Pain and discomfort

PAIN AND DISCOMFORT

WHAT IS PAIN?

• Unpleasant sensory and emotional experience associated with actual or potential tissue damage

• Pain is a protective mechanism

• Subjective

TYPES OF PAIN

• FAST AND SLOW PAIN

• ACUTE PAIN

• CHRONIC PAIN

• CHRONIC RECURRENT PAIN

SYMPTOMS OF PAIN

THEORIES OF PAIN

DESCARTES VIEW

• Rene’ Descartes

• Cartesian Theory of pain

• French Philosopher that first proposed that pain was a disturbance that passed down along nerve fibers until the disturbance reached the brain.

DESCARTES VIEW

INTENSIVE THEORY

• Whilliam Erb(1874)

• Also called as Intensity Theory

• Pain = stimulas intensity + central summation

• Dorsal horn cells

Specificity Thory

• Von Frey,1895

• First modern theory

• Pain centre in brain

• Separate sensory system for pain

• Free nerve endings are pain receptors

Pattern Theory

• JP Nafe, 1929

• Specific and particular pattern of nerve firing give pain sensation

• Touch receptors also sense pain

• Patterns occur with intense stimulation

The fourth theory of pain

• Hardy, Wolff, and Goodell, 1940s

• Pain has two components

– Perception

– Reaction

Central summation theory

• Livingstone,1943

• Intense stimulation from tissue damage pools within spinal cord

• Prolonged abnormal activity in spinal cord projects to brain for pain perception

Gate control theoy

• Melzack ad Wall, 1965

• There exist a gate system within spinal cord

• Inhibit = gate closed

• Allow = gate open

• T cells in substantia gelatinosa

Factors influencing gate control

• Amount of activity in pain fibers

• Amount of activity in other peripheral fibers

• Messages that descend from barin

Bio psycho social model of pain

PAIN ASSESSMENT

HOW WE MEASURE PEOPLE’S PAIN

THREE WAYS

• Self report

• Behavioural

• Physiological

Tools are assisted

FLACC

• Face

• Legs

• Activity

• Cry

• Consolabilty

• (used for neonatal babies)

Wong Baker faces pain scale

Uses self report of patient

Visual analogue scale

Physiological indicators

• Increased heart rate

• Increased respiratory rate

• Increased blood pressure

• Decreased oxygen saturation rate

MANAGING AND CONTROLLING

CLINICAL PAIN

Pharmacological control

• Nonopioid analgesics

• Nonnarcotic drugs

Surgical control

Repairing source or altering nervous system

Sensory Control

counterirritation

Biofeedback

Most common techniques

• Transcendental

• Mindfulness

Hypnosis

ACCUPUNTURE