Pain Physiology Flashcards
(46 cards)
1
Q
A patient states that they have 8/10 pain in their abdomen. Nurse Karen assessess the patient and believes that the patients is full of caca and is lying about their condition. As a nurse, what should Karen know?
A
- Pain in a personal/individual experience
- pain exists wherever/whatever the patient says it
2
Q
What is pain?
A
- an unpleasant sensory and emotional experience associated with actual or potential tissue damage
3
Q
Explain the pain pathway
A
- Transduction – Activation of pain receptors, converts stimuli to electrical impulses.
- Transmission – pain signals from spinal cord travel to brain (CNS)
- Perception – Recognition and interpretation of pain
-
Modulation – Body adjust to pain response; send inhibitory signals to spinal cord
-> Endogenous opioids inhibit release of substance P ➡ reduces pain
-> Endorphins: body’s natural pain reliever
-> Enkephalins: less potent; widespread; reduce pain
4
Q
What does Substance P do?
A
- continues the pain signal from the spinal cord to the brain
5
Q
What is the general effect of endogenous opioids/neurotransmitters? What are examples of endogenous opioids/neurotransmitters?
A
- Inhibit the release of Substance P
Examples:
- Endorphins
- Ekephalins
6
Q
What are Endorphins?
A
- the body’s natural pain reliever
7
Q
What are Enkephalins?
A
- less potent, pain reliever
-> for widespread pain
8
Q
Describe the Mechanisms of Pain Tranmission
A
- Tissue damage → release of pain mediators
- Bradykinin: causes pain & swelling
- Histamine: causes swelling & redness
- Potassium: stimulate nociceptors
- Prostaglandins: make pain feel worse
- Serotonin: modify pain (⬆ or ⬇)
- Pain mediators activate nociceptors
- A-Delta Fibers: Long, Myelinated, rapid transmission → sharp, well defined pain
- C Fibers: Short, Unmyelinated, slow transmission → dull, poorly localized pain
- Signal from fibers travel to spinal cord
- Spinal cord stimulate release of:
- Substance P: continue the pain signal to the brain
- Endogenous opioids/neurotransmitters
-> Endorphins
-> Enkephalins
9
Q
What does Bradykinin cause?
A
- pain
- swelling
10
Q
What do Histamines cause?
A
- swelling
- redness
11
Q
What does Potassium do?
A
- stimualte nocicpetors
12
Q
What do Prostaglandins do?
A
- pain
- inflammation
- block clot aggregation
13
Q
What does Serotonin do?
A
- modify pain (↑ or ↓ pain)
14
Q
Describe the following type of nerve fiber:
A-Delta
(Size, Myelin Sheath?, Conduction Speed, Type of Pain)
A
Size:
- Large
Myelin Sheath?
- Myelinated
Conduction Speed:
- Rapid transmision
Type of Pain:
- sharp & well localized
15
Q
Describe the following type of nerve fiber:
C fibers
(Size, Myelin Sheath?, Conduction Speed, Type of Pain)
A
Size:
- Small
Myelin Sheath?
- Unmyelinated
Conduction Speed:
- Slow
Type of Pain:
- dull & nonlocalized
16
Q
What does the Gate Theory of Pain suggest?
A
- the Nervous System processess limited imput at a time
17
Q
What is the premise of the Gate Control Theory of Pain?
A
- Pain impulses (thin nerve fibers) compete with sensory input (large fibers like pressure, heat/cold) for brain recognition
18
Q
What happens when large sensory fibers are activated?
A
- it closes the gate for thin nerve fibers, allowing large nerve fibers to come in
-> decreases pain
19
Q
What is an example of a method that uses the Gate Control Theory of Pain?
A
- Transcutaneous Electrical Nerve Stimulation (TENS).
20
Q
A patient reports chronic back pain. The nurse applies a TENS unit which sends mild electrical impulses to the area. After a few minutes, the patient says the pain feels less intense. According to the Gate Control Theory of Pain, what is the reason for this?
A
- electrical stimulation activates large nerve fibers, closing the gate to thin pain fibers, decreasing the perception of pain.
21
Q
Describe the following pain duration:
Acute Pain
(Physiology?, How long does it last?, Treatability, Onset, Localized or Generalized, Effects on the Body, Examples)
Examples: MAD BBLS
A
Physiology:
- warning signals by activating SNS
-> cause physiologic responses
How long does it last?:
- usually temporary (< 3 months)
Treatability:
- Easy to treat
Onset:
- Sudden onset
Localized or Genralized:
- Localized
Efects on the Body:
- activate fight or fligt
-> sweating & dilated pupils - ↑ VS
-> BP, HR, RR
Examples
- MI
- Appendicitis
- Dental procedure
- Burns/cuts
- Broken bones
- Labor/childbirth
- Surgery
22
Q
Describe the following pain duration:
Chronic Pain
(Physiology?, How long does it last?, Treatability, Onset, Localized or Generalized, Effects on the Body, Examples)
Examples: CC DR P
A
Physiology:
- results from CNS dmg
-> cause sometimes unclear
How long does it last?:
- > 3 months
Treatability:
- Difficult to treat
-> persistent/recurring
Onset:
- Gradual onset
Localized or Genralized:
- Both (character/quality changes over time)
-> dull/persistent aching
Efects on the Body:
- ↓ VS or stable
-> BP, HR, RR
Examples
- Crohn’s dz
- Cancer pain
- Diabetes
- Rheumatoid Arthritis
- Procedural pain (chronification)
23
Q
What does localized pain mean?
A
- pain confined to specific area
24
Q
What does gernalized pain mean?
