E2 Pain Flashcards by Kassi Ziemann

Acute pain is ____

protective –> promotes withdrawal from painful stimuli, allows injured parts to heal, and teaches avoidance

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What are the 3 parts of the nervous system involved in the sensation, perception, and response to pain?

Afferent pathway: begin in PNS, travels to CNS (Sensation)
Interpretive centers: Cortical and subcortical areas of brain- Brain stem, midbrain, cerebral cortex (Interpret sensation)
Efferent Pathway: CNS back to PNS
(elicit physical and mental response to pain)

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Define Nociception

Process of feeling pain or sensation

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Decine Nociceptors

Pain receptors

Free nerve endings in afferent PNS that when stimulated calls nociceptive pain

We target these pain receptors when we give pain meds

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Nociceptive stimuli

stimuli of a certain intensity that cause or are close to causing tissue injury

Sharp objects, electric current, heat, coldness, chemical stimuli (pain meds)

With low intensity may not be activated (prick finger)

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Where are nociceptive receptors located?

skin, dental pulp, periosteum, meninges, some internal organs

None or very few in brain, alveoli, deep tissues

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Neurotransmitter modulate control related to the _____ of pain impulses and can be _____

transmission

inhibitory or excitatory

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Endorphins

Natural neurochemicals or endogenous opioids that aid in inhibiting the pain response
-Produced in brain
-Produce sense of exhilaration that dulls or inhibits pain

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What are the 4 steps in the physiology of pain (nociception)?

Transduction
Transmission
Perception
Modulation

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Transduction

Painful stimuli concerted to action potentials at the sensory receptor: occurs at A-DELTA fibers and C FIBERS
-Substances/chemical mediators released as a result of a direct injury and inflammation (prostaglandin)

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Define prostaglandin

important mediator that when activated lowers the pain threshold

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A delta

-Small diameter
-Less of these
-Myelinated: rapid transmission of pain
-Pain is sharp, stinging, cutting, pinching
-Localized

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C Fibers

-Small diameter
-More of these
-Unmyelinated: slow transmission of pain
-Dull, burning, aching
-Poorly localized

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A alpha and A beta

Large diameter
Don’t transmit pain signals

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Transmission

Process where action potentials move from peripheral receptors to the spinal cord and then the brain
-A delta and C-fibers are responsible for this transmission

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Perception

Brain then receives these signals adn interprets them as painful

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What are the factors that influence perception of pain

-Attention
-Distraction
-Anxiety
-Fear
-Fatigue
-Previous experiences
-Genetics
-Age
-Cultural impact
-level of health

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Pain tolerance

-Greatest intensity of pain a person can handle
-Varies greatly overtime
-Childbirth: Tolerance is way up

-Increase: Alcohol, persistant opioid use, hypnosis, distracting, strong faith

-Decrease: fatigue, anger, bordem, sleep deprivation, apprehension

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Pain threshold

-Lowest intensity of pain that a person can recognize
-Perceptual dominance occurs
-Intense pain at one location may increase threshold in another location

-Increase threshold: stress, sex, exercise, physical exertion, acupuncture

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Opioid tolerance

state of adaptation in which exposure to a drug causes changes in drug receptors that result in reduced drug effects overtime

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Modulation

Synaptic transmission of pain signals in altered
-Can be amplified or dampened
-endorphins mediate pre-synaptic transmission
-Morphine mimics the effect of endorphins

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What is the gate control theory

Theory that if we can block the pain before it gets to the thalamus/cortex we can stop or lower pain perception (stimulate A delta and C-fibers)

Touch, rubbing skin, massage, distraction, acupuncture, getting active

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Signs and symptoms of inflammation are produced by

chemical mediators

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What are the S/S of chemical mediators

pain, swelling, redness, heat, immobility

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Chemical mediators begin to be present in the plasma and activated by _______

tissue injury

What are 2 examples of chemical mediators?

Histamine & Arachidonic Acid Metabolites (prostaglandins & leukotrienes)

What do prostaglandins do?

Promote inflammation, pain, and fever COX-1 & COX-2 -Protect the lining of the stomach from the effects of acid -Promote blood clotting by activating platelets -Affect kidney function--> dilate blood vessels that lead to the kidneys

How long does acute pain last?

Transient, can last seconds to months (no longer than 3 months) Pain stops when chemical mediator or injury is gone

How long does chronic pain last?

more than 3-6 months

Acute pain stimulates the ___ causing

ANS physcial response to pain such as Increased HR & BP, diaphoresis, dilated pupils, anxiety

Chronic pain serves no _____ and has no ____ response

No purpose No ANS response

Acute pain is mostly ____ while chronic pain is mostly _____

Tissue input Emotions

Chronic pain stimulas is ____ the CNS

within

Nociceptive pain: Cutaneous/somatic pain Involves? Complaints? Location?

