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The International Association for the Study of Pain defines pain
as an “unpleasant sensory and emotional experience associated
with actual or potential tissue damage.” Pain is the most
common symptom that brings patients to see a physician, and it is
frequently the first alert of an ongoing pathologic process. Whenever
possible, inform the patient beforehand about the nature and the
degree of pain to be expected during a hospital stay. Make the pain
control options clear during and after hospitalization so that the
patient will have realistic expectations.
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A well-localized constant, achy area in skin and subcutaneous
tissues and less well-localized in bone, connective tissues, blood
vessels, and muscles. Examples are incisional pain, bone fractures,
bony metastasis, osteoarthritis and rheumatoid arthritis, and peripheral
vascular disease.
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Poorly localized, crampy, diffuse, and deep sensation originating
from an internal organ or a cavity lining. Examples are bladder
distention and spasms, intestinal distention, inflammatory bowel disease,
hiatal hernia, organ metastasis, and pericarditis.
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A poorly localized, electric-shock-like, lancinating, shooting
sensation originating from injury to a peripheral nerve, the spinal
cord, or the brain. Examples are diabetic neuropathy, radiculopathy, postherpetic
neuralgia, phantom limb pain, and tumor-related nerve compression.
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Table 14–1 shows adverse effects
of pain as they relate to specific organ systems.
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Pain assessment has physiologic, emotional, and psychological
aspects. Ask the patient about discomfort. Conduct a detailed history
interview to gather information about the patient’s pain.
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Information about what relieves the pain and what makes it worse
is as important as how long the pain lasts. Is the pain constant
or intermittent? Does it have any precipitating factors? Does the pain
radiate to a specific extremity, or is it referred from an internal
source? An example of a pain radiating to a limb is lower back pain
with associated right or left leg radiation. An example ...