31 Pain, comfort, and sleep Flashcards
Gate control theory
Pain transmission is viewed as being controlled by a gate mechanism in the CNS. Opening the gate allows the transmission of pain sensation, and closing the gate blocks the transmission
Endorphins
endogenous, naturally occurring, opiate-like peptides that reduce or block the perception of pain; comes from the words morphine and endogenous
Nociceptive pain; found where; examples
involves injury to the tissue where nociceptors are located; found in skin, joints, or organ viscera; trauma, burns, surgery
Nociceptive pain involves four phases
transduction, transmission, perception, modulation
Transduction phase
begins when tissue damage causes the release of substances that stimulate the nociceptors and start the sensation of pain
Transmission phase
involves movement of the pain sensation to the spinal cord
Perception phase
occurs when pain impulses reach the brain and the pain is recognized
Modulation phase
occurs when the neurons in the brain send signals back down the spinal cord by release of neurotransmitters
Neuropathic pain
usually associated with a dysfunction of the nervous system- specifically, an abnormality in processing sensations
Examples of neuropathic pain
pain receptors in the body become sensitive to stimuli and send pain signals more easily. Nerve endings grow additional branches that send stronger pain signals to the brain. As branches grow they influence touch and warmth receptors, these receptors began to send pain signals. In some cases (DM, Guillanin- Barre syndrome, MS, cancer, HIV, and nutritional deficiencies) the pain signal that normally moves from the periphery toward the brain reverses and is sent in the opposite direction
Type of pain pt is experiencing will help determine what
best method to relieve pain
Standards relative to direct pt care state:
-pt has right to appropriate assessment and management of pain
-pain is assessed in all pt’s
-pt’s are educated about pain and managing pain as part of treatment, as appropriate
-discharge process provides for containing pain care based on the pt’s assessed needs at the time of discharge
How treatment differs per type of pain (acute and chronic)
-acute pain is usually well controlled with analgesics or surgery
-chronic pain is usually treated with pharmacologic and nonpharmacologic treatments
cause of acute pain is often easily _____
determined
acute pain may be accompanied by an increase in what
increased: heart rate, bp, rr
acute pain relieved by
rest of affected part, medications for infections and inflammations
What’s the issue with taking pain medications before seeing the dr
can mask symptoms that the dr needs to observe to establish a diagnosis
Acute pain is often a warning of this; what does it allow
potential or true tissue damage; allows pt to withdraw from the source or to seek help in relieving symptoms
How is pain transmitted
to the brain through the nervous system- afferent (sensory) neurons leading to the spinal nerves and then to the brain
Gate theory: how do the small and large diameter nerve fibers differ
-gate may be opened by activity in the small-diameter from things like tissue damage.
-large-diameter nerve fibers such as massage or vibration seem to close the gate
What’s a possible reason people who are bored and lonely seem to have more intense pain than when they are occupied or distracted by visitors or an interesting program or activity
brainstem impulses caused by a high sensory input seem to close the gate, where a lack of this input allows the gate to open
Chronic pain maybe expresses as this type of pain ___; and be treated with _____ and _____ interventions
-dull, constant, shooting, tingling, or burning
-both pharmacologic and nonpharmacologic interventions
5 types of pain
acute
nociceptive
chronic
phantom
neuropathic
Treatment of nociceptive pain may be directed towards-
one or all four phases