Ch. 34 Comfort & Pain Flashcards
How are nociceptors activated?
1 Histamines released. 2 Lactic acid accumulates in injured tissues
What substances also stimulate nociceptors?
Bradykinin, Prostaglandins, & Substance P
Bradykinin stars working on injured area before brain responds by
Vasodilator, > capillary permeability + constricts smooth muscle. Releases histamine=starts inflammation
Prostaglandins
Send additional pain stimuli to brain
Substance P
sensitizes receptors on nerves to feel pain and > firing rate
Serotonin
stimulates smooth muscles, inhibits gastric secretion, & produces vasoconstriction
Prostaglindins, Substance P, & Serotonin are
Neurotransmitters
Transduction
The conversion of painful stimuli into electrical impulses that travel from the periphery to the spinal cord at the dorsal horn
Transmission
The pathway the stimulus takes to higher brain sensory centers
The two afferent pain receptor fibers
A-delta- fibers & C- fibers
Difference btn 2 pain receptor fibers
A- 𝛿 fibers are fast-conducting & transmit acute, localized pain (reflex). C-fibers convey diffuse, visceral pain that’s “burning/aching”
Pain threshold
When a pain is percieved
Modulation
pain is inhibited
Neuromodulators
Naturally present opioid compounds (morphine like chemical compounds)
Name 2 opioid neuromodulators
Endorphins, enkephalins
Endorphins
Analgesic + euphoria
Which endorphin has the most potent analgesic effect?
Dynorphin
Enkephalins
Less potent than endorphins. Reduces pain sensation by inhibiting the release of substance P from the terminals of the afferent neurons
Gate Control Theory
Only a limited amount of sensory information can be perceived at any moment
Remission
Disease is present but no pain rn
Exacerbation
symptoms reappear
Cutaneous pain
skin or subcutaneous tissue pain
Somatic pain
deep tissue pain
Visceral pain
Poorly localized
Gaurding
Reflexive action to prevent trauma to the underlying structures. Tenses their abdomen
Reffered Pain
Pain in area distant from actual injury
Neuropathic Pain
Disease affecting PNS or CNS
Allodynia
Pain that occurs after a weak or nonpainful stimului
Intractable
When pain is resistant to therapy and persists depsite interventions
Psychogenic pain
A physical cause for the pain cannot be IDed
Complex Regional Pain Syndrome
Partially injured peripheral nerve. Burning, severe, diffuse, & persistent & elicited by minimal movement. Continues after stimulation ceases
Posttherpetic neuralgia
Follows an acute CNS infection like herpes zoster (shingles)
Trigeminal Pain
paroxysms of lightening-like stabs of intense pain in trigeminal nerve
Patient- Controlled Analgesia system
infusion pump w prefilled prescribed opioid analgesic
Medication on Demand (MOD)
Device is an oral PCA device attached to an IV pole and requires the patient to wear a wristband that allows a drawer to open on the IV (locks out intervals)
Continuous Subcutaneous Infusion
Opioid consistently administered (hospice + palliative care)
When is epidural pain management contraindicated?
No informed consent, takes anticoagulants, infection, allergic to opioids or local anesthetics, history of NSAID
