Pain Classification by Physiological and Psycholo
Psychological
gical Factors
• Physiological Factors
Factors:
Nociceptive
Nociceptive: From physical injury to tissues.
Neuropathic
Neuropathic: From nerve damage or dysfunction.
Inflammatory
Inflammatory: Pain due to an inflammatory response (e.g., arthritis).
• Psychological Factors
Factors:
Influenced by mental state, emotional health, and coping mechanisms; anxiety and
depression can heighten pain perception.
6. Factors Aff
Affect
ect
ecting
ing the Pain Experience
• Age
Age: Younger children may have difficulty expressing pain, while older adults may
underreport pain.
• Gender
Gender: Women may experience pain differently due to hormonal variations.
• Culture
Culture: Cultural beliefs influence how pain is perceived, expressed, and treated.
• Previous Pain Experiences
Experiences: Prior experiences can affect pain threshold and coping
mechanisms.
• Social Support
Support: A strong support system can positively influence pain coping strategies.
7. Physiological Indicators of Acute Pain vs. Chronic Pain
• Acute Pain
Pain:
Elevated heart rate, blood pressure, and respiratory rate.
Increased muscle tension, dilated pupils, sweating.
• Chronic Pain
Pain:
Often lacks autonomic responses; may include signs like fatigue, irritability, sleep
disturbances, and depression.
8. Examples of Acute and Chronic Nociceptive Pain
• Acute
Acute: Post-surgical pain, bone fracture.
• Chronic
Chronic: Osteoarthritis, lower back pain.
9. Visceral vs. Somatic Pain
• Visceral Pain
Pain: From internal organs, typically dull, cramping, or aching and harder to
localize (e.g., gallstones).
• Somatic Pain
Pain: From skin, muscles, and joints; usually well-localized and sharp (e.g.,
arthritis, skin abrasions).
10. Examples of Neurop
Neuropathic
athic Pain
• Diabetic neuropathy, trigeminal neuralgia, postherpetic neuralgia (from shingles).
11. Nonpharmacological Nursing Interventions for Comfort
• Positioning
Positioning: Reduces pressure on painful areas.
• Heat/Cold Therapy
Therapy: Heat relaxes muscles, cold reduces inflammation.
• Massage
Massage: Relieves tension and promotes relaxation.
• Guided Imagery
Imagery: Helps shift focus away from pain.
• Distraction Techniques
Techniques: Music, TV, or hobbies help focus away from pain sensations.
,Osteoarthritis ((Chroni
Chroni
Chronicc Pain)
1. Pathophysiology of Osteoarthritis
• Degenerative joint disease causing cartilage breakdown, joint inflammation, and bone
spur formation, leading to pain, stiffness, and limited movement.
2. Risk Factors
• Age, obesity, previous joint injuries, repetitive joint use, genetics, and female gender.
3. Signs and Symptoms
• Joint pain and stiffness, especially after inactivity, swelling, and limited range of motion.
4. Diagnostic FFindings
indings
• X-rays (joint space narrowing, bone spurs), MRI (cartilage loss), and blood tests to rule
out inflammatory arthritis.
5. Medical/Surgical Management
• Non-Surgical
Non-Surgical: NSAIDs, physical therapy, weight management.
• Surgical
Surgical: Joint replacement for severe cases.
6. Nursing Process
• Assessment
Assessment: Pain, mobility limitations, and functional status.
• Diagnosis
Diagnosis: Chronic pain, impaired physical mobility.
• Planning
Planning: Pain management, mobility maintenance.
• Implementation
Implementation: Pain relief (NSAIDs, hot/cold application), encouragement of activity as
tolerated.
• Evaluation
Evaluation: Relief from pain, maintained mobility.
7. Complications
• Joint deformity, reduced mobility, increased fall risk.
8. Psychological Effects
• Depression, social withdrawal, altered self-image.
9. Pain Management Medication Comparison
• Acute: Immediate NSAIDs, short-term opioids.
• Chronic: Long-term NSAIDs, adjunct therapies (e.g., gabapentin)
Degenerative Disk Dis
Disease
ease (Neuropathic Pain)
1. Pathophysiology
• Spinal disc degeneration, leading to nerve compression, chronic pain, numbness, and
weakness.
2. Risk Factors
• Aging, repetitive strain, obesity, and smoking.
3. Signs and Symptoms
• Radiating pain, numbness, tingling in extremities, and decreased mobility.