Involves MS system Complaints: constant and achy Location: Well-Localized (muscles, blood vessels, connective tissue) Delta fiber (mostly) C-fibers (some)

Nociceptive pain: Visceral Pain Involves? Complaints? Location?

Involves Organs & inflammation sometimes present Complaints: cramping, splitting, N/V, Diaphoresis Location: Poorly-localized (internal organs, diffuse, deep) C fibers

Neuropathic pain: Neuropathic pain Involves? Complaints? Location?

Involves Nerves Complaints: shooting, burning, electric shock, sharp, numb, motor weakness Location: Poorly localized (peripheral nerves, spinal cord, brain)

Referred pain:

Pain is felt at a distance from the actual pathology Common in Visceral pain Ex. MI pain felt in chest/jaw/left arm Ex. Pancreatitis --> shoulder pain

Phantom pain:

Sensation of pain that originates from an amputated part -Constant (Chronic)

Who should not take tramadol?

If Seizure hx If taking CNS depressants (SSRIs & MAOIs)

What pain med can only be partially reversed by narcan?

Gabapentin

Gabapentin is used specifically for

neuropathic pain

NSAIDs

Non-steroidal anti-inflammatory drugs Nonselective COX inhibitors and Selective COX inhibitors

What NSAID is not a true NSAID

Acetaminophen/ Tylenol

What NSAID do people take to reduce formation of thromboxane?

Aspirin (reduces platelet activation)

Which type of NSAIDs has serious cardiovascular thrombotic events and has a 87% chance of developing a long-term ulcer?

Selective COX-2 inhibitors

What are the 2 black box warnings for NSAIDS?

Increased risk of Cardiovascular thrombotic events such as stroke or heart attack Increased risk of GI adverse effects (Elderly at great risk)

Salicylate poisoning/ toxicity

Aspirin side effect if taken too long or overdose Acute: N/V, Seizures, cerebral edema Chronic: N/V, tinnitus, hearing loss

Reye's syndrome

-Aspirin Side effect -NO aspirin for Kids -Can cause severe brain/liver damage, high mortality rate

What is the most potent NSAID?

Ketorolac (IV or IM) Used 5 days or less

What are the limitations of acetaminophen (Tylenol)?

-Ceiling effect (won't feel above 1000mg) -No anti-inflammatory properties (choose other NSAID if inflammation)

What is the adult dose restriction of acetaminophen?

4grams/ 24 hours

What is the acute ingestion antidote for acetaminophen?

acetylcysteine- may cause vomiting

Chronic alcohol users should limit acetaminophen (tylenol) use to ____

<2 g/ 24 hrs

Avoid taking acetaminophen in patients who have

hepatitis or liver dysfunction

When do you use IV tylenol (ofirmev)

-Acute pain/ post op pain -Usually in combination with opioids -Sometimes first dose given at the time of incision or in pre-op and continued post off

What are the opioids?

-Morphine -Hydromorphine -Fentanyl -Meperdine -Codeine -Oxycodone -Hydrocodone

All opioids are

High Alert Drugs

What do you need to assess prior to giving an opioid?

LOC, BP, HR, RR If RR <10/min, assess level of sedation (Don't give)

What are the interactions for morphine?

Alcohol & CNS depressants (like benedryl)

Nursing considerations for Opioids

-May impair mental or physical abilities required for operating machinery or car -PO dose is higher than IV dose

Common and serious adverse reactions of opioids

CONSTIPSATION Drowsiness/ fatigue Confusion, dry mouth, itching Respiratory depression CNS depression

What opioid do opioid abusers want?

Hydromorphone (dilaudid)

What opioid is EXTREMELY potent?

Fentanyl 0.1mg IV fentanyl = 10mg IV morphine

What opioid is not given often but is given usually in ED for migrane or shivering?

merperidine

What are important things to known about merperidine?

-Lots of drug/drug interactions -With repeated doses it breaks down to toxic metabolite -Can cause seizures

What opioid do alot of people say they are allergic to due to GI problems?

Codeine

Which opioid is a cough suppressant?

Hydrocodone

What is the opioid of choice for detoxification treatment in opioid addiction?

Methadone Longer half-life (1 or 2 x a day)

What are the adverse effects of naloxone?

-Abrupt reversal of opioid effects with recurrent pain -Increased BP

Strength of Opioids from lowest to highest

LOWEST strength Codeine Hydrocodone Oxycodone Merperidine Morphine Hydromorphone Fentanyl HIGHEST

E2 Pain Flashcards

(70 cards)