Pain

Question 1

McCaffery defined pain as

Answer 1

as
“whatever the experiencing patient
says it is and exists whenever he
says it does.”

Question 2

The International Association for the
Study of Pain (IASP) has defined
pain as

Answer 2

The International Association for the
Study of Pain (IASP) has defined
pain as

Question 3

Three things we think about when we think about pain

Answer 3

Duration
Acute or Chronic
Source of Pain

Question 4

Classifications of pain

Answer 4

Cancer related,
nociceptive,
neuropathic,
visceral, somatic,
headache, the
generalized pain
of fibromyalgia,
etc

Question 5

Pain involves the interactions of three

major systems:

Answer 5

Sensory/discriminative system
• Motivational/affective system
• Cognitive/evaluative system

Question 6

Pain threshold

Answer 6

The point at which that stimulus is experienced as
pain
• Differs from person to person

Question 7

Pain tolerance

Answer 7

The duration of time or the intensity of pain that a
person will endure before taking overt action to
relieve the pain
• Decreases with repeated exposure to pain
• Decreased by fatigue, anger, fear, and sleep
deprivation

Question 8

Neurological basis of Pain

Answer 8

Anatomy
• Afferent pathways
• Efferent pathways
• Physiology
• Tissue injury results in the production of arachidonic acid.
• Cyclooxygenase (COX) is needed to produce
prostaglandins.
• Prostaglandins lead to stimulation of nociceptors.
• Neuropeptides are associated with local pain and
inflammation.
• Norepinephrine and serotonin modulate pain in the
medulla and the pons.

Question 9

Efferent pathways are responsible for

Answer 9

modulating the sensation of pain

Question 10

Enodorphins are

Answer 10

inhibit neuropeptides and acts as body’s natural pain killer

Question 11

Endorphine facts - 5 facts

Answer 11

Attach to the opiate receptors in the spinal
cord and brain
• Inhibit the release of neuropeptides
• Opioid agonists: are exogenous opiates
• Opiate receptors in the hypothalamus
• Certain activities increase circulating
endorphins

Question 12

opioid recptors

Answer 12

Mu
Kappa
Delta

Question 13

Mu

Answer 13

Analgesic
• Euphoria
• Respiratory depression
• Physical dependence

Question 14

Kappa

Answer 14

Analgesic

Sedation

Question 15

Delta

Answer 15

Less analgesic
• Emotional and affective components of the pain experience
• Physical dependence

Question 16

Delta have important

Answer 16

Emotional and affective components of the pain experience

Question 17

Sigma

Answer 17

Technically no longer considered opioid receptors. Have psychomemitic effects. Produce dysphroa. PCP works on this

Question 18

Acute pain

Answer 18

less than 6 months duration

Question 19

Acute somatic

Answer 19

arises from connective tissue, muscle, bone, and skin

Question 20

Acute visceral

Answer 20

pain in the interanal organs and abdomen

Question 21

Referred pain

Answer 21

pain that is present in an area distant from its point of origin

Question 22

Acute somatic pain responds well to

Answer 22

acetaminophin, opoids, corticostroids, nsaid, local anthethics, ice and massage

Question 23

Acute visceral pain responds well to

Answer 23

opoids

Question 24

Chronic Pain

Answer 24

3 to 6 months OR beyond expected period of healing

Question 25

Chronic Pain is centrally located and can be

Answer 25

Non-neuropathic pain • Neuropathic pain • Psychogenic pain

Question 26

pure opioid agonists exampels

Answer 26

morphone and codeine

Question 27

mixed opioid agonist example Mu

Answer 27

buprenorphine

Question 28

mixed opioid agonists example kappa

Answer 28

pentazocine | butorphanol

Question 29

pure opioid antagonist

Answer 29

naloxone

Question 30

Purue opoid agonists work on

Answer 30

mu and kappa

Question 31

Mu effects

Answer 31

``` analgeisa decreased GI motility respiratory depression sedation dependence ```

Question 32

kappa effects

Answer 32

analgesia decreased GI motility sedation

Question 33

opoid agonists work

Answer 33

centrally to relieve pain

Question 34

opoid agonists bind to

Answer 34

opioid receptors, produce multiple responses | throughout the body.

Question 35

Moderate to serve pain what is 1st line

Answer 35

opoid

Question 36

Opoids can supress and slow what

Answer 36

Suppress cough, slow motility of the GI tract

Question 37

Adverse effect with opoids

Answer 37

Adverse effect: n/v, constipation, sedation and respiratory | depression*

Question 38

Schedule II opoid examples

Answer 38

Schedule II opioids - fentanyl, hydromorphone, | methadone, morphine, oxycodone, and oxymorphone.

Question 39

Opioid Antagonists

Answer 39

• Blockers of opioid activity • Reversal agents • Naloxone (Narcan) • Over-sedation and respiratory depression/arrest • Opioid antagonists can be provided in combo with opioids for patients with respiratory ailments

Question 40

Opioids with Mixed Agonist-Antagonist Activity*

Answer 40

Stimulate opioid receptor; withdrawal symptoms or adverse effects are not as intense due to partial activity of receptor subtypes

Question 41

Opioids can be combined with

Answer 41

non-narcotic analgesics (synergistically)

Question 42

Examples of opioid mixed agonists-antagonist activity

Answer 42

Buprenorphine