Online Companion: Fundamentals of Nursing Standards and Practice 2E

Frequently Asked Questions

Why is pain so difficult to manage?

Pain is a concept that is universally felt by all individuals at some point in their life but still remains difficult to manage in the clinical setting for it relies on the subjective perception of the individual. This results in common myths relative to the concept of pain that can affect assessment and treatment of “pain”. Clients differ in their ability to tolerate pain and physical and emotional responses to pain are equally varied. Another reason why pain is so difficult to manage is that many clients wait until the pain is overwhelming before instituting measures to relieve the pain cycle. This leads to a poor clinical response and prolonged pain levels due to increased pain thresholds. In addition, clients are often reluctant to try pain medication for they fear the possibility of drug dependency. It is important to provide accurate information to the client as to available treatment modalities (both pharmacologic and nonpharmacologic) that can be used to treat pain symptoms. Many clients are unaware that there are other options available besides medication therapy that can assist with the pain experience.

What is the difference between nocieptive pain and neuropathic pain in terms of presentation and treatment?

Nocieptive pain has a varied presentation with a pain pattern that decreases in a period of days to weeks following the specific incident (injury or inflammation). A release of chemical mediators is seen in response to tissue damage that affects transmission of pain. In terms of management, nocieptive pain responds to opioids and NSAIDS. Tricyclic antidepressants and anticonvulsants are generally not effective. Local anesthetics are not normally used to treat nocieptive pain. Neuropathic pain has a distinct presentation that manifests as sharp, tingling or burning with a pain pattern that persists or even intensifies. Neuropathic pain can occur in a tissue that appears normal (allodynia) or as tingling sensations (paresthesia). The presentation of trigger points is associated with neuropathic pain. In terms of management, neuropathic pain is resistant to opioids and NSAIDS. However, the use of tricyclic antidepressants, anticonvulsants and local anesthetics provide relief.

What is the difference between acute pain and chronic pain?

Acute pain refers to an episode of sudden onset with an anticipated end and duration of less than 6 months. Chronic pain refers to pain that has no defined ending with a duration of greater than 6 months.

What is the significance of the different stages of sleep with regard to client well being?

There are two basic categories of sleep, that of non-rapid eye movement (NREM) and rapid eye movement (REM). During NREM sleep, the client progresses through 4 stages as they pass deeper in to the sleep process. Stage 1 is a light stage from which an individual can be easily awakened. Stage 2 is still considered a light stage but the EEG pattern shows slowing and loss of rolling eye movements. Stage 3 is medium and stage 4 is considered to be the deepest stage of sleep. Following the progression of NREM sleep the client proceeds to REM sleep. As the individual ages, there are changes in the sleep cycle and amount of time that is spent in each sleep stage. Disruption of sleep cycles is associated with alterations in a client’s ability to feel relaxed and energized to meet the demands of daily living. This can lead to increased stress that can affect the client’s mood and healing. Dream states, night terrors and sleepwalking are seen in specific sleep stages (stages 3 and 4) that have clinical implications for these stages are viewed as having restorative value.