Pain Flashcards
Characterize the types of pain
Acute Pain
-increase BP, HR. Limiting pain, serves a purpose
Chronic Pain
-non limiting pain, limit opioids within 90 days, BP doesn’t rise
Cutaneous/superficial pain
-laceration to skin
Deep somatic pain
- bones, muscles, joints
- acute or chronic
- throbing aching, well localized
Visceral Pain
- appendicitis, block bile duct, chest pain
- burning, stabbing, squeezing, comes and go,
Refered pain
-myocardio pain, feels it in the arm or jaw
Neuropathic pain
-sciatica, diabeticneuropathy in feet, pins and needles, burning
Phantom
Describe the physiology of pain
Nociception
-transduction, transmission, perception of pain, modulation
TRANSDUCTION
-stimuli causes tissue damage in which substances such as bradykinins, prostaglandins are released. These substances stimulates pain receptors. Medications are often used to target these substances.
-an action potential converting pain stimuli into an impulse from periphery to spinal cord.
TRANSMISSION
- injury site to spinal cord
- spinal cord to dorsal horn for processing
- to thalamus and cortex
- antiseizure meds disrupts the action potential and inactivates the NA channel
PERCEPTION
- conscious experience of pain
- pain is responded, defined and experienced by individual
MODULATION
-activation of the descending pathways to inhibits the transmission of pain.
Identify factors affecting the individual’s response to pain
Pain intolerance - maximum amount can tolerate
Pain threshold - when you start to feel pain
Fear and Fatigue - coping & magnify
Developmental Factors - depending on age can tolerate different levels of pain
Sociocultural Influence
Gender
Psychological and physiological factors
nurses interpretation or biases
What are some pain assessment plan for clinical practice
Ask open ended questions Listen carefully Trust the client’s description of pain Obtain a pain history Onset, effect of pain on ADLs, Use an appropriate assessment tool OPQRSTA , PAIN as in med-surg text Descriptive scale: mild, moderate or severe Numerical scale , initial assessment tool Age relevant such as faces scale
Describe pharmacologic approach to pain management
-acetaminophen, NSAIDS (NON-OPIOIDS) - inhibits the chemicals that activate the nociceptors. Inhibits enzymes that produce prostaglandin involved in information (transduction) AFFECTS - liver toxicity, GI BLEED (NSAID)
OPIOIDS - produce affects by binding to receptors in the cns, terminals of sensory nerves and on surfaces of immune cells (transmission)
ADJUVANTS -Purpose is to manage selective types of pain -enhances the effectiveness of other analgesic meds, may help decrease dose of opioids CLASSIFICATION antidepressant - Chronic pain anti-anxiety - anxiety, muscle spasm anticonvulsant - neuropathic pain corticosteroid - CA pain, Bone pain
LADDER
STEP 1 = non-opioids
STEP 2 = mild-opioids (oxycodone, t3)
STEP 3 = stronger opioids with non opioids and adjuvant (dilaudid, fentanyl, methadone)
Analgesic for specific pain
Musculoskeletal
-tylenol, NSAID, COX2-inhibitor
BONE
-corticosteroid for bone CA, calcitonin, vitamin D and calcium for osteoporoses
Neuropathic
-anticonvulsant, antidepressant
Musclespasm - baclofen
Principals of Pharmacological Management
Three step pain ladder (cancer patients)
Combined analgesia
preemptive analgesia (perioperative TX)
titrating upward or downward
Describe non-pharmacologic approaches to pain management
- not a substitute for analgesic
- contribute to pain relief by decreasing pain intensity
- needs to be individualized for each person
- outcomes can be unpredictable
What are secondary symptoms of pain
Treat secondary symptoms to reduce suffering
Nausea, vomiting
Constipation
Dehydration
Insomnia
Anticipate and tx adverse effect of analgesics
What are some common non-drug
Cutaneous stimulation (Superficial Heating & Cooling, Vibration)
Distraction
Relaxation
Describe specific pain assessment and management consideration in elderly
Ask about pain regularly.
Expect pain whenever there is any possibility of it.
Use appropriate pain rating scales.
Believe the patient & the family.
Use the word pain medicine over drugs/narcotics.
MANAGEMENT -WHO Ladder Combined Analgesia Titrate – start low, go slow Preemptive analgesia Route – oral preferred ATC dosing Use certain drugs with caution
Describe pain assessment and management considerations in children
Conceptualization of pain r/t age/stage Responses to pain r/t age/stage Common behaviors associated with pain Cognitive knowledge Control issues Examples of assessment tools QUESTT examples of assessment tool
MANAGEMENT
-Utilize principles of pain management (steps for analgesia).
Always consider pharmacological & non-pharmacological management.
Create an environment conducive for relaxation and pain & anxiety management.
Describe the dimensions of pain
physiological and sensory
-sensory discriminative = the recognition of the sensation as painful, include pattern, area, intensity, nature.
motivation-affective= emotional responses to the pain experience, include anger, fear, depression, anxiety
Behavior= the observable action used to express or control the pain, include facial expression, grimacing, posting
Cognitive-evaluation = beliefs, attitudes, memories and the meaning of pain. Meaning of pain can contribute to the pain experience. Factors that affect cognitive can alter your sense of pain.
