Pain Management - Concept Map
Pain Management: Comprehensive Assessment and Multimodal Treatment Approach
Related concepts
Pain Physiology and Types
Sub concepts
- Transduction - noxious stimulus activates nociceptors
- Transmission - impulse travels to spinal cord and brain
- Perception - conscious awareness of pain
- Modulation - body dampens/amplifies signal via endogenous opioids
- Acute Pain - recent onset, warning signal, resolves with healing
- Chronic Pain - persists beyond 3-6 months, lacks acute signs
- Nociceptive Pain - from tissue damage (somatic/visceral)
- Neuropathic Pain - from nerve damage/dysfunction
Relationship to central
Foundation for understanding pain mechanisms and guides assessment and intervention selection
Pain Assessment
Sub concepts
- PQRST Framework - Provocation, Quality, Region, Severity, Timing
- Numeric Rating Scale 0-10 - adult standard
- Wong-Baker FACES Scale - children aged 3+ and communication barriers
- FLACC Scale - behavioral tool for infants/nonverbal (Face, Legs, Activity, Cry, Consolability)
- Reassessment timing - 30-60 min post-oral, 15-30 min post-IV
- Functional assessment - effect on sleep, activity, mood
- Cultural considerations in pain expression
Relationship to central
Essential first step in nursing process; guides treatment selection and monitors effectiveness
Pharmacologic Management
Sub concepts
- WHO Analgesic Ladder - Step 1 non-opioids, Step 2 weak opioids, Step 3 strong opioids
- Non-Opioid Analgesics - Acetaminophen (hepatotoxicity risk, max 4g/day), NSAIDs (GI/renal risks)
- Opioid Analgesics - Morphine, Fentanyl, Hydromorphone, Oxycodone (respiratory depression risk)
- Adjuvant Drugs - Antidepressants, Anticonvulsants (gabapentin), Corticosteroids
- Routes of Administration - Oral preferred, IV acute, Transdermal chronic, Epidural, Intrathecal
- Equianalgesic Dosing - prevents under/over-dosing during route changes
- Around-the-clock dosing for continuous pain vs. PRN for breakthrough
Relationship to central
Primary treatment modality; requires knowledge of drugs, dosing, safety, and monitoring
Opioid Safety and Critical Nursing Responsibilities
Sub concepts
- Respiratory depression - most dangerous adverse effect
- Assess respiratory rate BEFORE administration - hold if RR <12
- Monitor level of consciousness and oxygen saturation
- Naloxone - opioid antagonist/antidote for overdose reversal
- Constipation management - proactive bowel regimen required
- Other adverse effects - sedation, nausea, urinary retention, hypotension, miosis
- Special populations - older adults (start low, go slow), opioid-naive patients
- Recognize tolerance, physical dependence vs. addiction distinctions
Relationship to central
Patient-safety critical; prevents adverse events and overdose complications
Patient-Controlled Analgesia (PCA)
Sub concepts
- Mechanism - patient self-administers preset IV opioid dose via button
- Safety feature - lockout interval prevents overdose
- Key rule - ONLY patient presses button, never family (PCA by proxy is unsafe)
- Nursing verification - drug, concentration, dose, lockout limits with second nurse
- Monitoring parameters - RR, sedation, SpO2, pain relief, amounts delivered/attempted
- Equipment readiness - naloxone and resuscitation equipment must be available
- Patient education - press when pain begins, understand lockout intervals
Relationship to central
Evidence-based technique providing patient autonomy and steady pain control
Non-Pharmacologic Management
Sub concepts
- Cutaneous stimulation - heat, cold, massage, TENS (Transcutaneous Electrical Nerve Stimulation)
- Cognitive-behavioral - relaxation, guided imagery, distraction, music, biofeedback
- Positioning, rest, immobilization of painful area
- Acupuncture and acupressure
- Gate control theory rationale - non-painful stimuli close spinal gate, reduce transmission
- Especially valuable for chronic pain and adjunct to reduce opioid needs
Relationship to central
Complements medications, supports gate control theory, reduces opioid requirements
Chronic Pain Management
Sub concepts
- Multimodal approach - combines analgesics, adjuvants, therapy, psychosocial support
- Around-the-clock long-acting opioids with breakthrough doses (cancer pain model)
