Chapter 51
Pain Management
The subjective fifth vital sign
What Pain Is
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is a subjective, individual experience with physical, psychological, and social determinants, and there is no objective measurement of pain. In the United States alone, more than 75 million individuals experience recurrent or persistent pain.
Because pain is subjective, the patient's self-report is the standard for assessment. Pain is classified by duration and mechanism, and each type calls for a different management strategy.
Acute vs Chronic
Acute pain is self-limiting, decreases as the injury heals, and is accompanied by increased autonomic activity (tachycardia, tachypnea, hypertension, diaphoresis, mydriasis). Chronic pain lasts beyond normal healing (some say > 6 months), is a cyclic process, lacks autonomic signs (so the patient may not look in pain), and instead causes depression, insomnia, and weight loss.
📖 “Pain: unpleasant sensory/emotional experience with tissue damage; subjective, no objective measure; >75 million Americans. Acute: self-limiting, autonomic signs (tachycardia, HTN, diaphoresis, mydriasis). Chronic: >6 mo, cyclic, no autonomic signs, causes depression/insomnia/weight loss.”