Pain Flashcards
(121 cards)
1
Q
How can pain be defined
A
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
2
Q
Sensory receptors
A
Monitor conditions inside or outside the body
3
Q
The receptive field
A
The area monitored by a single receptor cell
4
Q
The smaller the receptive field…
A
The more precise the sensory information can be localized
5
Q
Sensation
A
The arriving sensory information in the form of action potentials
6
Q
How is pain sensation information routed
A
Routed to specific cortex based on location and nature of stimulus
7
Q
Perception
A
Conscious awareness and interpretation of sensory input by the integration areas of cerebral cortex
8
Q
Adaptation
A
A reduction in sensitivity in the presence of a constant stimulus
Reduces the amount of information arriving at cerebral cortex
9
Q
General sense include
A
Temperature Pain Touch Pressure Vibration Proprioception (body position)
10
Q
Classes of General Sensory Receptors
A
Nociceptors
Thermoreceptors
Mechanoreceptors
Chemoreceptors
11
Q
Nociceptors
A
Respond to pain
12
Q
Thermoreceptors
A
respond to temperature
13
Q
Mechanoreceptors
A
respond to physical distortion
14
Q
chemoreceptors
A
Respond to chemical stimuli
15
Q
What are nociceptors
A
Free nerve endings in skin, muscles, joints, arteries, and the viscera that respond and adapt very slowly to chemical, mechanical, and thermal stimuli
16
Q
Nociceptors are very common in
A
in superficial skin, joint capsules, covering of bones, and around blood vessels
17
Q
Nociceptors respond to…
A
Extremes of temperature, mechanical damage, or dissolved chemicals
18
Q
What is the size of nociceptors receptive fields
A
Large that can detect a wide range of stimuli
19
Q
Neuroanatomy of pain
A
Transduction
Transmission
Perception
Modulation
20
Q
Transduction
A
activation of nociceptors
21
Q
Transmission
A
Conduction to dorsal horn and up spinal cord
22
Q
Perception
A
Sensory-discriminative system
Motivational-affective system
Cognitive-evalautive system
23
Q
Modulation
A
Facilitation or inhibition of transmission before, during, or after perception
24
Q
Where are neuromodulators located?
A
Pathways of nervous system
25
What are neuromodulators triggered by?
tissue injury and inflammation
26
Which are excitatory neurotransmitters in CNS and PNS
Substance P
Glutamate
Calcitonin
27
Inhibitory neurotransmitters
GABA
Glycine
Serotonin
Norepinephrine
28
Pathways of Modulation
Descending inhibitory or facilitatory pathway
Segmental inhibition of pain
Diffuse noxious inhibitory control (DNIC)
Placebo effect
29
Descending inhibitory or faciliatory pathway
Inhibits or facilitates pain by activating opioid receptors
30
Segmental inhibition of pain
A beta fibres stimulate inhibitory interneurons and decrease pain transmission
31
Diffuse noxious inhibitory control
Pain relieved when 2 noxious stimuli occur at the same time from different sites
32
Placebo effect
Cognitive expectations cause physiological effects
33
Pain Threshold
Point at which a stimulus is perceived as pain
34
Perceptual dominance
Pain at one location may cause an increase in the threshold in another location
35
Pain tolerance
Duration of time or the intensity of pain that a person will endure before initiation of pain responses
36
Types of pain
Fast pain
Slow pain
Referred pain
37
Fast pain
Also known as prickling pain
Localized sensations
Transmitted quickly to CNS through myelinated axons
38
Slow pain
Also known as burning and aching pain
Transmitted by unmyelinated axons
Identified only as general area involved
39
Referred pain
Perception of pain in an unrelated area of the body
| Usually from pain related to visceral organs
40
Sources of pain
Visceral pain
Deep somatic pain
Cutaneous pain
Referred pain
41
Classification of pain
Acute
| Chronic
42
Acute pain
Intense pain over a defined period of time
Pain lasts over a few days and may result in increased heart rate, respiratory rate and sweating
