6.1 Pain

Question 1

Pain

Answer 1

• Primary reason people seek healthcare
  Acute - Surgery, Trauma, Pain
  Chronic - Cancer, Back Pain

Question 2

Endocrine (Chronic Pain)

Answer 2

• Increases cortisol
• Increased epinephrine
• Increased diuretic hormone
• Decreased insulin
• Decreased testosterone

Question 3

Metabolic (Chronic Pain)

Answer 3

• Hyperglycemia

- Insulin Resistance

Question 4

CVD (Chronic Pain)

Answer 4

• Increased HR
• Increased workload
• Increased PVR (Pulmonary Vascular Resistance)

Question 5

Respiratory (Chronic Pain)

Answer 5

• Decreased Flow and Volume
• Atelectasis
• Decreased cough
• Infection

Question 6

Genitourinary (Chronic Pain)

Answer 6

• Decreased Urinary Output (UOP)
• Retention
• Fluid Overload

Question 7

GI (Chronic Pain)

Answer 7

• Decreased gastric and bowel motility

Question 8

Musculoskeletal (Chronic Pain)

Answer 8

• Spasm
• Fatigue
• Immobility

Question 9

Cognitive (Chronic Pain)

Answer 9

• Mental Confusion
• ## Reduction in Cognitive Function

Question 10

Immune (Chronic Pain)

Answer 10

• Depression of Immune Response

Question 11

Developmental (Chronic Pain)

Answer 11

• Increased behavioral and physiological responses of pain

Question 12

Future Pain (Chronic Pain)

Answer 12

• Affects the way you handle future pain

Chronic Pain Syndromes - Phantom Pain

Question 13

Quality of Life (Chronic Pain)

Answer 13

• Sleeplessness
• Anxiety
• Increased thoughts of suicide

Question 14

Influences of Pain

Answer 14

• Age, Sex, Gender, Race, Socioeconomic Status.

- Affects every body system

Question 15

Cancer Chronic Pain vs Non-Cancer Chronic Pain

Answer 15

• Breakthrough pain (Acute Exacerbations)

Question 16

Nociceptive Pain

Answer 16

• Tissue injury

- Normal Pain

Question 17

Neuropathic Pain

Answer 17

• Abnormal pain

- Pathologic and results from damage to CNS or PNS

Question 18

Processes of Nociceptive Pain

Answer 18

Transduction - Stimuli activates afferent neuroreceptors
Transmission - Action potential transmitted across nerve
Perception - Activation of brain for awareness
Modulation - Response to the stimuli

Question 19

Neuropathic Pain

Answer 19

• Mechanisms drive by damage to PNS or CNS
• Abnormal processing of stimuli
• May occur in absence of tissue damage and inflammation
• Phantom pain, diabetic neuropathy, shingles pain

Question 20

Pain Assessment

Answer 20

• Location
• Intensity
• Quality
• Onset
• Duration
• Aggravating/Relieving Factors
• Effects on quality of life
• Comfort and function goals

Question 21

Pain Assessments

Answer 21

• 1-10 scale
• Wong-Baker FACES scale for children
• Faces pain scale revised - Similar to Wong-Baker
• Verbal Descriptor Scale - (pain, mild pain, severe pain. Describe pain as a phrase)
• Visual Analog Scale (VAS) - (No pain to Worst Possible pain). Line with words across it.
• Hierarchy of pain measures - Non-Verbal Patients
• FLACC - Used for young children, look at facial expressions, leg movement, activity, crying

Question 22

Pain Assessments (cont)

Answer 22

• Pain AD - For Advanced Dementia

- CPOT - Critical Care Patient Observation Tool for ICU patients who are intubated and cannot talk

Question 23

Pharmacological Pain Management

Answer 23

• Opioids (inhibits nociceptive pain)
• NSAID’s (inhibit prostaglandins)
• Local Anesthetics (block nerve conduction at local level)

Question 24

Nonopioid Analgesic

Answer 24

Tylenol, Ibuprofen,

Question 25

Opioid Analgesics

Answer 25

- Morphine, Fentanyl, Oxycodone

Question 26

Adjuvant Analgesic

Answer 26

- Local anesthetics (lidocaine patch) - Anticonvulsants (Neurotin/gabapentin) - Antidepressants (Elavil/amitriptyline) - Ketamine (Dissociative Anesthetic)

Question 27

Physical Dependence

Answer 27

- Physical Dependence - Do not abruptly stop. Taper off - Abrupt stop will show signs of withdrawal

Question 28

Tolerance

Answer 28

- Needs higher dose to achieve same effect

Question 29

Addiction

Answer 29

- Chronic relapsing treatable neurological disease - Genetic/psychosocial/environmental factors lead to addiction - Compulsive use and craving for effects other than pain relief.

Question 30

Pseudo-Addiction

Answer 30

- Problem with patient not being treated correctly for pain relief - Often mistaked for drug seeking patients - Not accurately or adequately treated for pain relief

Question 31

Elderly and Medication

Answer 31

- Start low go slow - NSAID's can cause GI Issues especially in elderly - Sensitive to adjuvant analgesic's such as anti-depressants and anti-convulsant for chronic pain - Opioids should be reduced by 25-50% dose (70+)

Question 32

Non-Pharmacological Pain Relief

Answer 32

- Physical Therapy - Occupational Therapy - Hot/Cold - Proper Alignment

Question 33

Cognitive/Behavioral Pain Relief

Answer 33

- Relaxation - Breathing - Music - Humor - Pet therapy - Herbs - Medicine - Yoga

Question 34

Steps of Pain

Answer 34

- After injury, nerves send a signal to the spinal cord - Signal enters spinal cord via the dorsal root - Nociceptors release "Substance P" - Second order neuron receives information from substance P and sends information towards the brain - Travels to brain via spinothalamic tract (goes to thalamus) -

Question 35

Alpha Delta Receptors

Answer 35

- Myelinated and produce fast, well localized, sharp pain

Question 36

C-Fibers

Answer 36

- Unmyelinated and produce slow poorly localized pain | - Burning and Throbbing pain

Question 37

Nociceptors

Answer 37

- Afferent Fibers because they bring information into the brain