- Functional goals over pain elimination - improved sleep, activity, quality of life
- Address depression, anxiety, social isolation
- Believe patient's report; avoid undertreating due to addiction fears
- Monitor tolerance (needing more for same effect) - distinct from addiction
- Physical dependence (withdrawal on abrupt stop) - expected, not addiction
- Addiction - compulsive use despite harm
- Palliative care - generous opioid titration for suffering relief
Relationship to central
Requires distinct multimodal interdisciplinary approach with functional goals
Legal and Ethical Framework (RA 9173)
Sub concepts
- RA 9173 Nursing Act - defines Registered Nurse scope of practice
- Nursing diagnosis - NANDA application (e.g., Acute Pain, Chronic Pain)
- Maslow-based prioritization - pain management addresses safety/comfort needs
- NCM levels - independent, dependent, collaborative nursing actions
- Documentation requirements - pain assessment, interventions, outcomes, reassessment
- Philippine healthcare delivery context - access, resource availability, cultural factors
- Interdisciplinary collaboration - coordination with physicians, therapists, specialists
Relationship to central
Governs nursing practice in pain management; defines scope and accountability
Concept connections
- Pain PhysiologyPain TypesUnderstanding the four processes (transduction, transmission, perception, modulation) explains how different pain types (acute, chronic, nociceptive, neuropathic) are generated and perceived
- Pain TypesPain AssessmentDifferent pain types require different assessment approaches; acute pain shows sympathetic signs while chronic pain may not; neuropathic pain requires specific descriptors like burning or shooting
- Pain AssessmentPharmacologic ManagementAssessment findings (pain severity, type, location) determine which step of WHO ladder to initiate and guide medication selection and dosing
- Pain AssessmentNon-Pharmacologic ManagementAssessment establishes baseline; non-pharmacologic measures complement pharmacologic treatment and are continuously reassessed for effectiveness
- Pharmacologic ManagementOpioid SafetyOpioid safety monitoring is essential when using Step 2 and Step 3 medications; respiratory depression is the most critical adverse effect requiring before-administration RR assessment
- Opioid SafetyNaloxone KnowledgeUnderstanding opioid adverse effects, particularly respiratory depression, necessitates knowledge of naloxone as the reversal antidote and its short-acting properties requiring potential repeat dosing
- Patient-Controlled AnalgesiaOpioid SafetyPCA typically delivers opioids; same safety monitoring parameters apply (RR, sedation, SpO2) with additional safety feature of lockout interval and emphasis on patient-only button use
- WHO Analgesic LadderChronic Pain ManagementChronic pain uses WHO ladder principles but with long-acting medications around-the-clock plus breakthrough doses; escalates based on functional goals rather than pain elimination alone
- Non-Pharmacologic ManagementGate Control TheoryNon-pharmacologic measures (heat, massage, distraction) work by closing the spinal gate to pain transmission, reducing the perception and transmission of pain impulses
- Chronic Pain ManagementTolerance vs Addiction DistinctionIn chronic pain, tolerance (needing more drug for same effect) and physical dependence (withdrawal on abrupt stop) are expected and distinct from addiction (compulsive use despite harm)
- Pharmacologic ManagementNon-Opioid AnalgesicsNon-opioids (acetaminophen, NSAIDs) comprise Step 1 of WHO ladder; understanding their mechanisms, maximum doses, and adverse effects is critical for safe administration and monitoring
- Pain PhysiologyModulation PathwayThe modulation process involving endogenous opioids (endorphins) and descending pathways explains how both pharmacologic opioids and non-pharmacologic measures reduce pain perception
- Legal Framework RA 9173Pain AssessmentRA 9173 defines nursing scope; pain assessment is an independent nursing action and responsibility in all healthcare settings across Philippines NCM levels
- Legal Framework RA 9173NANDA Nursing DiagnosesCommon pain-related NANDA diagnoses include Acute Pain and Chronic Pain; proper documentation aligns with RA 9173 standards and guides interdisciplinary collaboration
