Pain and Pain Management

Question 1

What is the 5th vital sign?

Answer 1

pain

Question 1

What is pain?

Answer 1

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 2

What are the pain-related goals for clinicians?

Answer 2

• eliminate source of pain
• teach patient to function within pain limitations
• improve pain control through physical and psychological methods
• relieve drug dependency
• treat overall well-being
• improve family and community support systems

Question 3

What does optimal pain management do for patients?

Answer 3

• helps patients understand their symptoms, adhere to their treatment plan, and return to their normal lives

Question 4

What is a passive medicine for pain?

Answer 4

opioids

Question 5

What are the three phases/types of pain ?

Answer 5

• acute: < 30 days, well localized and defined
• chronic: longer than 3-6 months duration; nociceptive, neuropathic (CNS,PNS, SNS)
• Referred: perceived as coming from site different from source (visceral pain)

Question 6

What is the most reliable indicator for pain?

Answer 6

self - report of pain = subjective

Question 7

What is a quantitative rating of intensity of pain?

Answer 7

• pain scales
  = objectify the measure

Question 8

What are some objective measures of pain?

Answer 8

• verbal rating scales
• numeric rating scales
• visual analog scales
• picture or face scales

Question 9

What do we need to consider when selecting a method of pain measurement?

Answer 9

• consider symptom duration, pt’s abilities, and time needed
• complexity of measure to be sensitive to change

Question 10

What are nonverbal pain indicators?

Answer 10

• sighs, gasps, moans, groans, cries
• facial grimaces, winces
• bracing or guarding against movement
• restlessness’
• rubbing the area
• vital sign response: increased HR, RR, BP

Question 11

Which sensory pathway or tract does crude touch and pain follow in the spinal column as the signal courses toward the cortex?

Answer 11

anterolateral spinothalmic pathway

Question 12

What is the anterolateral spinothalmic pathway the primary sensation for?

Answer 12

• primary sensation for nondescrimative/crude touch, pain, temp

Question 13

What does the anterolateral spinothalmic pathway receive signals from?

Answer 13

mechanoreceptors, nociceptors, thermoceptors

Question 14

What are C-fibers?

Answer 14

small, unmyelinated peripherial nerve

Question 15

What is nociception?

Answer 15

neural process of encoding a noxious stimuli

Question 16

Is pain nociception?

Answer 16

NO

Question 17

What can happen to nociception on its way to the brain?

Answer 17

can be facilitated or inhibited along the way

• MODALITIES CAN INHIBIT

Question 18

What is pain triggered by?

Answer 18

the action potential of a nociceptor and converted to conscious understanding of that stimulus

Question 19

What is the perception of nociception by the cerebrum?

Answer 19

pain

Question 20

What are the three dimensions of the experience of pain?

Answer 20

Sensory-discrimative
motivationsal-affective
cognative-evaluative

Question 21

What is sensory-discriminative?

Answer 21

where the pain is felt and what it feels like

Question 22

What is motivational-affective?

Answer 22

how the patient feels about the pain emotionally

Question 23

What is cognative-evaluative?

Answer 23

what the patient thinks about the pain intellectually and what they expect

Question 24

What are nociceptors?

Answer 24

type of sensory receptor that responds to noxious stimuli and result in the perception of pain

Question 25

Where are sensory receptors located?

Answer 25

At the distal ends of an afferent nerve

Question 26

Sensory receptors are __________ and __________ to the type of stimulus for which they were designed “sense”

Answer 26

specific and sensitive

Question 27

What are free nerve endings ?

Answer 27

Type of nociceptor/mechanoreceptor that “senses” pain

Question 28

What are nociceptors triggered by?

Answer 28

• intense thermal, mechanical or chemical stimuli
• exogenous source: brick, acid, bleach, fire
• endogenous source: fx, inflammatory response (chemicals bradykinin, histamine, arachidonic acid)

Question 29

Nocicpetors are nerve endings for afferent neurons:

Answer 29

C fibers and A-delta fibers

Question 30

What are 80% pain transmitting fibers?

Answer 30

C- fibers

• 20% a-delta