Chapter 46 Pain Management Clinical Application of Gate Control Theory • Stop nociceptor firing • Apply topical therapies • Address client’s mood • Address client’s goals Comprehensive Pain History • Pain location • Intensity • Quality • Patterns • Precipitating factors • Alleviating factors • Associated symptoms Comprehensive Pain History (cont'd) • Effect on ADL’s • Past pain experiences • Meaning of pain to the person • Coping resources • Affective responses Addiction • Primary, chronic, neurobiologic disease • Genetic, psychosocial, and environment are influential factors • Behaviors can include: – Impaired control over drug use – Compulsive use – Craving – Continued use despite harm Figure 46-9 The WHO three-step analgesic ladder. From Cancer Pain Relief, 2nd ed., by World Health Organization, 1996, Geneva: Author. © Copyright World Health Organization (WHO). All rights reserved. WHO Ladder Step • Step 1 – For clients with mild pain (1-3 on a 0-10 scale) – Use of nonopioid analgesics (with or without a coanalgesic)