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Flashcards in Pain Deck (13):
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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.

1

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


2

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

3

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

4

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)

5

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

6

Principals of Pharmacological Management

Three step pain ladder (cancer patients)
Combined analgesia
preemptive analgesia (perioperative TX)
titrating upward or downward

7

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

8

What are secondary symptoms of pain

Treat secondary symptoms to reduce suffering
Nausea, vomiting
Constipation
Dehydration
Insomnia
Anticipate and tx adverse effect of analgesics

9

What are some common non-drug

Cutaneous stimulation (Superficial Heating & Cooling, Vibration)

Distraction

Relaxation

10

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

11

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.

12

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.