Chapter 14. Pain Management

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.

Somatic Pain

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.

Visceral Pain

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.

Neuropathic Pain

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.

Table 14–1 shows adverse effects of pain as they relate to specific organ systems.

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.

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 ...