4. Diagnostic Findings
, • MRI or CT scan showing disc degeneration or herniation.
5. Medical/Surgical Management
• Non-Surgical
Non-Surgical: Physical therapy, NSAIDs, muscle relaxants.
• Surgical
Surgical: Spinal fusion, discectomy.
6. Nursing Process
• Pain management, mobility support, post-surgical care if needed.
7. Complications
• Chronic pain, nerve damage, limited function
Total JJoint
oint Arthroplasty (Post
(Post-Operative
-Operative Acute Pain)
1. Nursing Process in Post
Post-Op
-Op Pain Management
• Assessment
Assessment: Monitor pain levels, vital signs.
• Planning
Planning: Pain control, early ambulation.
• Implementation
Implementation: Administer analgesics, positioning.
• Evaluation
Evaluation: Pain relief, patient comfort.
2. PCA Pump Care
• Educate on use, monitor dose administration, assess for adverse effects like respiratory
depression.
Procedural Pain
1. Nursing Process
• Pre-procedure preparation, pain management during and after procedures.
2. Independent Interventions
• Distraction, positioning, relaxation.
3. Collaborative Interventions
• Coordinate with medical team for analgesic plans, possible sedation if needed.
Chapter 36: Osteoarthritis (pp. 1122-
1122-1124)
1124)
Osteoarthritis (OA) is discussed in terms of its etiology, risk factors, clinical presentation, and
management options for patients experiencing chronic joint pain and reduced function.
1. Pathophysiology of Osteoarthriti
Osteoarthritiss :
a. OA is characterized by the gradual breakdown of articular cartilage, leading to joint
pain, stiffness, and reduced mobility. It involves joint space narrowing, subchondral
bone sclerosis, and the formation of bone spurs (osteophytes).
2. Risk Factors
Factors:
a. Major risk factors include advanced age, obesity, joint injury, repetitive joint use
(e.g., in certain occupations or sports), and genetic predisposition.
3. Signs and Symptoms
Symptoms:
, a. Symptoms include joint pain (worse with activity), stiffness (especially in the
morning or after inactivity), crepitus (grating sound with movement), and
decreased range of motion.
b. Commonly affected joints include knees, hips, hands, and spine.
4. Di
Diagnostic
agnostic Findings
Findings:
a. Ima
Imaging
ging
ging: X-rays are typically used to assess joint space narrowing, bony
outgrowths, and alignment changes.
b. Lab Tes
Tests
ts
ts: Typically, there are no specific lab tests for OA, but tests may be used to
rule out other types of arthritis.
5. Management
anagement:
a. Pharmacologic
harmacologic: Acetaminophen for mild pain; NSAIDs for moderate pain and
inflammation; intra-articular corticosteroid injections for severe pain.
b. Non-
Non-Pharmacologic
Pharmacologic
Pharmacologic: Exercise programs, weight loss, assistive devices (e.g., canes),
and heat or cold therapy to improve joint function and reduce pain.
c. Surgical
Surgical: Joint replacement (arthroplasty) is considered for severe cases when
conservative management fails.
6. Nursin
Nursingg Process in OA Care
Care:
a. Assessment of pain levels, joint function, and mobility limitations.
b. Interventions include pain management, patient education on joint protection,
encouragement of low-impact exercise, and nutritional counseling for weight
management.
7. Co
Complications
mplications
mplications:
a. OA complications can include reduced mobility, muscle atrophy due to decreased
activity, and secondary problems like depression from chronic pain.
8. Psychol
Psychological
ogical Effects
Effects:
a. Chronic pain can lead to feelings of helplessness, frustration, and depression,
which the nurse should address through holistic patient-centered care.
Chapter 65: DeDegenerat
generat
generative
ive Disc Disease (pp. 2133-21
2133-2134
34
34))
Degenerative Disc Disease (DDD) is a condition characterized by the breakdown of
intervertebral discs, leading to chronic back pain and, in some cases, nerve compression and
neuropathic symptoms.
1. Pathophysiology of DDD DDD:
a. DDD involves the gradual loss of disc hydration and elasticity, causing the disc to
lose height and become less effective as a cushion between vertebrae. This may
lead to disc herniation or bone spur formation, compressing nearby nerves.
2. Risk Factors
Factors:
a. Risk factors include age (natural aging process), smoking, obesity, genetic
predisposition, and repetitive stress or trauma to the spine.
