Nursing

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.