Protocols - Hemorio

ATTACHMENT IV – PAIN APPROACH ROUTINE
1 – KINDS OF PAIN
In addition to the temporal classification, that divides the pain in “acute” or “chronic”, the pains may be
classified regarding its origin:
NOCICEPTIVE OR
SOMATIC
VISCERAL
NEUROPATIC OR
BY
DEAFFERENTATION
BY STIMULATION: when the normal tissue is damaged by stimulation (heat,
pressure, cut). Constant and well located, by nociceptors activation; for instance,
the pain of an incisive injury or burn;
TISSUE DAMAGE: when a disease causes some damage to the tissue. It is
usually associated to the damaged tissue inflammation. In this case, the
nociceptive system is more sensible.
The nociceptive pain usually resolves to the resolution of the tissue damage and
tends to respond well to the treatment with anti-inflammatory and opioid.
Constant, barely located, referred to skin sites. Its mechanism involves the
activation of nociceptors and/or autonomic component. For instance: pancreas
cancer and cholecystitis.
In volley, paroxysms like shock, burning and dysesthesia. Its mechanism is not
nociceptive, but paroxystic discharges of the CNS and Peripheral Nervous System
and autonomic compound. As examples, the branchial plexopathy and lombus
sacrum; post-surgical syndromes and ghost member.
It is common to evolve with alodinia persistent, which is resultant from a not
painful stimulation, such as a mild touch, as the blow of the wind, it is common at
the long-term neuropathic pain. It is usually difficult to be treated.
2 - ANALGESIA
EVALUATION AND REEVALUATION OF THE PAIN:
The pain is considered as the “fifth vital sign”. It means that the Pain must be regularly measured in each
subject and, thus, an evaluation method may be proposed at the following way, following the mnemonic
method “HAMSTER”.
H History
A
Functional evaluation (in accordance to a proper scale or in accordance to the report of the
subject regarding his capacity to perform his common daily activities or labor activities). You must
evaluate, in addition to the intensity of the pain, its frequency, onset, length, location, as well as
the detailed history of the pain itself, with a physical and neurological exam.
M Mechanism of the pain
Social and psychological: changes caused by the pain at the individual’s life, appearance of
depression, anxiety and/or sleep disturbances. The pain is an experience both sensorial and
S emotional, and one can not be treated without the other. Psychiatric and/or psychological changes
predispose the subjects to the chronic pain and the decrease of the functionality of those subjects
when they present the pain.
T Treatment: drugs, dose, effects
E Education of the subject in relation to his disease and how to live with it
R Reevaluation
198