- Legal Framework RA 9173Interdisciplinary CollaborationRA 9173 specifies that nurses work collaboratively with physicians and other healthcare providers in pain management; defines scope of independent vs dependent vs collaborative actions
- Assessment Tool SelectionWong-Baker FACES ScaleFACES scale is appropriate for children aged 3+ and adults with communication barriers; simple visual tool aligns with pediatric pain assessment standards
- Assessment Tool SelectionFLACC ScaleFLACC is behavioral tool for infants and nonverbal patients; requires observational skills rather than self-report; useful in NCM context for vulnerable populations
Diagrams
Pain Management Concept Hierarchy - Complete Overview
Comprehensive mind map showing all major pain management concepts, their relationships, and hierarchical organization. Central concept connects to eight major branches: physiology, types, assessment, pharmacologic management, opioid safety, PCA, non-pharmacologic, chronic pain, and legal framework. Each branch contains specific sub-concepts relevant to NLE examination preparation.
WHO Analgesic Ladder and Pain Management Decision Tree
Step-by-step decision tree showing the WHO analgesic ladder approach from initial pain assessment through treatment escalation. Illustrates critical safety checkpoints including respiratory rate assessment before opioid administration, timing of reassessment, and integration of non-pharmacologic measures. Shows continuous monitoring and documentation requirements throughout the process.
Opioid Safety Monitoring and Naloxone Reversal Protocol
Critical safety protocol showing opioid administration monitoring, identification of respiratory depression, and naloxone reversal procedure. Emphasizes the key safety threshold of respiratory rate less than 12 breaths per minute as hold criterion, highlights the short-acting nature of naloxone requiring potential repeat dosing, and shows the need for continuous monitoring post-intervention. Essential for patient safety and NLE examination.
Pain Assessment Tool Selection Based on Patient Population
Decision tree for selecting appropriate pain assessment tools based on patient population and communication ability. Shows the three primary NLE-focused assessment tools (Numeric 0-10, Wong-Baker FACES, FLACC), their specific applications, scoring methods, and the importance of baseline assessment and post-intervention reassessment. Includes cultural considerations aligned with Philippine healthcare context.
Patient-Controlled Analgesia Safety and Operation Protocol
Comprehensive PCA safety protocol showing the critical steps from order verification through patient education and ongoing monitoring. Emphasizes the crucial safety principle that only the patient should press the button, highlights the dangerous practice of PCA by proxy, shows verification requirements with a second nurse, and outlines specific monitoring parameters. Includes documentation requirements and emergency preparedness with naloxone available.
Opioid Adverse Effects Profile - Frequency and Clinical Significance
Distribution pie chart showing the relative incidence and clinical priority of opioid adverse effects. Constipation is most common (30%) and requires proactive management. Respiratory depression (25%) is most critical/dangerous despite lower frequency. Sedation (20%) and nausea (15%) are common. Miosis, urinary retention, and pruritus (10%) are less frequent. This visual emphasizes to nursing students which effects require preventive measures and continuous monitoring for patient safety.
Acute vs Chronic Pain State Transition and Characteristics
State diagram showing the transition from acute to chronic pain states and the characteristics of each. Illustrates that acute pain (less than 3-6 months) has warning function and sympathetic signs, while chronic pain (persisting beyond 3-6 months) lacks these acute indicators and requires multimodal management. Shows the clinical reality that acute pain can transition to chronic pain if not adequately managed, necessitating different nursing assessment and intervention approaches aligned with NANDA pain diagnoses.