CH 10 Pain Flashcards
How does pain function as a protective mechanism?
It alerts the body to injury and prevents further damage.
What is the International Association for the Study of Pain (IASP) definition of pain?
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
What is Margo McCaffery’s definition of pain?
“Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does.”
What is the gold standard for pain assessment?
The patient’s self-report of pain.
What are the two main types of pain?
Acute pain and chronic pain.
How long does acute pain typically last?
Less than 3 months, but up to 6 months in some cases.
What is a key characteristic of acute pain?
It prompts an inflammatory response and has short-term physical symptoms (e.g., increased heart rate, elevated blood pressure).
Give an example of acute pain.
A broken bone.
How long does chronic pain last?
More than 6 months, persisting beyond the usual healing time.
What is a key challenge of chronic pain?
Patients may not always appear to be in pain.
What conditions are commonly associated with chronic pain?
Arthritis, fibromyalgia, and nerve damage.
How does chronic pain affect mental health?
It can increase the risk of depression, anxiety, and behavioral changes.
What is suffering in relation to pain?
Continuous distress that occurs when pain is untreated or persists beyond expected healing time.
How can spirituality help with pain management?
Prayer, meditation, self-reflection, and social connections can provide comfort.
What are the four physiological processes of pain?
Transduction, transmission, perception, and modulation.
What happens during transduction?
A painful stimulus converts to an electrical impulse at the site of injury.
What neurotransmitters are released during transduction?
Prostaglandins, bradykinin, serotonin, and substance P.
What is the role of transmission in pain processing?
The pain signal travels from peripheral nerves to the spinal cord and brain.
Where is pain perceived in the brain?
The cerebral cortex and hypothalamus.
What is modulation?
The body’s attempt to interrupt pain impulses by releasing endorphins like enkephalins.
What are the two main types of nociceptive pain?
Somatic pain and visceral pain.
How is somatic pain described?
Localized, throbbing, and aching.
Give an example of somatic pain.
Bone pain from metastatic cancer.
How is visceral pain described?
Cramping and poorly localized.
Give an example of visceral pain.
Pain from a bowel obstruction.
What is neuropathic pain?
Pain caused by damage to the peripheral or central nervous system.
How is neuropathic pain described?
Burning, tingling, shooting, or electric-like pain.
Give an example of neuropathic pain.
Diabetic neuropathy or phantom limb pain.
What is referred pain?
Pain that is felt in a different location than its actual source.
Give an example of referred pain.
Back and flank pain caused by a bladder infection.
What does the “WHAT’S UP?” mnemonic stand for in pain assessment?
Where? How? Aggravating/alleviating factors? Timing? Severity? Useful data? Patient perception.
What pain scales are commonly used?
Numeric Pain Scale, Faces Pain Scale (Revised), and PAINAD for dementia patients.
What are some nonverbal indicators of pain?
Grimacing, guarding, increased heart rate, shallow breathing, dilated pupils, and muscle tension.
How can cultural beliefs affect pain expression?
Some cultures are stoic, while others are more expressive.
What are the three main types of analgesics?
Opioids, non-opioids, and adjuvant medications.
What are examples of non-opioid analgesics?
Acetaminophen, aspirin, and NSAIDs like ibuprofen.
What is the ceiling effect in non-opioid analgesics?
A point where increasing the dose does not improve pain relief but increases side effects.
What is the maximum safe daily dose of acetaminophen?
4 grams (4000 mg).
How do NSAIDs work?
They block prostaglandin synthesis, reducing pain and inflammation.
What are risks of long-term NSAID use?
Gastrointestinal bleeding and kidney damage.
What is the first-line opioid for severe pain?
Morphine.
Name other opioid analgesics.
Codeine, fentanyl, hydromorphone, oxycodone, tramadol.
How do opioids work?
They bind to opioid receptors in the brain and spinal cord to inhibit pain perception.
What are common side effects of opioids?
Respiratory depression, constipation, nausea, confusion, and fatigue.
What is an opioid antagonist, and what is its function?
Naloxone (Narcan), which reverses opioid effects such as respiratory depression.
What are adjuvant medications?
Drugs not originally developed for pain but can help manage it.
Give examples of adjuvant analgesics.
Corticosteroids, benzodiazepines, antidepressants, anticonvulsants.
What is the WHO pain ladder?
A stepwise approach to pain management starting with non-opioids and progressing to stronger opioids.
What is patient-controlled analgesia (PCA)?
A device that allows patients to self-administer opioids with preset safety limits.
What is the most important PCA safety rule?
Only the patient should press the button—not family or nurses.
What are non-pharmacologic pain management techniques?
Education, relaxation, guided imagery, distraction, biofeedback.
What are physical agent interventions for pain?
Heat, cold, massage, exercise, immobilization, TENS therapy.
What is pseudoaddiction?
Drug-seeking behavior caused by inadequate pain control, which stops when pain is properly treated.
What is the difference between tolerance, dependence, and addiction?
