Pain (Principles/meds/comfort Care)

Basics

Description

Unpleasant sensory and emotional experience that may be secondary to actual or perceived damage to tissue, the somatosensory system, or a psychogenic dysfunction

It is an individual, subjective, multifactorial experience influenced by culture, medical history, beliefs, mood, and ability to cope

Epidemiology

Incidence and Prevalence Estimates

Most common reason for seeking health care
Up to 78% of visits to the ED
Pain is severe for 2/3rds of patients presenting with pain
Chronic pain is present in up to 35% of the population
Prevalence of neuropathic pain is 21.4% in EDs
The U.S. ranks number one for the consumption of prescribed opioids, with a per capita consumption rate two to three times that of European countries

Etiology

Different components of pain can be combined in a same patient
Nociceptive pain:
- Stimulation of peripheral nerve fibers (nociceptors) that arises from actual or threatened damage to nonneural tissue
- Visceral pain:
  - Stimulation of visceral nociceptors
  - Diffuse, difficult to locate, and often referred to a distant, usually superficial, structure
  - Sickening, deep, squeezing, dull
- Deep somatic pain:
  - Stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae, and muscles
  - Dull, aching, poorly localized pain
- Superficial pain:
  - Stimulation of nociceptors in the skin or other superficial tissue
  - Sharp, well defined, and clearly located
Neuropathic pain:
- Exacerbation of normally nonpainful stimuli (allodynia)
- Paroxysmal episodes likened to electric shocks
- Continuous sensations include burning or coldness, “pins and needles” sensations, numbness, and itching
Psychogenic pain:
- Pain caused, increased, or prolonged by mental, emotional, or behavioral factors

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