What is pain and how can a nerve block help your patients?
Let’s do a brief general overview of pain management and Interventional Nerve Blocks shall we?
Pain is the body’s natural response to harm and possible harm. It serves as a warning that an injury is impending or has occurred and that we need to take action. As nurses, we are taught to be objective….so pain is anything the patient says it is.
There are 2 types of pain:
- Nociceptive - When a harmful stimulus is applied to our skin, joints or muscles, specialized nerve endings, called nociceptors are activated. When they are activated, we feel pain and react to eliminate the cause to prevent further harm. Pains from the activation of these receptors are called nociceptive or Somatic pain. It can be described as either sharp or dull; examples would be tissue damage as a result of cancer, or pain from an injured muscle or bone. Frequently it responds well to anti-inflammatory agents and pain relievers.
- Neuropathic - Pain can also arise spontaneously, without a stimulus, to the nociceptors, often as a result of dysfunction or damage to the nervous system through injury, disease, or localized trauma (e.g. an infection or surgery.) This is called neuropathic or chronic pain. Some patients describe this pain as continuous, burning or intense, stabbing pain that continues all day and night with out relief. For others, it is intermittent but severe. Chronic pain does not respond well to drugs and other standard therapies. The chronic pain can become the focal point of one’s life and the negative effects can be extensive.
Pain incorporates two components:
- the sensation of pain
- the reaction to pain
An individual’s reaction to pain can be divided into three phases:
- Immediate pain occurs directly after an injury such as a burn or a cut, and it might last for seconds or minutes. The response to immediate pain is a reflex withdrawal and active protection of the injured part.
- Acute pain occurs hours or days following an injury such as a twisted ankle. It is the throbbing sensation that occurs after the immediate pain vanishes. Acute pain acts as a protective mechanism; it warns the individual to avoid using the injured area during the healing process to prevent further injury. The response to acute pain is typically a combination of anxiety, avoidance, and guarding of the injured area.
- Chronic pain can be defined as pain that exists for 1 month longer than expected, persists longer than six months after an injury, reoccurs periodically over six months, or continues for an indefinite length of time. Chronic intractable pain is chronic pain that has not been completely removed by ordinary medical, surgical, or nursing measures.
Chronic pain treatments can be divided into three tiers. Nerve blocks are considered second-tier.
Therapeutic nerve blocks are local anesthetic and/or steroid injected directly onto the nerve serving the painful area. With epidural blocks, local anesthetics and/or steroids may provide pain relief for up to six months, depending on the patient’s specific etiology. Some patients get no relief or have exacerbation of their pain. (more…)
Chest pain, congestive heart failure, lower GI bleed, pneumonia, urinary tract infection, acute renal failure. These are the admitting diagnoses of 80 to 99 year-olds. Our very elderly are living much longer. It is commonplace to treat acute medical problems stemming from old age. IV diuretics and inotropes. Short term intubation. Interventional cardiology. IV antibiotics. Hemodialysis. PICC lines, tracheostomies, PEG tubes. Long-term placement, functional decline, hospice care. What we want to avoid is a 90-year-old being hospitalized with a serious illness or debilitating injury who we know will not recover yet treat him aggressively for weeks before altering the plan of care. We must avoid end-of-life suffering for the elderly at all costs and without fail. 