Pain (Principles/meds/comfort Care)



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


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


  • 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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