Tolerance: Needing a higher dose for the same effect. Dependence: Physical withdrawal symptoms if stopped. Addiction: Compulsive drug use despite harm.
What are risks of uncontrolled pain?
Tissue breakdown, stress response, impaired immune function, and emotional distress.
What is the primary reason patients seek medical care?
Pain.
What is the key characteristic of pain?
It is a personal and subjective experience.
What are the four dimensions of pain?
Physical, emotional, social, and spiritual.
How does pain affect a person emotionally?
It can lead to anxiety, depression, and frustration.
What is the purpose of pain?
It serves as a warning mechanism to protect the body from harm.
Why is pain sometimes undertreated?
Due to misconceptions, fear of addiction, and inadequate assessment.
What is breakthrough pain?
A temporary flare-up of pain despite ongoing pain management.
What is incident pain?
Pain that occurs with movement or specific activities.
What is the most reliable indicator of pain?
The patient’s self-report.
Why might older adults underreport pain?
Fear of addiction, belief that pain is a normal part of aging, or cognitive impairment.
What is the best way to assess pain in a nonverbal patient?
Observing facial expressions, body movements, and vital signs.
What are common barriers to pain management?
Fear of addiction, inadequate provider knowledge, and cultural differences.
How can nurses advocate for better pain management?
By educating patients, using appropriate pain scales, and ensuring timely medication administration.
What is the first step in pain transmission?
Transduction, where a noxious stimulus is converted to an electrical impulse.
What is the function of prostaglandins in pain?
They increase sensitivity to pain and promote inflammation.
Where does pain transmission occur?
From the peripheral nerves to the spinal cord and then to the brain.
What part of the brain perceives pain?
The cerebral cortex.
How does modulation help control pain?
The body releases endorphins to reduce pain perception.
What are two types of nociceptive pain?
Somatic pain and visceral pain.
How is somatic pain treated?
With NSAIDs or opioids, depending on severity.
What is an example of visceral pain?
Menstrual cramps or pain from a bowel obstruction.
What causes neuropathic pain?
Nerve damage from conditions like diabetes, shingles, or chemotherapy.
What is allodynia?
Pain from a normally non-painful stimulus (e.g., light touch).
What is the most common tool for pain assessment?
The Numeric Pain Rating Scale (0-10).
What scale is used for children or nonverbal patients?
The FACES Pain Scale.
What pain scale is used for dementia patients?
The PAINAD scale (Pain Assessment in Advanced Dementia).
What is a level of sedation scale used for?
Monitoring opioid effects and preventing over-sedation.
What nonverbal cues might indicate pain?
Grimacing, guarding, restlessness, increased heart rate, or shallow breathing.
How can culture influence pain expression?
Some cultures encourage stoicism, while others expect expressive behavior.
What ethical principle supports treating all patients’ pain equally?
Justice.
What is the role of The Joint Commission in pain management?
It reviews hospital policies on pain assessment and management.
What are three main classes of pain medications?
Opioids, non-opioids, and adjuvant analgesics.
What is the primary treatment for mild pain?
Non-opioid analgesics such as NSAIDs or acetaminophen.
What is the risk of exceeding 4g/day of acetaminophen?
Liver toxicity.
What is a major side effect of NSAIDs?
Gastrointestinal bleeding.
What type of pain is best treated with opioids?
Moderate to severe pain.
What is the most commonly used opioid for severe pain?
Morphine.
Why should opioids be used cautiously in older adults?
They are more sensitive to side effects such as sedation and respiratory depression.
What opioid side effect is most dangerous?
Respiratory depression.
What should always be prescribed with opioids?
A bowel regimen to prevent constipation.
What is the function of naloxone (Narcan)?
It reverses opioid overdose.
What are adjuvant analgesics?
Medications not initially developed for pain but can enhance pain relief.
What are examples of adjuvant medications?
Antidepressants, anticonvulsants, corticosteroids, benzodiazepines.
What type of pain is commonly treated with antidepressants?
Neuropathic pain.
What is multimodal analgesia?
Combining multiple pain relief strategies for better management.
What are non-pharmacologic pain management techniques?
Heat, cold, massage, guided imagery, distraction, and relaxation techniques.
How does cold therapy help pain?
It reduces inflammation and numbs the area.
What is transcutaneous electrical nerve stimulation (TENS)?
A therapy that uses electrical impulses to reduce pain.
What is PCA (patient-controlled analgesia)?
A system that allows patients to self-administer opioids with preset limits.
What is the most important PCA safety rule?
Only the patient should push the button.
How does scheduling pain medication help chronic pain patients?
Prevents pain from becoming severe and harder to control.
Why should opioids be tapered instead of stopped abruptly?
To prevent withdrawal symptoms.
What is pseudoaddiction?
Drug-seeking behavior caused by inadequate pain control.
What is an opioid-tolerant patient?
A patient who requires higher doses for pain relief due to long-term opioid use.
Why is it important to educate patients about pain management?
To promote safe medication use and adherence to treatment plans.