3. Cl
Clinical
inical Manifestations
Manifestations:
Psychological
gical Factors
• Physiological Factors
Factors:
Nociceptive
Nociceptive: From physical injury to tissues.
Neuropathic
Neuropathic: From nerve damage or dysfunction.
Inflammatory
Inflammatory: Pain due to an inflammatory response (e.g., arthritis).
• Psychological Factors
Factors:
Influenced by mental state, emotional health, and coping mechanisms; anxiety and
depression can heighten pain perception.
6. Factors Aff
Affect
ect
ecting
ing the Pain Experience
• Age
Age: Younger children may have difficulty expressing pain, while older adults may
underreport pain.
• Gender
Gender: Women may experience pain differently due to hormonal variations.
• Culture
Culture: Cultural beliefs influence how pain is perceived, expressed, and treated.
• Previous Pain Experiences
Experiences: Prior experiences can affect pain threshold and coping
mechanisms.
• Social Support
Support: A strong support system can positively influence pain coping strategies.
7. Physiological Indicators of Acute Pain vs. Chronic Pain
• Acute Pain
Pain:
Elevated heart rate, blood pressure, and respiratory rate.
Increased muscle tension, dilated pupils, sweating.
• Chronic Pain
Pain:
Often lacks autonomic responses; may include signs like fatigue, irritability, sleep
disturbances, and depression.
8. Examples of Acute and Chronic Nociceptive Pain
• Acute
Acute: Post-surgical pain, bone fracture.
• Chronic
Chronic: Osteoarthritis, lower back pain.
9. Visceral vs. Somatic Pain
• Visceral Pain
Pain: From internal organs, typically dull, cramping, or aching and harder to
localize (e.g., gallstones).
• Somatic Pain
Pain: From skin, muscles, and joints; usually well-localized and sharp (e.g.,
arthritis, skin abrasions).
10. Examples of Neurop
Neuropathic
athic Pain
• Diabetic neuropathy, trigeminal neuralgia, postherpetic neuralgia (from shingles).
11. Nonpharmacological Nursing Interventions for Comfort
• Positioning
Positioning: Reduces pressure on painful areas.
• Heat/Cold Therapy
Therapy: Heat relaxes muscles, cold reduces inflammation.
• Massage
Massage: Relieves tension and promotes relaxation.
• Guided Imagery
Imagery: Helps shift focus away from pain.
• Distraction Techniques
Techniques: Music, TV, or hobbies help focus away from pain sensations.
,Osteoarthritis ((Chroni
Chroni
Chronicc Pain)
1. Pathophysiology of Osteoarthritis
• Degenerative joint disease causing cartilage breakdown, joint inflammation, and bone
spur formation, leading to pain, stiffness, and limited movement.
2. Risk Factors
• Age, obesity, previous joint injuries, repetitive joint use, genetics, and female gender.
3. Signs and Symptoms
• Joint pain and stiffness, especially after inactivity, swelling, and limited range of motion.
4. Diagnostic FFindings
indings
• X-rays (joint space narrowing, bone spurs), MRI (cartilage loss), and blood tests to rule
out inflammatory arthritis.
5. Medical/Surgical Management
• Non-Surgical
Non-Surgical: NSAIDs, physical therapy, weight management.
• Surgical
Surgical: Joint replacement for severe cases.
6. Nursing Process
• Assessment
Assessment: Pain, mobility limitations, and functional status.
• Diagnosis
Diagnosis: Chronic pain, impaired physical mobility.
• Planning
Planning: Pain management, mobility maintenance.
• Implementation
Implementation: Pain relief (NSAIDs, hot/cold application), encouragement of activity as
tolerated.
• Evaluation
Evaluation: Relief from pain, maintained mobility.
7. Complications
• Joint deformity, reduced mobility, increased fall risk.
8. Psychological Effects
• Depression, social withdrawal, altered self-image.
9. Pain Management Medication Comparison
• Acute: Immediate NSAIDs, short-term opioids.
• Chronic: Long-term NSAIDs, adjunct therapies (e.g., gabapentin)
Degenerative Disk Dis
Disease
ease (Neuropathic Pain)
1. Pathophysiology
• Spinal disc degeneration, leading to nerve compression, chronic pain, numbness, and
weakness.
2. Risk Factors
• Aging, repetitive strain, obesity, and smoking.
3. Signs and Symptoms
• Radiating pain, numbness, tingling in extremities, and decreased mobility.
