Fundamentals - Practice & Skills, part 6: Pain - Types, Etiology, and Treatments

by Meris Shuwarger July 28, 2021 Updated: July 29, 2021

Full Transcript

Hi, I'm Meris. And in this video, I'm going to be talking to you today about types of pain and their treatments. I'm going to be following along with our nursing fundamentals flashcards. These are available on along with a lot more flashcards, so definitely check it out if you don't have your own set. And if you do have a set for yourself, I am starting on card number 58, so let's get started. So before we get started, I want to invite you to stay until the end. I'm going to share a personal story with you about why it's so important that we take patients' pain seriously based on what they say and not what we perceive. So stay to the end for that, but let's get started with card 58. We're talking about different types of pain. And you can see here on this card, we've got a big, bold red statement here, so let's go through this. Acute pain. Acute pain means it's new or sudden onset, short-term. With acute pain, I like to think of appendicitis, right? Someone with appendicitis, they're going to be in a lot of pain. They're going to be guarding, holding their abdomen, maybe sweating. They look tense, and their vital signs will be impacted. Now, compare that with chronic pain. Chronic pain means that this is pain that is persisting for a long time and the body learns to adapt to deal with it. So your vital signs may not be impacted. That's bold and red on this card, very important to understand. So just because you see that your patient has normal vital signs but they're telling you that they have a 5 out of 10 pain, it doesn't mean that they're telling you a lie. It may mean that they are able to deal with the pain that they have. Keep in mind that chronic pain persists for longer than three months. So this is not something like, "Oh, I've tweaked my back, and it's hurting me for a week." This is like, "In my case, I have scoliosis. My back hurts every single day of my life, and I'm at a constant 3 out of 10, but I live my life anyway."

You'll also see on here breakthrough and cancer pain. Breakthrough means pain that breaks through. So for instance, maybe I have surgery. I'm doing okay, and then I walk the halls, and now my pain is higher than it would be. And that's even though I'm taking pain medicine. Cancer pain can be related to the cancer and the treatment itself, but keep in mind that that's going to be a very intense kind of pain compared to some other types of pain. Now, moving on, let's talk about pain etiology and location. Etiology means where does it start from, where does it begin from. So under the etiology, you can see we have nociceptive, neuropathic, and idiopathic. If you remember all the way back to A&P, nociceptors are certain types of nerves in our body. Their whole job is to pick up on painful or noxious stimuli. So this is going to be pain caused by injury to a tissue those little nerves are picking up on and saying, "This hurts really bad. This is going to be aching or throbbing." Now neuropathic, neuro meaning nerves and pathic meaning disorder, so this is a disorder of the nerves. Right? This is caused by injury to the nerves, so this kind of pain is going to be described differently. It's going to be burning or shooting pain. Your patients may also call this pins and needles. And then idiopathic means with unknown origin, unknown cause. So this is someone who comes and says, "I'm having really bad pain," and we can't find an explanation for their pain. Idiopathic. Then location of pain. I'm not going to go through all of these with you, but just know that the location differs based on what the problem is. So if I have cutaneous pain versus somatic versus visceral, my pain is going to feel different. So be sure to be familiar with all of those terms.

Okay. So moving on to talk about therapies for pain. How do we treat pain? Well, if you look at this card, number 60, we talk about pharmacological and nonpharmacological treatments, pharmacological meaning related to medications; nonpharmacological, obviously, no medication involved. So when it comes to treating pain with medications, there are different options. We usually start off with nonopioids. These would be things like Tylenol, acetaminophen, NSAIDs, nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen, aspirin, those sorts of things. That's going to typically be for mild to moderate pain. I have a headache at home, I take an ibuprofen. Right?

Now when we talk about opioid medications, these are narcotics, and these are certainly not what we want to start treating pain with most of the time. So this is going to be for moderate to severe pain, and examples of these, which you'll talk about much more extensively in pharmacology, would be things like Fentanyl, morphine, Dilaudid, oxycodone, hydrocodone. All of those are narcotics.

And then we having something called adjuvants. So adjuvant medications are things that are used to help treat pain in addition to analgesic drugs. So we have some examples here, like antidepressants such as amitriptyline. Anticonvulsants - these are used a lot - things like gabapentin and carbamazepine. And then topical analgesics, which actually numb the area, like lidocaine. Then some nonpharmacological treatments. These are going to be things like distraction, meditation, massage, biofeedback. A lot of those things that we talk about in the complementary and alternative medicine card on card number 29. So definitely be familiar with the options available to your patients that are both based in pharmacology and those that are drug-free.

Okay. So now we're on card number 61. We are talking about PCA pumps. These are patient-controlled analgesia, so as the name implies, it is controlled by your patient. That is a very important thing to remember. The patient is the only one who controls the PCA. Meaning that I, as the nurse, do not come in and push the button for them. The family members, the visitors need to be educated that they do not push the button either. It is patient-controlled. And what this means is that my patient has an IV going to their arm, going to their hand, and they have a medication prescribed by their provider. Maybe it's morphine or Dilaudid, something along those lines. It's a small dose that they can receive at a certain interval, so this is called the lockout interval. So, for instance, let's say it's 0.2 mg of Dilaudid every 10 minutes, is what my patient can have, but they don't automatically get that. What that means is every 10 minutes that button, if it is pushed, will deliver 0.2 mg of Dilaudid. Now, it is not going to deliver it unless that button is pushed, so this allows my patient to control their pain management. This allows my patient to get the pain management on demand, without involving the nurse. So some important things to know here. When my patient is set up with a PCA pump, I will very likely need another RN to verify the pump settings. This is very dangerous. I need to make sure that what the provider ordered is indeed what the pump says. And the other thing, like I said, educating patients and their family members that only the patient touches it, nobody else; hugely important to patient education and family education. And then the other thing is that, it's just important to know that you can still suffer those sort of toxic effects of medication, so if my patient is pushing that button every 10 minutes, it is still possible that they receive too much medication. I don't mean that they're receiving more than ordered. I mean they're receiving more than their body can tolerate, just like any pain management, right.? So I need to still be assessing that patient frequently, making sure their respiratory status is good, and checking in on the status of that patient's pain. Okay, so that is it for types of pain and their treatments. I hope that review was helpful. If it was, please be sure to like this video, and leave a comment below. If there's some awesome way that you remember something, I very much want to hear it. In the next video, I'm going to be talking about sleep basics, sleep disorders, and general adaptation syndrome, so be sure that you subscribe to the channel, so that you're the first to know when it posts. Thanks so much and happy studying.

So I have a very extensive medical and surgical history, and when I was 21, I was having some complications from surgery. And I went to the emergency room and I said, "I am in severe pain." And I had been in pain for a very long time, and the doctor who came and examined me said, "I just don't think that you're in as much pain as you say you are." And I was talking to him probably similar to how I'm talking to you right now, because I was used to dealing with the pain. Well, as it turns out, I was in exactly as much pain as I said I was, because I went on to become septic later and had emergency surgery, and had an extensive hospital stay. So just because your patient might look composed, might look like they're not in pain, it's very important to take seriously whatever the patient says. You don't get to decide what your patient's pain is, they do. You can document it. You can document your objective findings and the subjective findings, but ultimately, pain is what the patient says it is, and it's very important to respect that. So thank goodness for the nurses who were on my side and really advocated for me and ended up speaking up when I did develop serious complications.

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