2M RLE Flashcards
are sensory receptors that detect signals from the damaged tissue.
Nociceptors or Pain receptors
sensitive to intense mechanical stimulation. Example: pliers pinching skin
Mechanosensitive nociceptors
sensitive to extreme heat and cold
Thermosensitive nociceptors
sensitive to noxious stimuli of mechanical, thermal, or chemical nature.
Polymodal nociceptors
THREE TYPES of nociceptors
Mechanosensitive nociceptors
Thermosensitive nociceptors
Polymodal nociceptors
Physiologic processes involved in pain
transduction, transmission,
perception, and modulation
mechanical, thermal, or chemical stimulus results in tissue injury or damage stimulating the nociceptors.
TRANSDUCTION
Noxious stimuli initiate a painful stimulus that results in an inflammatory process leading to the release of cytokines and neuropeptides from circulating leukocytes, platelets, vascular endothelial cells, immune cells, and cells from within the peripheral nervous system.
TRANSDUCTION
initiated by this inflammatory process, resulting in the conduction of an impulse in the primary afferent neurons to the dorsal horn of the spinal cord.
TRANSMISSION
neurotransmitters are released and concentrated in the substantia gelatinosa and bind to specific receptors.
TRANSMISSION
emotional status affects directly the level of pain perceived and thus, reported by clients.
PERCEPTION
The hypothalamus and limbic system are responsible for the rational interpretation and response to pain.
PERCEPTION
changes or inhibits the pain message relay in the spinal cord. The descending modular pain pathways either increase or inhibit pain transmission.
MODULATION
unpleasant sensory and emotional experience associated with actual and potential tissue damage, or as explained in terms of such damage or both
Pain
Classifications of pain
CAUSE
DURATION AND ETIOLOGY
LOCATION
CAUSE
Nociceptive pain
Neuropathic pain
Inflammatory pain
a kind of pain brought on by physical tissue injury. It’s a typical sign of an external injury. It is frequently described as a sharp, achy, or sharp discomfort
Ex. stubbing your toe, hitting your elbow, you trip and twisting your ankle, or you scratch up your knee.
Nociceptive pain
is a condition that develops when the neurological system is damaged or dysfunctional as a result of illness or injury. Usually, the pain is described as having a pins-and-needles sensation or as feeling like it burning, shooting, or stabbing.
Ex. diabetes, amputation, stroke
Neuropathic pain
such as migraine, rheumatoid arthritis, fibromyalgia, and back and shoulder pain. Inflammatory pain can intensify the pain experience.
Ex. Heat, Swelling, Tenderness, skin rash
Inflammatory pain
lasts less than 30 days. Anytime the underlying cause is identified and treated, it disappears on its own. When not properly managed, it can affect not just the immune system but also sleep, emotions, oxygen levels, and healing.
Ex. broke bones, childbirth, burns, and cuts
Acute pain
is more time-consuming in comparison to acute pain Persistent nonmalignant pain is pain brought on by an illness or an injury that lasts longer than intended, 3 to 6 months or longer. With the passage of time, the situation frequently worsens and becomes very risky.
Ex. Joint pain, Tumor
Chronic nonmalignant pain
DURATION AND ETIOLOGY
Acute pain
Chronic nonmalignant pain
Cancer pain
Intractable pain
LOCATION
Visceral pain
Cutaneous pain
Deep somatic pain
This tool assesses the patient’s Pain using a 0-10 numerical scale, with the numbers indicating the severity of the pain. Zero represents no pain, 4-6 represents moderate symptoms of discomfort, and 10 represents the greatest possible discomfort/pain. These assessments and ratings are subsequently documented in the hospital’s electronic health record (EHR) or electronic medical record (EMR), which assists in tracking the patient’s pain over time.
Numeric Pain Assessment Tool
Both adults and children can this to measure their pain. These rating scales feature descriptions/adjectives that are simple to understand and vary based on the level of discomfort. The descriptions in different sorts are presented below, ranging from no discomfort to the greatest possible pain.
Verbal Descriptor Or Verbal rating scales
The scale displays a sequence of expressions ranging from a joyful smile at 0, or “no hurt”, to a sobbing face at 10, which indicates “hurts like the worst pain ever”. The patient selects the face that best matches their level of discomfort based on the faces and written explanations.
Wong-Baker Faces
This pain scale was designed originally for children. It can, however, be used on all patients aged 3 and up. It is effective for children since they may not comprehend evaluating their pain on a scale of 0-10, but are able to understand the cartoon faces and the emotions they represent and point to the one that “best reflects their severity of pain”.
