIMULI

Although pain is referred to as the fifth TYPE Causes RESPONSE

vital sign, pain is a symptom, Subjective
in nature pain is “whatever the person
Mechanic Tissue Tissue
say it is, whenever she or he says it
al trauma, damage
does.” such as directly
It is the most common reason patient surgery stimulates
seek healthcare. laceration pain receptors
alteration and activated
PROCESS OF PAIN of tissue, inflammatory
such as response
TRANSDUCTION: Transduction begins edema
with a response to a noxious/painful obstructio
stimulus that results in tissue injury. n, such as
biliary or
TRANSMISION: Once the nociceptors
bowel
are activated, the nerve impulse is abnormal
transmitted to the spinal cord and brain. growth
PERCEPTION: Is in awareness of pain tissue.
and involves both the cortical and the Thermal Extreme Extreme
heat or temperatures
limbic system structures.
cold cause tissue
MODULATION: Never transmission from damage and
the dorsal horn is modulated by activate
descending inhibitory input. Inhibition thermosensitiv
can also occur at the peripheral, spinal, e pain
and supraspinal levels. receptors.
Chemical Tissue Decreased
SENSITIZATION ischemia blood supply
such as leads to tissue
PERIPHERAL SENSITIATION: Occurs coronary ischemia and
with prolonged exposure to noxious artery damage, with
stimuli. The result is a lower threshold of disease or lactic acid
pain, leading to hyperalgesia (increased muscle production
response to painful stimuli) and spasms and release of
allodynia (painful response to nonpainful tissue
stimuli) byproducts,
such as
CENTRAL SENSITIZATION: Also bradykinin,
occurs with prolonged exposure to that stimulate
noxious stimuli with spinal neuron pain
hyperexcitability and results in receptors.
hyperalgesia and allodynia as well as
persistent pain and referred pain.
NOXIOUS STIMULI Persists beyond expected healing time.
These noxious stimuli can be Parasympathetic response.
mechanical, thermal, or chemical. The
Malignant conditions Chronic non-life-
noxious stimuli are then converted into a
threatening diseases.
nerve impulse by sensory receptors
called nociceptors. CANCER/MALIGNANCY
Nociceptors are receptors found in the Malignancy diagnostic procedure, or
skin, subcutaneous tissue, joints, walls disease treatment.
of arteries, and most internal organs
(with the highest concentration found the May be acute or chronic.
skin and the least in internal organs that Variable depending on location and
respond to painful stimuli.) duration.
In response to tissue injury, cells break Malignancy and associated diagnostic
down and release byproducts and test and treatments.
inflammation mediators.
CHRONIC NONCANCER
These substances activate or sensitize
the nociceptors. Bradykinin also acts as Weak connection between cause and
a potent vasodilator. extent of pain.

The inflammatory response is the Prolonged possibly lifelong

greatest cause of pain, however all pain Pain, ranging from mid to excruciating.
that originates from the periphery is not
nociceptive pain, Damage peripheral Osteoarthritis, Low back pain.
nerves can result in peripheral CHRONIC PAIN WITH SYNDROME
neuropathic pain.
Chronic pain with that consumes and in
TYPES OF PAIN capitates patient.
ACUTE: Prolonged possibly lifelong.
Injury or pathology Psychosocial dysfunction such as anger,
Receives with healing. depression, anxiety, substance abuse.

Activates ANS and protective NOCICEPTIVE PAIN

responses. Nociceptive pain results from exposure
Medical or surgical procedures Labor to noxious (painful) stimuli. The painful
acute disease. stimuli can occur in the viscera, resulting
in visceral pain, or tissue, resulting in
CHRONIC: somatic pain.
May or may not be associated with
pathology.
VISCERAL PAIN results from BIOGRAPHICAL DATA.
overdistension, spasms, ischemia,
Review the patient’s biographical data.
inflammation, or traction of organs.
Patient’s age, ethnicity, and religion may
REFERRED PAIN
affect her or his…
Is felt at a site other than at the site of
CIRREMT HEALTH STATUS
origin.
The mnemonic PQRST provides a
RADIATING PAIN
thorough description of pain,
Begins in one area and extends to
Precipitating/Palliative/Provocative
others.
Factors
SUPERFICIAL PAIN
- What were you doing when the pain
Originates in the skin or mucous started?
membrane from external stimuli.
- Does anything make it better?
NEUROPATHIC PAIN
Quality/Quantity
MONE/POLYNEUROPATHIES: Involves
- What does it feel like?
pain along one or more damaged
peripheral nerves. - To what degree is the pain affecting
your ability to perform your usual daily
NEUROPATHIC PAIN: Results from
activities?
injury to the peripheral or central
nervous system. Region/Radiation/Related symptoms
DEAFFERENTATION PAIN: Occurs - Can you point to where it hurts?
with loss of afferent input from damage
to a peripheral nerve, ganglion, plexus, - Does the pain occur or spread
or CNS, Example: Phantom limb and anywhere else?
postmastectomy. - Do you have any other symptoms?
SYMPATHETHICALLY MAINTAINED Severity:
PAIN: Is a pain mechanism that results
from sympathetic nervous stimulation. - Pain scale

