PAIN MANAGEMENT
the spinal cord.
 Negative sensation experienced by all human beings
during the process of living.
 Is a complex phenomenon derived from sensory
stimuli or neurologic injury and modified by individual
memory, expectations and emotions; usually
associated w/ injury or a pathophysiologic process that
causes an uncomfortable experience.
PATHOPHYSIOLOGY of PAIN
 Three major components of the Nervous system that
cause the sensation and perception of pain are:
 Afferent Pathways (reception)
 Central Nervous System (perception)
 Efferent Pathways (reaction)
 Afferent pathways have nociceptors and are found on
the skin
 Pacinian Corpuscles – nerve endings distributed in the
skin– mediate sensation including pain, pressure and
itch
 Free nerve endings of nociceptors – sensitive to
mechanical, thermal, electrical, or chemical stimuli =
responsible for transmitting sensory pain information
 Stimulation flows through peripheral sensory nerves
(afferent pathways) to the spinal cord
 A painful stimulus (e.g., pinprick) sends an impulse to
a nociceptor (a receptor for painful stimuli) along a
peripheral nerve fiber, which enters the gray matter of
 Nociceptors terminate in the SC
 Nociceptors stimulation flows to the brain through a
series of relay neurons.
 When the pain stimulus or signal reaches the CNS –
evaluated and interpreted in the limbic system,
reticular formation, thalamus, hypothalamus, medulla
and cerebral cortex.
The brain’s interpretation is based on both physical and
psychologic aspects
THE ART AND SCIENCE OF PAIN RELIEF
 The goal of ideal pain mgt
To relieve both acute and chronic pain with pharma and
non-pharma techniques while minimizing side effects
 responsible for the assessment of pain, administration
of medications and assessment of effectiveness of
pain mgt plan
 greater reductions in the pain are seen when pharma
and non-pharma techniques are combined
PHARMACOLOGICAL MANAGEMENT (adjuvant drugs)
 are not typically considered pain medicines but may
relieve discomfort and potentiate the effect of pain
meds to reduce side effect burden.
1. Antidepressants and anticonvulsant
(tricyclics, SSRI, Carbamazepine,gabapentin)
 -helpful for diabetic neuropathy, trigeminal neuralgia, 1. Pain meds given by mouth is the preferred way to
postherpetic neuralgia control pain.

2. Topical analgesics It is the safest, least expensive and easiest route.

(capsaicin, menthol methylsalicylate, EMLA cream, lidocaine
gel)
-helpful in chronic arthritis pain, herpes zoster and diabetic
neuropathy; maybe used in painful procedures such as blood
draws and venipuncture
3. Muscle relaxants
2. Works best when administered around the clock
-long acting or sustained release forms
for chronic pain conditions
-immediate release or short acting breakthrough pain or
pain associated with activity or procedures

(baclofen,diazepam) -muscle spasm
4. Antianxiety meds
(diazepam,doxepin)-anxious or agitated
5. Meds to dry secretions
(scopolamine,glycopyrrolate)
- thick secretions that require frequent suctioning
6. Antipruritics (diphenhydramine, hydroxyzine)
- sec to liver dse that are itchy and result in scratching
7. Diuretics (lasix) – ease discomfort from ascites from liver
cancer or cirrhosis
8. Magic mouthwash
3. Avoid the use of prn medications for pain control as
the patient will learn to expect the return of pain
- suffer psychologically and spiritually
4. Warn patients that crushing or chewing sustained
release preparations of analgesics destroys their
controlled release properties and cause rapid absorption
resulting to overdosage
NON PHARMACOLOGICAL METHODS TO MANAGE PAIN
 Pain education program
 Socialization or recreation program – movies, art
therapy, therapeutic use of music
 Modification of behaviour – imagery, hypnosis,
relaxation

(diphen elixir/Maalox/ lidocaine)  Physical Therapy – massage, ultrasound, exercise,

hot and cold packs
– mucositis from chemo; add nystatin if w/ thrush
 Neurostimulation – acupuncture, TENS
PHARMACOLOGICAL PRINCIPLES
FOR
SUCCESSFUL PAIN MANAGEMENT