Typically occurs over less than 6 weeks
43
Chronic pain
Longer than 3-6 months
| Can interfere with daily activities
44
Acute pain protective mechanism
Alerts an individual to a condition or experience that is immediately harmful to the body
45
Acute somatic pain
Arises from skin, joints, and muscles
46
Acute somatic Pain A delta fibres
Pain is sharp and well localized
47
Acute somatic pain C fibres
Dull aching and poorly localized pain
48
Acute Visceral Pain
Pain in the internal organs and lining of the body cavities
49
Acute visceral pain transmitted by C fibres
Poorly localized with an aching, gnawing, throbbing or intermittent cramping quality
50
Neuropathic pain
Chronic
| Amplification of pain without stimulation
51
Neuropathic pain is often described as
Burning, shooting, shock like or tingling
52
Peripheral neuropathic pain
Caused by peripheral nerve lesions
53
Central neuropathic pain
Caused by lesion or dysfunction in brain or spinal cord
54
PQRSTU
```
Provocative or palliative
Quality of pain
Region of body
Severity
Timing and onset of pain
Understanding of pain
```
55
Who is an expert on their pain
the patient
56
Barriers to effective pain management
```
Lack of information
Limited training
Fear of addictive nature of opiates
Lack of information with combining therapies
ineffective assessment
```
57
Nonpharmacological Pain interventions
```
Massage
Positioning and body alignment
Splinting
Thermal interventions
Mind-body therapies
Acupuncture
Biofeedback therapy
Relaxation therapy
Art or music therapy
Imagery
Chiropractic manipulation
Hypnosis
Therapeutic touch
Transcutaneous electrical stimulation
Energy therapies
Physical and Aquatic therapy
```
58
Two categories every of analgesics
Non opioids
| Opioids
59
When should non opioids be used
Minor (0-4) to moderate pain (4-6)
60
When should opioids be used
Severe pain (7-10)
61
Adjuvant analgesics
Enhance the analgesic action of non opioids and opioids
Assist the primary drugs in relieving pain
Allow for smaller dosages of opioids to be described
62
Non opioids
Acetaminophen
NSAIDS
Tramadol
Clonidine
63
Opiod Analgesics
Morphine
Fentanyl
Hydromorphone
Oxycodone
64
Adjuvant analgesics
Local anesthetic (Bupivacine, Ropivacaine, lidocaine)
Anticonvulsants (Gabapentin, pregabalin)
Antidepressants (Desipramine, nortiptyline, duloxetine)
65
Endogenous Opioids
Morphine-like neuropeptides
| Enkephalins
66
Morphine-like neuropeptides
Bind with opioid receptors to inhibit pain impulses in periphery, spinal cord and brain
67
Enkephalins
Have pharmacological actions similar to morphine
| Bind as direct agonists to opioid receptors
68
Most common natural opioid
Endorphins
Dynorphins
Endomorphins
69
Acetaminophen overdose leads to..
hepatotoxicity due to the formation of toxic metabolites
70
What is Acetylcysteine used for
Acetaminophen overdoses
Used to reduce the extent of liver damage
detoxifies the toxic metabolite and allows for other routes of metabolism
71
Adverse effects of Acetlycysteine
```
Flushing
Urticaria
Rash
Hypotension
Bronchospasm
```
72
Endocannabinoids are classified as?
Classified as escanoids
73
What are endocannabinoids synthesized from?
Phospholipids
74
Endocannabinoids
Cannabis produces a resin contains cannabinoids
| Analgesic in humans
75
Drawbacks of endocannbinoids
Psychoactive and addictive properties
76
What is the prototype drug for severe pain
Morphine
77
Opioids
Narcotic analgesic
| Can be natural or synthetic
78
In what type of pain should adjuvant medications be used with opioids
Neuropathic pain
79
Morphine Sulphate
Controlled substance derived from the opium poppy
| CNS depressant
80
Are epidurals available for morphine sulphate?
yes
81
Morphine Sulphate Route
PO
IV
SC
IM
82
Morphine sulphate Onset of action
Rapid
83
Morphine sulphate Peak
30-60 min
84
Morphine sulphate half life
1.7-4.5 hours
85
Morphine sulphate duration of action
6-7 hours
86
How do opioids work?