CENTRAL PAIN: - How painful is it?

HEALTH HISTORY Timing

Self-report is the most accurate indicator - When did it happened.

of pain,
The history also allows you to assess
past experiences with pain, effective
pain treatments, and the effects pain
has on every aspect of the patient’s life.
 The BPI is used to quantify pain
intensity and associated disability.
C. MCGILL PAIN QUESTIONAIRE.
PAIN SCALING FOR ADULTS
The MPQ uses descriptive words to
1. UNIDIMENSIONAL PAIN SCALES
assess pain on three levels: sensory,
These scales generally use numeric, affective, and evaluative it can be used
verbal, or visual descriptors to quantify with other tools and is available in short
pain. and long forms.

2. MULTIDIMENSIONAL PAIN SCALES D. NEUROPATHIC PAIN SCALE

These scales assess pain The neuropathic pain scale assesses

characteristics and its effects on the type and degree of sensations
patient’s activities of daily living. associated with neuropathic pain. The
patient rates eight common qualities of
neuropathic pain (sharp, dull, hot, cold,
UNDIMENSIONAL PAIN SCALES sensitive, itchy, deep, or surface pain)
on a scale of 0 (no pain) to 10 (worst
B. Visual analogue scale. pain)
The visual analogue scale utilizes a PAIN ASSESSMENT IN ADVANCED
vertical or horizontal 10-cm line with DEMENTIA SCALE
anchors, one end of the line is labeled
“NO PAIN” and the opposite end of the Current recommendations for pain
line is labeled “Worst Pain” The patient reassessment include:
marks his or her current pain level on FACES PAIN RATING SCALE
the line.
The faces rating scale assesses pain for
C. Categorical scales. children ages 3 year and up. The wong-
Visual descriptors include the faces pain baker.
scale for adults and children, which Oucher scale
utilizes illustrated faces with facial
expressions ranging from happy to sad The oucher scale assesses pain for
and crying. children ages 3 to 13 years with photos
or numeric scale.
MULTIDIMENSIONAL PAIN SCALES
Numeric scale.
A. Initial pain assessment inventory:
Poker chip scale:
The IPAI is used for initial assessment of
pain, it assesses characteristics of pain; The poker chip tool assesses pain in
effects of pain on the patient’s life, such children 4 years of age and up to 13
as daily. years old. The nurse place red poker
chips horizontally in front of the child,
B. Brief pain inventory.
with the poker chips denoting “pices of If there is a problem in one system,
hurt.” eventually other systems will be
affected.
Visual analogue scale
Psychosocial profile.
Color tool
Assessing the psychosocial history
The colortool assesses pain for children
identifies the effects that pain has on
as young as 4 years by having the child
every aspect of the patient llife and
create a body outline using color
evulates quality of life.
markers or crayons.
PHYSICAL ASSESSMENT.
NEONATAL INFANT PAIN SCALE
General appearance. Abnormal body
The neonatal infant pain scale (NIPS) is
posture, splinting, guarding
used to assess infants at an average
gestational age. Facial expression: grimacing frowning
CRIES Integumentary: Pallor, diaphoresis:
possible signs of shock
Riley infant pain scale.
Respiratory: increased RR
Flacc postoperative pain scale.
Cardiovascular: increased HR,
PAST HEALTH HISTORY
increased BP, chest pain or heart attack
When conducting the past, health
Gastrointestinal: hypoactive bowel
history, make sure to identify
sounds. Delayed gastric emptying and
Cause of pain peristable resulting in constipations.

Past and present medical problems tha

may influence pain and its management.
Past psychiatric illness and chemical
dependence.
Past and present pain management
strategies.
Past experiences with pain
Chronic vs. Acute pain.
Family history: The family history also
identifies familial history of chronic pain
or illness, Ask the patient about
hereditary or familial health problems.
Review of systems