Pain

Question 1

**What is pain?

Answer 1

• subjective unpleasant sensory/emotional experience
• destructive physiological effects
• warns of potential injury
• McCaffrey- put your beliefs about pain aside and focus on the patients’ pain experience*

Question 2

What does pain affect?

Answer 2

• job performance
• engagement in social activities
• sexual intimacy
• sleep and rest
• ability to exercise
• ADLs

Question 3

***What is cutaneous/superficial pain?

Answer 3

arises from skin or subcutaneous tissue

example: burn or paper cut

Question 4

***What is deep somatic pain?

Answer 4

arises from ligaments, tendons, nerves, blood vessels and bones (achy, tender)

example: fracture, sprain, arthritis, bone cancer

Question 5

***What is visceral pain?

Answer 5

arises from deep internal pain receptors (tight, pressure, crampy)

example: menstrual cramps, labor pain, GI infection, bowel disorders, organ cancer

Question 6

***What is radiating pain?

Answer 6

starts at the origin and extends to other location

example: heartburn felt all ove thorax, sore throat making ears and head hurt

Question 7

***What is referred pain?

Answer 7

arises from an area that is distant to the original site

example: pain from a heart attack may be felt in jaw or left arm

Question 8

***What is phantom pain?

Answer 8

pain that is perceived to originate from an area that has been surgically removed (burning, itching, pain)

Question 9

***What is psychogenic pain?

Answer 9

arises from the mind, no other cause identified

Question 10

***What is nociceptive pain?

Answer 10

nociceptors (pain receptors) respond to stimuli that are potentially damaging

Question 11

***What is neuropathic pain?

Answer 11

injury to nerve results in repeated transmission of pain signals in the absence of stimuli

Question 12

***What is pain quality?

Answer 12

• sharp or dull
• aching
• throbbing
• stabbing
• burning
• ripping
• searing
• tingling

Question 13

***What is pain periodicity?

Answer 13

• episodic
• intermittent
• constant

Question 14

***What is pain intensity?

Answer 14

• mild
• moderate
• distracting
• severe
• intolerable

Question 15

What is transduction?

Answer 15

activation of nociceptors by stimuli (mechanical, thermal, chemical)

Question 16

What is transmission?

Answer 16

conduction of pain message to the spinal cord (via A-delta fibers-fast, via c fibers-slow)

Question 17

What is pain perception?

Answer 17

recognizing and defining pain in the cortex

Question 18

What is pain threshold vs pain tolerance?

Answer 18

Threshold- point at which the brain defines stimulus as pain

Tolerance- duration and intensity of pain the person is willing to endure

Question 19

What is pain modulation?

Answer 19

changing pain perception

Question 20

What is the endogenous analgesia system?

Answer 20

neurons in the brainstem send impulses down to trigger endogenous opioids (naturally occurring)

Question 21

What is the gate-control theory?

Answer 21

-interplay between two different kinds of fibers (produce pain, inhibit pain)

Question 22

What factors influence pain?

Answer 22

• emotions
• past experience with pain
• developmental stage
• sociocultural factors
• communication skills
• cognitive impairments

Question 23

How does pain affect the endocrine system? Result?

Answer 23

pain triggers excessive release of adrenocorticotrophic, cortisol, ADH, growth, catecholamines, and glucagon

Result: weight loss, tachycardia, fever, increased RR, death

Question 24

How does pain affect the cardiovascular system? Result?

Answer 24

hypercoagulation, tachycardia, hypertension, cardiac workload, oxygen demand

Result: unstable angina, intracoronary thrombosis, heart attack

Question 25

How does pain affect the respiratory system? Result?

Answer 25

splinting (shallow breathing) reduces tidal volume, increased i/e pressures Result: pneumonia, atelectasis, hypercarbia, respiratory acidosis

Question 26

How does pain affect the genitourinary system? Result?

Answer 26

release of excessive catecholamines, aldosterone, ADH, cortisol, angiotension II, prostaglandins Result: decreased urine output, urinary retention, fluid overload, hypokalemia, hypertension, increased cardiac output

Question 27

How does pain affect the gastrointestinal system? Result?

Answer 27

intestinal secretions and smooth muscle tone increase Result: gastric emptying, motility decrease

Question 28

****What are the characteristics we assess for of pain?

Answer 28

- pain location - quality (sharp/dull, burning, stabbing, aching, throbbing, ripping, searing, tingling) - intensity (pain scale, mild, distracting, moderate, severe, intolerable) - aggravating/alleviating factors (what makes it better/worse) - periodicity (episodic, intermittent, constant)

Question 29

What are some nonverbal signs of pain?

Answer 29

- facial expression (lowered brow, wincing, clenching jaw, closed eyes) - posture (guarding) - vital signs (increased HR, BP) - behavioral manifestations (depression, stoic, laughter, sleep)

Question 30

What does a TENS or PENS unit do?

Answer 30

-stimulates a-delta sensory fibers through pads applied to skin or needles inserted

Question 31

What is a spinal cord stimulator?

Answer 31

used for chronic neurological pain, implanted. Tingly sensation interferes with perception of pain

Question 32

**What is acupuncture?

Answer 32

needles to specific sites to relieve pain by stimulating endogenous analgesia system

Question 33

**What is acupressure?

Answer 33

pressure over pressure points releases endorphins

Question 34

What is massage?

Answer 34

cutaneous stimulation reduces pain

Question 35

Who would benefit from oral sucrose?

Answer 35

infants experiencing pain

Question 36

***What are some non-medical pain relief interventions?

Answer 36

- distraction - hot/cold therapy - therapeutic touch (massage) - sequential muscle relaxation - guided imagery - diaphragmatic breathing (relaxation) - hypnosis

Question 37

What do NSAIDS do?

Answer 37

- aspirin, ibuprofen - act on peripheral tissues best - interfere with production of prostaglandins

Question 38

What does acetaminophen do?

Answer 38

- safer than NSAIDS bc no GI upset, platelet function | - analgesic and fever-reducing properties

Question 39

What are adjuvant analgesics?

Answer 39

- reduce the amount of opioid needed - anticonvulsants, antidepressants, local anesthetics, topical agents, psychostimulants, muscle relaxants, neuroleptics, corticosteroids

Question 40

What do opioids do?

Answer 40

-find pain receptor sites (mu, delta, kappa, sigma) to bind with and block the pain impulse

Question 41

What are some examples of chemical pain relief measures

Answer 41

- nerve block - epidural injection - local anesthesia - topical anesthesia

Question 42

What is radiofrequency ablation?

Answer 42

electromagnetic waves target the pain nerves. Longer relief than steroids and nerve blocks

Question 43

What is a cordotomy?

Answer 43

interrupts pain and temp sensation below the tract that is severed

Question 44

What is a rhizotomy?

Answer 44

interrupts the anterior or posterior nerve route | -often used for head and neck pain produced by cancer

Question 45

What is a neurectomy?

Answer 45

peripheral and cranial pathways are interrupted

Question 46

What is a sympathectomy?

Answer 46

severs the paths to the sympathetic division of the autonomic nervous system

Question 47

****What types of pain scales are there?

Answer 47

- numerical rating scale (NRS) - visual analog scale (VAS) - Wong-Baker FACES - simple descriptive scale (SDS) - narrative descriptive scale (NDS)

Question 48

***What are the physiological responses to pain?

Answer 48

- increased BP, HR, RR | - dilated pupils