Ch. 11 (Pain Assessment) Flashcards
What is a highly complex and subjective experience that originates from the central or peripheral nervous system or both and is developed by nociceptive and neuropathic processing?
pain
What specialized nerve ending are designed to detect painful sensations from the periphery and transmit them to the central nervous system (CNS) via A and C fibers?
nociceptors
How can nociceptors be stimulated?
- directly by mechanical trauma
- directly by thermal trauma
- secondarily by chemical mediators (released from the site of tissue damage)
What are two ways pain can develop?
- nociceptive processing
- neuropathic processing
What type of pain develops when functioning and intact nerve fibers in the peripheral and central nervous systems are stimulated?
nociceptive pain
Where does nociceptive pain start?
outside the nervous system from actual or potential tissue damage
What are the four phases of nociception (nociceptive pain process)?
- transduction
- transmission (spinal cord -> brain)
- perception
- modulation
What type of pain is typically predictable and time limited based on the extent of the injury?
nociceptive pain
What type of pain does not adhere to typical and predictable phases and is due to a lesion or disease in the somatosensory system?
neuropathic pain
Neuropathic pain implies what?
abnormal processing of the pain message (an injury of the nerve fiber)
Fill in the blank:
Neuropathic pain is sustained on a ____ level.
neurochemical
What type of pain is very difficult to assess and treat because it is perceived long after the site of injury heals and thus turns into a chronic condition?
neuropathic pain
What kind of pain can change into another type of pain over time when pain has been poorly controlled?
- nociceptive pain
- neuropathic pain
Why does nociceptive pain become neuropathic pain when left untreated?
constant irritation and inflammation caused by a pain stimulus, which alters nerve cells, making them more sensitive to any future stimulus
What are different types of nociceptive pain?
- visceral pain
- somatic (deep & superficial) pain
What type of pain originates from larger internal organs?
visceral pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their stomach, what would their pain be classified as?
visceral pain
Physical pain sources are based on their origin?
If a patient is experiencing acute appendicitis, what would their pain be classified as?
visceral pain
Physical pain sources are based on their origin?
If a patient is experiencing ulcer pain, what would their pain be classified as?
visceral pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their intestines, what would their pain be classified as?
visceral pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their gallbladder, what would their pain be classified as?
visceral pain
Physical pain sources are based on their origin?
If patient is experiencing pain in their pancreas, what would their pain be classified as?
visceral pain
What type of pain originates from musculoskeletal tissues or the body surface?
somatic pain
What are two ways somatic pain can be described as?
- superficial
- deep
Physical pain sources are based on their origin?
If a patient is experiencing pain on their musculoskeleton, what would their pain be classified as?
somatic pain
What type of pain originates from sources such as blood vessels, joints, tendons, muscles, and bone?
deep somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their blood vessels, what would their pain be classified as?
deep somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their joints, what would their pain be classified as?
deep somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their tendons, what would their pain be classified as?
deep somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their muscles, what would their pain be classified as?
deep somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their bones, what would their pain be classified as?
deep somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing arthritis pain, what would their pain be classified as?
deep somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing radiating pain from a bone fracture, what would their pain be classified as?
deep somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing radiating pain from a tendon tear, what would their pain be classified as?
deep somatic pain
What type of pain occurs from the skin and subcutaneous tissues?
cutaneous/superficial somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing pain on their skin, what would their pain be classified as?
cutaneous/superifical somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their subcutaneous tissues, what would their pain be classified as?
cutaneous/superficial somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing pain on their skin from a sunburn, what would their pain be classified as?
cutaneous/superficial somatic pain
Physical pain sources are based on their origin?
If a patient is experiencing pain on their skin from a paper cut, what would their pain be classified as?
cutaneous/superficial somatic pain
What type of pain occurs when pain you feel in one part of your body is actually caused by pain or injury in another part of your body?
referred pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their lower back but originates from their injured pancreas, what would their pain be classified as?
referred pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their jaw but just had a heart attack, what would their pain be classified as?
referred pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their upper thigh from a foot that has been amputated, what would their pain be classified as?
referred pain
Physical pain sources are based on their origin?
If a patient is experiencing pain in their head after eating ice cream, what would their pain be classified as?
referred pain
the pain stimulus is happening in the patient’s mouth/throat
vagus nerve is stimulated and pain is felt in brain/head
Pain can also be classified by its duration.
What type of pain is short-term and self-limiting, often following a predictable track and dissipating after the injury heals?
acute pain
Pain can also be classified by its duration.
What type of pain continues for six months or longer and results from abnormal processing by pain fibers from peripheral or central sites and does not stop when the injury heals?
chronic (persistent) pain
Pain can also be classified by its duration.
What type of pain is described as a transient spike in pain level in an otherwise controlled pain syndrome or as the result of incident or episodic pain?
breakthrough pain
True or false?:
Preterm infants lack inhibitory neurotransmitters and are more sensitive to painful stimuli.
true
Pain is common in older adults.
But, is pain normal during the process of aging?
no
What are the two main symptoms of opioids?
- pain relief
- euphoria
What are the two most common side effects of opioids?
- respiratory depression
- constipation
What is the most reliable indicator of pain?
subjective report
What may a patient do if they are experiencing chronic pain?
- subconsciously rub the affected area (as a means of achieving pain relief)
- cranky/depression
What may a patient do if they are experiencing acute pain?
- diaphoresis (excessive sweating due to sec. condition)
- facial grimacing
- tenseness/guarded
- rigidity (resistance in range of motion)
What position do patients with chronic pulmonary conditions tend to lean into to help aid in exhalation?
the tripod position
leans forward with arms braced on the arms of the chair
What position do patients with congestive heart failure tend to lean into to help aid in respiration?
sits upright in a chair and will resist lying down
lying down may worsen the shortness of breath
What type of fibers transmit rapidly to the CNS; localized, short term, sharp pain?
A fibers
What type of fibers transmit pain more slowly to CNS; diffuse, aching, persistent?
C fibers
Does neuropathic pain go through the same four phases nociceptive pain goes through?
no, does not even have four phases
What type of pain describes a patient who has been on pain medicine but suddenly experiences pain again?
breakthrough pain