4. Diagnostic Findings
, • MRI or CT scan showing disc degeneration or herniation.
5. Medical/Surgical Management
• Non-Surgical
Non-Surgical: Physical therapy, NSAIDs, muscle relaxants.
• Surgical
Surgical: Spinal fusion, discectomy.
6. Nursing Process
• Pain management, mobility support, post-surgical care if needed.
7. Complications
• Chronic pain, nerve damage, limited function
Total JJoint
oint Arthroplasty (Post
(Post-Operative
-Operative Acute Pain)
1. Nursing Process in Post
Post-Op
-Op Pain Management
• Assessment
Assessment: Monitor pain levels, vital signs.
• Planning
Planning: Pain control, early ambulation.
• Implementation
Implementation: Administer analgesics, positioning.
• Evaluation
Evaluation: Pain relief, patient comfort.
2. PCA Pump Care
• Educate on use, monitor dose administration, assess for adverse effects like respiratory
depression.
Procedural Pain
1. Nursing Process
• Pre-procedure preparation, pain management during and after procedures.
2. Independent Interventions
• Distraction, positioning, relaxation.
3. Collaborative Interventions
• Coordinate with medical team for analgesic plans, possible sedation if needed.
Chapter 36: Osteoarthritis (pp. 1122-
1122-1124)
1124)
Osteoarthritis (OA) is discussed in terms of its etiology, risk factors, clinical presentation, and
management options for patients experiencing chronic joint pain and reduced function.
1. Pathophysiology of Osteoarthriti
Osteoarthritiss :
a. OA is characterized by the gradual breakdown of articular cartilage, leading to joint
pain, stiffness, and reduced mobility. It involves joint space narrowing, subchondral
bone sclerosis, and the formation of bone spurs (osteophytes).
2. Risk Factors
Factors:
a. Major risk factors include advanced age, obesity, joint injury, repetitive joint use
(e.g., in certain occupations or sports), and genetic predisposition.
3. Signs and Symptoms
Symptoms:
, a. Symptoms include joint pain (worse with activity), stiffness (especially in the
morning or after inactivity), crepitus (grating sound with movement), and
decreased range of motion.
b. Commonly affected joints include knees, hips, hands, and spine.
4. Di
Diagnostic
agnostic Findings
Findings:
a. Ima
Imaging
ging
ging: X-rays are typically used to assess joint space narrowing, bony
outgrowths, and alignment changes.
b. Lab Tes
Tests
ts
ts: Typically, there are no specific lab tests for OA, but tests may be used to
rule out other types of arthritis.
5. Management
anagement:
a. Pharmacologic
harmacologic: Acetaminophen for mild pain; NSAIDs for moderate pain and
inflammation; intra-articular corticosteroid injections for severe pain.
b. Non-
Non-Pharmacologic
Pharmacologic
Pharmacologic: Exercise programs, weight loss, assistive devices (e.g., canes),
and heat or cold therapy to improve joint function and reduce pain.
c. Surgical
Surgical: Joint replacement (arthroplasty) is considered for severe cases when
conservative management fails.
6. Nursin
Nursingg Process in OA Care
Care:
a. Assessment of pain levels, joint function, and mobility limitations.
b. Interventions include pain management, patient education on joint protection,
encouragement of low-impact exercise, and nutritional counseling for weight
management.
7. Co
Complications
mplications
mplications:
a. OA complications can include reduced mobility, muscle atrophy due to decreased
activity, and secondary problems like depression from chronic pain.
8. Psychol
Psychological
ogical Effects
Effects:
a. Chronic pain can lead to feelings of helplessness, frustration, and depression,
which the nurse should address through holistic patient-centered care.
Chapter 65: DeDegenerat
generat
generative
ive Disc Disease (pp. 2133-21
2133-2134
34
34))
Degenerative Disc Disease (DDD) is a condition characterized by the breakdown of
intervertebral discs, leading to chronic back pain and, in some cases, nerve compression and
neuropathic symptoms.
1. Pathophysiology of DDD DDD:
a. DDD involves the gradual loss of disc hydration and elasticity, causing the disc to
lose height and become less effective as a cushion between vertebrae. This may
lead to disc herniation or bone spur formation, compressing nearby nerves.
2. Risk Factors
Factors:
a. Risk factors include age (natural aging process), smoking, obesity, genetic
predisposition, and repetitive stress or trauma to the spine.
3. Cl
Clinical
inical Manifestations
Manifestations:
