Module Six: Pain
Objectives:
1. Address components of a thorough pain assessment, including assessment of nonverbal or cognitively impaired individuals.
2. Compare and contrast acute and chronic pain, considering pathogenesis, manifestations, and treatment approaches.
3. Discuss pain threshold and pain tolerance.
4. Explore pathogenesis, clinical manifestation, and treatment approaches for neuropathic, somatic, and visceral pain.
5. Differentiate pain from suffering.
Required readings and resources:
Carvalho, A. S., Martins Pereira, S., Jácomo, A., Magalhães, S., Araújo, J., Hernández-Marrero, P., Costa Gomes, C., & Schatman, M. (2018). Ethical decision making in pain management: A conceptual framework. Journal of Pain Research, 11, 967–976. https://mnpals-
smsu.primo.exlibrisgroup.com/permalink/01MNPALS_SMSU/8db547/cdi_doaj_primary_oai_do aj_org_article_f8ac91b04b2846369a9ff6855a116e01
Ohyun Kwon. (2021). Pathophysiology of neuropathic pain. Journal of the Korean Medical Association / Taehan Uisa Hyophoe Chi, 64(7), 468–476.
https://doi-org.ssuproxy.mnpals.net/10.5124/jkma.2021.64.7.468
Rodriguez, L. (2015). Pathophysiology of Pain: Implications for Perioperative Nursing. AORN
Journal, 101(3), 338–344.
https://doi-org.ssuproxy.mnpals.net/10.1016/j.aorn.2014.12.008
Siler, S., Borneman, T., & Ferrell, B. (2019). Pain and Suffering.
Seminars in Oncology
Nursing,
35(3), 310-314.
https://doi.org/10.1016/j.soncn.2019.04.013
Sorenson, M., Quinn, L., & Klein, D. (2019). Pathophysiology: Concepts of human disease. Pearson Education. Read chapter 32.
Stokes, L. (2019). ANA Position Statement: The Ethical Responsibility to Manage Pain and the
Suffering It Causes. Online Journal of Issues in Nursing, 24(1), 3.
https://doiorg.ssuproxy.mnpals.net/10.3912/OJIN.Vol24No01PoSCol01
Optional resources:
Bueno-Gómez, N. (2017). Conceptualizing suffering and pain. Philosophy, Ethics & Humanities in Medicine, 12, 1–11.
https://doi-org.ssuproxy.mnpals.net/10.1186/s13010-017-0049-5 Grant, A. (2018). Pain, suffering and the vulnerability of the empath. Journal of the Australian Traditional-Medicine Society, 24(3), 144–145.
https://ssuproxy.mnpals.net/login?url=https://search.ebscohost.com/login.aspx?direct=true&d b=ccm&AN=131833900&scope=site
Sonneborn, O., & Williams, A. (2020). How does the 2020 revised definition of pain impact nursing practice? Journal of Perioperative Nursing, 33(4), e25–e28.
https://doiorg.ssuproxy.mnpals.net/10.26550/2209-1092.1104
Resources linked into the module
Items due: Pain Exploration Worksheet
Please go to the Pain Exploration Assignment module under Content for guidance. An example, video, and downloadable template are included there.
Please see the course calendar for due dates. See the grading rubric in the syllabus appendices.
Appendix D: Pain Exploration Assignment Rubric
This exploration will be a worksheet / essay exercise that addresses a variety of types of pain, as well as contributing factors, manifestations, management, and consequences of unrelieved pain. Additional concepts related to pain will be explored.
For more guidance go to the Pain Exploration Assignment folder in the content area of this course shell
|
Criterion |
Excellent |
Developing |
Not Satisfactory |
|
|
1. Acute pain |
All columns in table addressed. Summarizes essential information. Clear, accurate, focused, organized. Information appropriate for the practice of nursing. Supported by professional evidence. (4 points) |
Critical information is accurate. Does not include all essential information. Organization is sporadic. Strength of professional evidence is questionable. (2 points) |
Incomplete. Essential information lacking. Lacks structure. Not supported by professional evidence. (0 points) |
|
|
2. Chronic pain |
Critical information is accurate. Does not include all essential information. Organization is sporadic. Strength of professional evidence is questionable. |
Incomplete. Essential information lacking. Lacks structure. Not supported by professional evidence. (0 points) |
||
|
3. Neuropathic pain |
All columns in table addressed. Summarizes | Critical information is accurate. Does not | Incomplete. Essential information lacking. |
| essential information. Clear, accurate, focused, organized. Information appropriate for the practice of nursing. Supported by professional evidence. (4 points) |
include all essential information. Organization is sporadic. Strength of professional evidence is questionable. (2 points) |
Lacks structure. Not supported by professional evidence. (0 points) | |||
|
4. Assessment in unique situations |
Response is focused, accurate, clearly and concisely presented. Includes information essential for quality nursing care. Critical thought evident. Supported by professional evidence. (4 points) |
Response is accurate. Some essential information lacking. Reasonably focused and clearly presented. Supported by professional evidence. (2 points) |
Incomplete. Difficult to follow. Not supported by professional evidence. (0 points) |
||
|
5. Pain threshold and pain tolerance |
Response is focused, accurate, clearly and concisely presented. Includes information essential for quality nursing care. Supported by professional evidence. (2 points) |
Response is accurate. Does not include all essential information. Reasonably focused and clearly presented. Supported by professional evidence. (1 point) |
Incomplete. Difficult to follow. Not supported by professional evidence. (0 points) |
||
|
6. Compare and contrast pain and suffering. |
Response is focused, accurate, clearly and concisely presented. Includes information essential for quality nursing care. Supported by professional evidence. (4 points) |
Response is accurate. Does not include all essential information. Reasonably focused and clearly presented. Supported by professional evidence. (2 points) |
|||
|
7. Ethical implications |
Response is focused, accurate, clearly and concisely presented. Explores a minimum three principles of ethics (ex. beneficence, nonmaleficence, justice, veracity, etc.). Supported by professional evidence. (6 points) |
Response is accurate. Explores less than three principles or exploration is limited. (3 points) |
|||
|
8. Writing quality / APA style |
Accesses and integrates at least three APA style. Sources developed for the lay person will not count as professional evidence. Minimal direct quotations. Fewer than five writing mechanics / APA style errors. (2 points) |
Multiple or lengthy direct quotations. References included, but do not meet criteria for professional evidence based sources. Five – ten writing mechanics / APA errors. (1 point) |
More than 10 writing mechanics /APA errors. Minimal professional evidence to support post. (0 points) |
Pain exploration
Causes/contributing
factors
Type of Pain Diagnosis, assessment,
and expected clinical
manifestations
Management (include
dependent, independent,
and interdisciplinary
intervention)
Consequences of less
than optimal
management
Dysfunction of the
central nervous system
(CNS) typically associated
with stroke, traumatic
brain injury, Multiple
Sclerosis, spinal cord
injury and more
(Hassaballa, et al., 2020
& Sorenson et al.,2019).
Pain is typically
“constant; moderate to
severe in intensity; and
aggravated by
movement, touch,
temperature changes
(especially cold),
emotions and stress”
(Sorenson, p. 803).
Central Pain – this is
a type of
neuropathic pain
(Hassaballa, et al.,
2020).
Pain may begin soon
after an injury or stroke
or be delayed (Sorenson,
et al., 2020). Central pain
is diagnosed only after
other types of pain have
been ruled out
(Hassaballa, et al., 2020).
Location of pain and
intensity depend on the
location of CNS injury.
Pain can be referred –
most often in feet or
hands (Sorenson, et al.).
Described as burning,
numbness, tingling,
aching, gnawing,
prickling, electric shock-
like pain. Sensory loss
often occurs in impacted
regions (Hassaballa,
2020).
There is often pain
induced weakness
(Hassaballa, 2020).
Central pain is often
refractory to effective
management. At this
time, there is no cure for
central neuropathic pain
(Hassaballa, et al., 2020).
Tricyclic antidepressants
and anticonvulsants are
often used (Hassaballa, et
al., & Sorenson et al.).
Medical cannabis may
have a positive effect for
some (Hassaballa, et al.).
“Individuals who fail
interdisciplinary pain
management and oral
medications may be
candidates for
neuromodulation
therapies” (Hassaballa et
al., p. 294).
Accupuncture has been
studies without conclusive
results (Hassaballa et al.)
Treatment with
pharmacologic agents is
Can significantly impact
quality of life,
contributes to sleep
disturbances, may lead
to mood disturbances
and depression. May
impact ability to work
and maintain social and
family relationships
(Hassaballa, et al.,
2020).
Opiod addiction can
occur (Hassaballa).
often not effective as
individuals experience side
effects that limit doses
needed for effective
management (Hassaballa,
et al.)
May benefit from
occupational therapy,
physical therapies,
counselling, relaxation
therapies (Hassaballa, et
al.)
These individuals can
benefit from nursing
support and teaching.
Opiods may be used if no
other forms of
management are effective
(Hassaballa, et al.)
References:
Hassaballa, D., Harvey, R. L., & Zasler, N. (2020). Central pain syndromes. NeuroRehabilitation, 47(3), 285–297. https://doi-
org.ssuproxy.mnpals.net/10.3233/NRE-208003
Sorenson, M., Quinn, L., & Klein, D. (2019). Pathophysiology: Concepts of human disease. Pearson Education.
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