Flashcards in Pain Deck (13):
Describe the physiology of pain
-transduction, transmission, perception of pain, modulation
-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.
-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
-conscious experience of pain
-pain is responded, defined and experienced by individual
-activation of the descending pathways to inhibits the transmission of pain.
Characterize the types of pain
-increase BP, HR. Limiting pain, serves a purpose
-non limiting pain, limit opioids within 90 days, BP doesn't rise
-laceration to skin
Deep somatic pain
-bones, muscles, joints
-acute or chronic
-throbing aching, well localized
-appendicitis, block bile duct, chest pain
-burning, stabbing, squeezing, comes and go,
-myocardio pain, feels it in the arm or jaw
-sciatica, diabeticneuropathy in feet, pins and needles, burning
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
Psychological and physiological factors
nurses interpretation or biases
What are some pain assessment plan for clinical practice
Ask open ended questions
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)
-Purpose is to manage selective types of pain
-enhances the effectiveness of other analgesic meds, may help decrease dose of opioids
antidepressant - Chronic pain
anti-anxiety - anxiety, muscle spasm
anticonvulsant - neuropathic pain
corticosteroid - CA pain, Bone pain
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
-tylenol, NSAID, COX2-inhibitor
-corticosteroid for bone CA, calcitonin, vitamin D and calcium for osteoporoses
Musclespasm - baclofen
Principals of Pharmacological Management
Three step pain ladder (cancer patients)
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
Anticipate and tx adverse effect of analgesics
What are some common non-drug
Cutaneous stimulation (Superficial Heating & Cooling, Vibration)
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.
Titrate – start low, go slow
Route – oral preferred
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
Examples of assessment tools
QUESTT examples of assessment tool
-Utilize principles of pain management (steps for analgesia).
Always consider pharmacological & non-pharmacological management.
Create an environment conducive for relaxation and pain & anxiety management.