Wong-Baker Faces
is a measurement tool that is commonly used in pain scale surveys to assess the severity of a patient’s discomfort. A measurement instrument is used to try and measure something that is thought to range across a range of values and cannot be directly measured. It is commonly used to measure the intensity or frequency of various symptoms, such as pain, which can range anywhere from none to extreme pain.
Visual Analog Scale
a behavioral pain assessment scale used for nonverbal or preverbal patients who are unable to self-report their level of pain. Scores are assigned after assessing Facial expression, Leg movement, Activity, Crying, and Consolability
FLACC
FLACC
Facial expression
Leg movement
Activity
Crying
Consolability
Infants and children aged 2 months to 18 years. Target populations include children with mild to severe cognitive impairments, developmental delay, and cerebral palsy.
FLACC
indicated for use in adults with advanced dementia who are not able to verbalize their needs. Patterned after the FLACC,
Pain Assessment IN Advanced Dementia (PAINAD)
Indicated for use in patients in critical care units who cannot self-report pain, may or may not be intubated. It is also patterned after the FLACC.
Critical Care Pain Observation (CCPO)
can be used to guide healthcare professionals through an initial assessment of patient pain. This tool includes diagrams of the human body to help patients locate the pain they experience as well as questions to prompt the patient to describe the intensity, quality, causes, effects, and contributing factors of the pain.
McCaffrey Initial Pain Assessment Tool
COLDSPA
Character
Onset
Location
Duration
Severity
Pattern
Associated Factors
management of pain without the use of medication.
Non-pharmacological pain management
frequently caused by compression of the meninges or peripheral nerves, or by damage to these tissues as a result of surgery, chemotherapy, radiation, or the development and invasion of tumors.
Ex. , numbness, tingling in hands and feet, burning sensation
Cancer pain
is pain that cannot be managed with traditional medical care. The definition of this is “difficult to treat or the aim of treatment is to make you more comfortable and feel improved because this kind of pain isn’t treatable. If you experience persistent pain, it’s so bad that you might need to be hospitalized or forced to remain in bed.
Ex. migraine headaches, muscular dystrophy
Intractable pain
When stimuli trigger pain receptors in our inside organs, we experience visceral discomfort in organs or tissues, such as the chest, abdomen, and skull.
Ex. Menstrual cramps, irritable bowel syndrome
Visceral pain
occurs when stimuli in the body cause discomfort in subcutaneous tissue or skin.
Ex. stinging, burning in minor wounds or cuts
Cutaneous pain
occurs when stimuli in the body cause discomfort in bodily parts such as blood arteries, nerves, bones, ligaments, and tendons.
Ex. arthritis pain, fractures, or when you bump your knee, you just feel pain in that particular knee.
Deep somatic pain
Non-Pharmacologic Measures
Guided Imagery
Music Therapy
Relaxation
otherwise known as visualization, is a relaxation technique that seeks to reduce levels of stress hormones such as cortisol in the body. It is a mind-body technique that helps enhance physical health and overall wellness with the use of guided thoughts and images.
Guided imagery
an evidence-based therapeutic approach that utilizes the naturally mood-lifting properties of music to alleviate stress and help individuals uplift their mental and overall well-being.
Music Therapy
therapeutic exercises geared towards helping individuals relieve stress by decreasing tension and anxiety, both physically and psychologically. In the healthcare setting, such techniques are used as complementary therapies to treat patients experiencing various types of distress such as pain, stress, anxiety, and depression.
Relaxation
Refers to the process of rubbing and kneading parts of the body to relieve muscle tension and alleviate pain. This process promotes blood and lymphatic circulation and decreases inflammation.
Massage
cost-effective approach to pain relief with the application of either Hot or cold compress onto the affected area. Active warming is recommended for pain associated with mild trauma, cystitis, urolithiasis, cholelithiasis, appendicitis, colitis, and rectal trauma, while cold treatment can increase pain threshold, decrease edema, and suppress the inflammatory process.
Gel packs (Hot or Cold treatment)
Inserting a needle in a specific area of the body to stimulate the nerves. The micro-injuries in the stimulated area promote the immune system to increase circulation, thereby reducing pain.
Acupuncture
Refers to the delivery of low-voltage electrical impulses using an electrical device positioned over the painful area to stimulate the myelinated nerve fibers.
Transcutaneous Electrical Nerve Stimulation
An approach to pain management that targets cognitive responses and
maladaptive behavior to modify perceptions of pain.
Cognitive Behavioral Therapy
LOTTAARP
location, onset, timing, type, associated symptoms, alleviating factors, radiation, precipitating event
pain that affects the bone
deep somatic
directs the attention away from the pain
distraction
too much acetaminophen (used to treat mild-moderate pain) damaged liver
hepatotoxicity
opioid analgesic
ex. morphine
