Pain- 32

Question 1

Pain

Answer 1

is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

Question 2

Pain is

Answer 2

“whatever the person says it is, and existing whenever the person says it does”

Question 3

Cutaneous or superficial pain

Answer 3

arises in the skin or the subcutaneous tissue (e.g., a burn or an abrasion). Although the injury is superficial, it may cause significant short-term pain.

Question 4

Deep somatic pain

Answer 4

originates in the ligaments, tendons, nerves, blood vessels, and bones. Deep somatic pain is more diffuse than cutaneous pain and tends to last longer.

Question 5

Visceral pain

Answer 5

is caused by the stimulation of deep internal pain receptors, most often in the abdominal cavity, cranium, or thorax.

Question 6

Radiating pain

Answer 6

starts at the origin but extends to other locations. For instance, the pain of a severe sore throat may extend to the ears and head.

Question 7

Referred pain

Answer 7

occurs in an area that is distant from the original site.

Question 8

Phantom pain

Answer 8

is pain that is perceived to originate from an area that has been surgically removed.

Question 9

Psychogenic pain

Answer 9

refers to pain that is believed to arise from the mind. The patient perceives the pain despite the fact that no physical cause can be identified.

Question 10

Nociceptive Pain

Answer 10

is the most common type of pain. It occurs when pain receptors, which are called nociceptors, respond to stimuli that are potentially damaging

Question 11

Neuropathic Pain

Answer 11

is complex and often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli.

Question 12

Acute pain

Answer 12

has a short duration with rapid onset. It varies in intensity and may last up to 6 months

Question 13

Chronic (or persistent) pain

Answer 13

lasts 3 to 6 months or longer and often interferes with daily activities.

Question 14

intractable pain

Answer 14

is both chronic and highly resistant to relief. This type of pain is especially frustrating for the patient and care provider.

Question 15

Pain quality

Answer 15

may be described as sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling.

Question 16

Pain periodicity

Answer 16

may be referred to as episodic, intermittent, or constant.

Question 17

Pain intensity

Answer 17

is described with a variety of terms, such as mild, distracting, moderate, severe, or intolerable.

Question 18

transduction

Answer 18

nociceptors become activated by the perception of mechanical, thermal, and chemical stimuli.

Question 19

Mechanical stimuli

Answer 19

are external forces that result in pressure or friction against the body. They involve stretching of body tissues

Question 20

Thermal stimuli

Answer 20

result from exposure to extreme heat or cold.

Question 21

Chemical stimuli

Answer 21

stimuli can be internal or external.

Question 22

transmission

Answer 22

Peripheral nerves carry the pain message to the dorsal horn of the spinal cord

Question 23

A-delta fibers

Answer 23

These fibers transmit fast pain impulses from acute, focused mechanical and thermal stimuli.

Question 24

C fibers

Answer 24

smaller unmyelinated fibers that transmit slow pain impulses, that is, dull, diffuse pain impulses that travel at a slow rate.

Question 25

neurotransmitters

Answer 25

Pain transmission involves endogenous chemicals

Question 26

Perception

Answer 26

involves the recognition and interpretation of pain in the frontal cortex

Question 27

Pain threshold

Answer 27

is the duration or intensity of pain that a person can endure.

Question 28

hyperalgesia

Answer 28

Extreme sensitivity to pain

Question 29

modulation

Answer 29

changes the perception of pain by either facilitating or inhibiting pain signals through the endogenous analgesia system and the gate-control mechanism.

Question 30

endogenous analgesia system

Answer 30

neurons in the brainstem activate descending nerve fibers that conduct impulses back to the spinal column

Question 31

Endogenous opioids

Answer 31

naturally occurring analgesic neurotransmitters that inhibit the transmission of pain impulses.

Question 32

Key point

Answer 32

Pain is universal, yet each person experiences and responds to pain differently.