A
pain felt in larger area of the body or the entire body
25
Descrribe the fllowing type of pain:
**Cutaneous Pain**
(AKA, Description, Location, Example)
**AKA:**
- Superficial pain
**Description:**
- Sharp
**Location:**
- Skin
- Subcutaneous tissue
**Example:**
- Paper cut
26
Descrribe the fllowing type of pain:
**Somatic Pain**
(AKA, Description, Location, Example)
## Footnote
Location: TV aNd BBL
**AKA:**
- Deep Somatic pain
**Description:**
- deep, tissue, scattered
**Location:**
- tendons
- vessels
- nerves
- blood
- bones
- ligaments
**Example:**
- Ankle sprain
27
Descrribe the fllowing type of pain:
**Visceral Pain**
(AKA, Description, Location, Example)
**AKA:**
- Splanchic pain
**Description:**
- deep, dull, poorly localized (hard to pinpoint)
**Location:**
Body organs in:
- Thorax
- Cranium
- Abdomen
**Example:**
- Abdominal pain
28
Descrribe the fllowing type of pain:
**Referred Pain**
(Description, Location, Example)
**AKA:**
- X
**Description:**
- pain felt in different locations than its source
**Location:**
- Neck
- Shoulders
- Back
- Jaw (teeth too)
**Example:**
- Heart Attack
29
Describes the categorizagion of pain:
**Nociceptive Pain**
(Pain process, Damage or Inflammation, Examples)
**Pain Process:**
- Normal pain process
-> transduction
-> transmission
-> perception
-> modulation
**Damage or Inflammation:**
- actual or potential tissue dmg or inflammation
**Examples:**
- Somatic
- Visceral
30
Describes the categorizagion of pain:
**Neuropathic Pain**
(Pain process, Damage or Inflammation, Examples)
**Pain Process:**
- Abnormla pain process
-> dmg to or dysfunction to CNS and/or PNS
**Damage or Inflammation:**
- abscence of tissue dmg or inflammation
**Examples:**
- Nerve Pain
31
# Describe these quality of pain
1. Sharp
2. Dull
3. Diffuse
4. Shifting
**Sharp**
- severe/piercing
**Dull**
- more widespread than painful
**Diffuse**
- widespread pain (ex: entire abdomen)
**Shifting**
- pain travels from one place to another
32
When would the Wong-Baker scale be utilized?
- children over 3
- adults w/ cognitive/communication impairment
33
What is the FLACC Behavioral Scale? Who is it used one? What does it assess?
- tool used to assess pain in babies to toddlers (2 months - 7 years)
- Face (F)
- Legs (L)
- Activity (A)
- Cry (C)
- Consolability
34
What is the WHO Analgesic ladder?
- three-step analgesic ladder that outlines the appropriate progression of drugs and dosages to manage cancer-related pain effectively
35
According to the WHO Analgesic ladder, what medication would be given if the patient is experiencing mild pain?
**non-opioid analgesic (painkiller)**
- non-narcotics analgesics: Acetominnophen
- NSAIDS
36
According to the WHO Analgesic ladder, what medication would be given if the patient is experiencing moderate pain?
**non-opioid analgesics + opioids**
- opioids/narcotic analgesics:
-> morphine
-> codeine
-> oxycodone
-> meriperidine
-> hydromorphone
-> methadone
37
According to the WHO Analgesic ladder, what medication would be given if the patient is experiencing severe pain?
**non-opioid analgesics + opioids + adjuvants**
- Adjuvants:
-> anticonvulsants
-> antidepressants
- mulipurpose drug
38
Nurse Karen is assessing a Japanese patient. Karen notices that the patient is in obvious pain but he keeps claiming that he has no pain and that he wants to leave. What factor could be influencing his pain?
- Culture/Ethnic Variables
- expressing pain may be forwned upon
39
A patient recovering from surgery is surrounded by supportive family members who encourage them and help with daily tasks. The patient reports lower pain levels than expected. What factor could be helping reduce their pain experience?
- Environment/Support System
-> can reduce or increase discomfort.
40
A patient with chronic back pain is also dealing with job loss and family stress. Despite medication, the patient reports intense, unmanageable pain. What factor is liekly affecting this patient pain levels?
- Anxiety & Other Stressors
-> exacerbate pain and make it harder to control.
41
A patient who had a traumatic experience with unmanaged pain during a previous hospital stay now demands pain medication frequently and rates their pain high, even with mild symptoms. What factor could be inflluencing this response?
- Past pain experience
-> affects how present pain is experience and managed
42
Nurse Chloe is assessing an elderly man. Chloe keeps insisting that the patient is exaggerating pain to get narcotics. Chloe delays giving the patient any medication. What is Chloe assuming about their paitent?
- Chloe is assuming that the paitne is drug-seeking & lying
-> this ssumption leads to undertreatment especially in women, minorites and the elderly
43
A physician prescribes a lower dose of opioids than needed for a post-op patient, fearing they might become addicted. What stigma is infuencing the physisians decision?
- fear of addiction
-> lead to underdosing patient on opioids
44
A nurse documents that a patient "looks fine" and withholds pain meds despite their verbal reports of pain.
What stigma is influencing this action?
- Showing no emotion = no pain
-> this leads to pain meds bing withhelt and undertreatment
45
A provider dismisses a patient with long-standing fibromyalgia, stating, “They’re always asking for meds.” Which stigma is involved?
- the providier is assuming that chronic pain patient are drug seekers.
-> this leads to undertreatment
46
A care team insists on using only ice packs and guided imagery for a patient with post-surgical pain, even though the patient requests pain medication. What stigma is affecting care?
- the care team believes that pain should be a last resort
-> some nursing philosophies prioritize non-pharmaceutical treatements over actual reliefs
