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Flashcards in Pain and Management Deck (19)
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Pain - definition

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

"Whatever the experiencing person says it is, existing whenever she/he says it does"


The Complexity of Pain

Pain is unpleasant and is uniquely experienced by each individual.

It cannot be defined, identified or measured by the observer.

Is the most common reason to seek medical attention.


Pain Pathway

Pain producing stimuli - mechanical thermal-chemical.
Activation - of primary afferent nociceptors.
Generation - of a barrage of electro chemical impulses.
Propagation - through the nerves to activate spinal cord nerve cells.
Spinal Cord Nerve Cells - in turn give rise to pathways that conduct the pain message to higher centres in the thalamus and cerebral cortex that are required for the conscious perception of pain.



A nociceptor is a sensory neuron (nerve cell) that responds to potentially damaging stimuli by sending nerve signals to the spinal cord and brain.
(Nociceptor - Peripheral Nerve - Spinal Cord - Thalamus - Cerebral Cortex)


Somatogenic and Psychogenic pain

Somatogenic = such as a crushed finger or heart attack is a pain of cause.

Psychogenic = no known physical cause.


Acute pain

Protective mechanism.
Mobilises an individual to act.
Pain is relieved after the chemical mediators that stimulate the nociceptors are removed.
Split into three categories:
Somatic = superficial.
Visceral = Internal organs. Can radiate.
Referred Origin = removed or distant from the origin.


Referred pain sites

Liver and Gall Bladder = Right shoulder & Upper right quadrant.
Lung & Diaphragm = Left shoulder.
Heart = Left arm & upper back.


Chronic Pain

Two distinct definitions:
1. Prolonged and lasts longer than 6 months.
2. Pain that extends beyond the expected period of healing.
Can be persistent or intermittent.


Gate Control Theory

Proposed by Ronald Melzack and Patrick Wall during the early 1960s, gate control theory suggests that the spinal cord contains a neurological "gate" that either blocks pain signals or allows them to continue on to the brain. Unlike an actual gate, which opens and closes to allow things to pass through, the "gate" in the spinal cord operates by differentiating between the types of fibres carrying pain signals. Pain signals travelling via small nerve fibres are allowed to pass through, while signals sent by large nerve fibres are blocked. Gate control theory is often used to explain phantom or chronic pain.


Cancer Pain

Some clinicians define the pain caused by tumours as distinctly different from acute or chronic.


Chronic Pain: the persistent pain cycle

Persistent pain.
Being less active.
Loss of fitness, weak muscles and joint stiffness.
Create 'no go' lists of things you cannot do.
Sleep problems/tiredness/fatigue.
Weight gain/loss.
Negative thinking, fear of the future, depression/mood swings.
Time off work, money worries, relationship concerns.

(sometimes the arrows can also go anti-clockwise)


Physiological effects.

Increased heart & respiration rate.
Elevated BP.
Pallor or Flushing.
Dilated Pupils.
Diaphoresis (sweating).


Threshold and Tolerance.

Threshold is the point which a stimulus is perceived as pain.

Tolerance is the duration of time or the intensity of pain that an individual will endure before initiating a response.


Pain assessment barriers

Fear of unpleasant procedures.
Prolonged hospitalisation.
Distress to relatives.


Assessing pain - SOCRATES

Associated symptoms.
Exacerbating or relieving factors.


Numerical Rating Scale

NRS is the preferred method in pre-hospital care due to its simplistic verbal administration and recording ease. 1= no pain 5= moderate pain 10= severe pain


Child pain assessment

Infants have abilities to perceive pain.
Changes in facial expression, crying and movement are the most consistent observed expressions of infants in pain.
Wong-Baker Faces:
a :-) = 0 no pain - less smiley but smiley = 2 hurts little bit - :-| = 4 hurts little more - less unhappy/slight :-( = 6 hurts even more - a sad face :-( = 8 hurts whole lot - a crying :-( = 10 hurts worst



Face, Legs, Activity, Cry, Consolability Scale.

no particular expression = 0
Occasional grimace or frown, withdrawn uninterested = 1
Frequent to constant quivering chin. Clenched jaw = 2

Normal position or relaxed = 0
Uneasy, restless, tense = 1
Kicking or legs drawn up = 2

Lying quietly, normal position, moves easily = 0
Squirming, shifting back and forth, tense = 1
Arched, rigid or jerking = 2

No cry (awake or asleep) = 0
Moans and whimpers, occasional complaint = 1
Crying steadily, screams or sobs, frequent complaints = 2

Content, relaxed = 0
Reassured by occasional touching, hugging or being talked to, distractable = 1
Difficult to console or comfort = 2


Management of pain

Think step-wise:
Psychological -> Immobilisation -> Pharmacological.