Question 33

Emotions

Answer 33

multitude of feelings may overwhelm them and escalate their pain. fear confusion/helplessness anxiety/depression

Question 34

pain: infants/children

Answer 34

Newborns have the same sensitivity to pain as older infants and children, and preterm infants may have a greater sensitivity usually cry- sometimes don't cry but are still in pain alters pain scales pain goes untreated

Question 35

pain:older adults

Answer 35

Pain occurs in more than half of the geriatric population. - cognitive impairment - nonverbal cues - atypical response - diminished quality of life

Question 36

nonverbal cues

Answer 36

``` Facial expressions vocalizations change in physical activity change in routine mental status change physiological cues *lack of cues does not mean no pain ```

Question 37

onset of acute pain

Answer 37

activates the sympathetic nervous system.

Question 38

If the pain continues

Answer 38

the body adapts, and the parasympathetic nervous system takes over

Question 39

Sympathetic Responses (Acute Pain)

Answer 39

Dilated blood vessels to the brain, increased alertness Dilated pupils Increased heart rate and force of contraction Increased respiratory rate Increased systolic blood pressure Rapid speech Pallor

Question 40

Parasympathetic Responses (Deep or Prolonged Pain)

Answer 40

Changeable breathing patterns Constricted pupils Decreased pulse rate Decreased systolic blood pressure, feeling faint, possible syncope Slow, monotonous speech Withdrawal

Question 41

Behavioral Responses (Voluntary)

Answer 41

Agitation Crying Facial grimacing Guarding the painful area Moaning Withdrawing from painful stimuli

Question 42

Psychological (Affective) Responses

Answer 42

Anger Anxiety Depression Exhaustion Fear Hopelessness Irritability

Question 43

Pain assessment

Answer 43

Pain location and quality Pain intensity Aggravating and alleviating factors Timing and duration Pain relief and expectations for how much pain is realistic Questions that reveal the patient’s ability to perform activities of daily living Mobility Psychological/social factors

Question 44

The Visual Analog Scale

Answer 44

“No pain” is written on the left side and “Worst pain imaginable” is written on the right. Patients point to a location on the line that reflects their current pain.

Question 45

The Numerical Rating Scale

Answer 45

Zero indicates no pain at all, whereas a 10 indicates the worst possible pain.

Question 46

The Simple Descriptor Scale

Answer 46

is a list of adjectives that describe different levels of pain intensity. The simplest version of this scale uses the words mild, moderate, and severe.

Question 47

The Wong-Baker FACES Pain Rating Scale

Answer 47

FACES scale uses simple illustrations of faces to depict various levels of pain. It requires no numerical or reading skill.

Question 48

Assessing Pain in Infants and Children

Answer 48

self-report, behavioral observation, or physiological measures - ask parents usual signals - use play to assess coping - age appropriate toys to act out feelings - simple pain rating scales

Question 49

Nonverbal Signs of Pain

Answer 49

- Facial expression, posture, and body position - change in vital signs- only last a short time - pt can be in pain and not act like it - ask pt and believe them - use interpreter - some think they are being weak - assess for depression

Question 50

Cutaneous Stimulation

Answer 50

This process diminishes the patient’s perception of pain. Cutaneous stimulation works best on pain that is localized and not diffuse.

Question 51

TENS Units

Answer 51

consists of electrode pads, connecting wire, and the stimulator. The pads are applied directly to the painful area, which is most often muscle and soft tissue.

Question 52

PENS Units

Answer 52

combines a TENS unit with needle probes percutaneously placed (through the skin) to stimulate peripheral sensory nerves. PENS is effective in short-term management of acute and chronic pain.

Question 53

Spinal Cord Stimulator

Answer 53

The SCS produces a tingly sensation that interferes with the perception of pain.

Question 54

Acupuncture

Answer 54

Application of extremely fine needles to specific sites in the body to relieve pain

Question 55

Acupressure

Answer 55

stimulates specific sites in the body.

Question 56

Massage

Answer 56

Massage has been shown to be effective in reducing pain. By providing cutaneous stimulation and relaxing the muscles

Question 57

Myofascial release

Answer 57

manual pressure applied between overused or injured muscles and nerves to loosen adhesions that develop from overuse.

Question 58

Application of Heat and Cold

Answer 58

The application of cold causes vasoconstriction and can help prevent swelling and bleeding Heat promotes vasodilation and circulation, which speeds healing.

Question 59

Contralateral Stimulation

Answer 59

stimulating the skin in an area opposite to the painful site.