Bind to the pain receptors in the brain and cause an analgesic response
Work by exerting their action by interacting with at least 6 types of receptors
87
MU Receptor responses
```
Analgesia
Decreased GI motility
Euphoria
Physical dependence
Respiratory depression
Sedation
```
88
Kappa Receptor Responses
Analgesia
Decreased GI motility
Miosis
Sedation
89
General effects of opioids
```
Suppress cough reflex
Slow GI motility
Sedation
Euphoria
Intense relaxation
Respiratory depression
Nausea and vomiting
Potential for physical and psychological dependence
```
90
Use opioids with caution in patients with
hepatic disease
91
Side effects of opioids
```
Respiratory depression
Constipation
Decreased LOC
Orthostatic hypotension
Nausea and vomiting
Urinary output
```
92
Opiod overdose
Overly aggressive pain therapy or substance abuse
93
Most commonly abused opioids
Morphine
Meperidine
Heroin
94
Manifestations of Opioid overdose
```
Euphoria
Arousable somnolence
Nausea
Pinpoint pupils
Slow and shallow respirations
Coma
Seizures
```
95
Opiod overdose treatment Action
Blocks MU and Kappa receptors
| Given if the patient is experiencing severe respiratory distress
96
Opioid overdose treatment Pharmacokinetics
Well absorbed following SC or IM administration
| Widely distributed and crosses BBB and placenta
97
Opioid overdose treatment half life
60-90 min in adults
| Up to 3 hours in neonates
98
Opioid overdose treatment adverse effects
Minimal toxicity
| Rapid reversal for analgesic
99
Opioid overdose treatment Drug interactions
Reversal or analgesic effects of opioid agonist and antagonist
100
Opioid overdose treatment prototype
Naloxone (Narcan)
101
Nursing considerations for naloxone
Know when to administer it
Monitor CV status
Monitor withdrawal post administration
Monitor VS during and after administration
102
What is the treatment for opioid dependence?
Methadone
103
Combination Medication
Common practice to combine opioids and non opioids into a single tablet
Work to relieve pain
104
How do combination medication work?
Keep the doses of narcotic small to reduce dependence and opioid related side effects
105
Percocet
Oxycodone (HCL)- 5mg
| Acetaminophen- 325mg
106
Atasol 30
Acetaminophen- 325mg
Caffeine- 30mg
Codeine- 30mg
107
Tylenol with codeine No. 3
Acetaminophen- 325mg
Caffeine- 15mg
Codeine- 15mg
108
Migraine
Familial, episodic disorder whose marker is headache and is defined as repeated, episodic headache lasting 4 to 72 hours
109
Migraines are caused by...
Caused by combination of multiple genetic and environmental factors
110
Diagnosis of Migraine
Unilateral, throbbing, worsened by movement, moderate or severe, and any one of these symptoms: nausea, vomiting, photophobia, or phonophobia
111
Migraine Triggers
```
Altered sleep patterns
Skipping meals
Overexertion
Weather change
Stress or relaxation from stress
Hormonal changes
Bright lights
Strong smells
Chemicals
```
112
Cluster headaches
Occur in clusters (minutes to hours) for a period of days, followed by a long period of spontaneous remission
113
Tension headaches
Most common
Mild to moderate bilateral headache with a sensation of a tight band or pressure around the head with gradual onset of pain
May last hours or days
114
Headache Treatments
begin with acetaminophen or NSAIDS
| then triptans or ergot alkaloids
115
Triptans
Selective for serotonin řeceptors
Constrict certain inter cranial vessels
Aborts migraine with or without aura
116
Ergot Alkaloids
Interact with adrenergic, dopamine, and serotonin blockers
| Aborts migraines
117
3 origins of labor pain
Visceral
Somatic
referred
118
First stage of labor pain
Uterine contractions
Decrease in blood flow causing local oxygen defecit
Pain is felt from uterine contractions
119
Second stage of labor pain
Sharp burning pain Somatic pain
Distention & tration on the peritoneum and uterocervical supports
Pressure against the bladder & rectum
Stretching & dissention of perineal tissues & the
pelfic floor
Lacerations of soft tissue (cervix, vagina, perineum)
120
Stage three of labor pain
Uterine in nature
| Similar to the first stage of labor
121
Drug exposure during pregnancy
Opioid use can have a negative effect on mothers and their babies
Infants can be born with breathing and feeding problems
Preterm birth
Low birthweight
Maternal mortality
Neonatal abstinence Syndrome
