chapter 10 pain - week 1 Flashcards
what is pain
Pain is a complex experience with sensory-discriminative, motivational–affective, and cognitive–evaluative dimensions. For many people, it is a major problem that causes suffering and reduces quality of life. Pain is one
of the major reasons that people seek health care, and effective pain relief is a basic human right
What is the consequence of untreated pain or inadequate pain management?
Endocrine
↑ Adrenocorticotropic hormone (ACTH), ↑ cortisol, ↑ antidiuretic hormone (ADH), ↑ epinephrine, ↑ norepinephrine, ↑ growth hormone, ↑ renin, ↑ aldosterone levels; ↓ insulin, ↓ testosterone levels
Metabolic
Gluconeogenesis, glycogenolysis, hyperglycemia, glucose intolerance, insulin resistance, muscle protein catabolism, ↑ lipolysis
Cardiovascular
↑ Heart rate, ↑ cardiac output, ↑ peripheral vascular resistance, hypertension, ↑ myocardial oxygen consumption, ↑ coagulation
Respiratory
↓ Tidal volume, atelectasis, shunting, hypoxemia, ↓ cough, sputum retention, infection
Genitourinary
↓ Urinary output, urinary retention
Gasto-intestinal
↓ Gastric and bowel motility
Musculo-skeletal
Muscle spasm, impaired muscle function, fatigue, immobility
Neurological
↓ Cognitive function; mental confusion
Immunological
↓ Immune response
what is nursings role in pain management
Nurses have a central role in pain assessment and management. Components of the
nursing role include
a) assessing pain and documenting and communicating this information to other health care providers,
b) ensuring delivery of effective pain relief measures,
c) evaluating the effectiveness of these interventions,
d) monitoring ongoing effectiveness of pain management strategies, and
e) providing education to patients and their families regarding pain management approaches and possible adverse effects.
what Nocicpetive pain and the two different types
Definition- Processing of noxious stimuli by an intact nervous system; usually responsive to analgesics (e.g., opioids, NSAIDs) or physical modalities
Types
Somatic Pain
Arises from bone, joint, muscle, skin,
or connective tissue; usually aching or throbbing in quality and well localized
Visceral Pain
Arises from organs, such as the gastro-intestinal tract and bladder. Can be
further subdivided as follows:
* Tumor involvement of the organ
capsule that causes aching and fairly well-localized pain
* Obstruction of hollow organ that causes intermittent cramping and poorly localized pain
Neuropathic pain and the two different types
Abnormal processing of sensory input as a result of injury of the peripheral or central nervous system; treatment includes a variety of analgesics (e.g., antidepressants, opioids, antiseizure drugs)
Types
Centrally Generated Pain
* Deafferentation pain, caused by injury to either the peripheral or central nervous system (e.g., phantom pain may reflect injury to peripheral nerve)
* Sympathetically maintained pain, associated with dysregulation of the autonomic nervous system (e.g., reflex sympathetic dystrophy)
Peripherally Generated Pain
* Painful polyneuropathies, in which pain is felt along the
distribution of many peripheral nerves (e.g., diabetic neuropathy,
alcohol-nutritional neuropathy, Guillain-Barré syndrome)
* Painful mononeuropathies, usually associated with a known peripheral nerve injury and in which pain is felt at least partly along the distribution of the damaged nerve (e.g., nerve root compression,trigeminal neuralgia)
Acute pain
Onset
sudden
Duration
Usually within the normal time for healing
Severity
Mild to severe
Cause of Pain
In general, a precipitating illness or event (e.g., surgery) can be identified
Course of pain
↓ Over time and goes away as recovery occurs
Typical physical and behavioral manifestations
Manifestations reflect
sympathetic nervous system
activation:
* ↑ Heart rate
* ↑ Respiratory rate
* ↑ Blood pressure
* Diaphoresis, pallor
* Anxiety, agitation, confusion
NOTE: Responses normalize
quickly owing to adaptation
Usual goals of treatment
Pain control with eventual elimination
Persistant pain
onset
Sudden or gradual
duration
May start as acute injury but continues past the normal time for healing to occur
serverity
Mild to severe
cause of pain
May not be known; original cause of pain may differ from mechanisms that maintain the pain
course of pain
Typically, pain persists and may be ongoing, episodic, or both
typical physical and behvaioural manifestations
Predominantly behavioral manifestations:
* Changes in affect
* ↓ Physical movement and activity
* Fatigue
* Withdrawal from other people and social
interaction
goals
Minimizing pain to the extent possible; focusing on enhancing function and quality of life
breakthrough pain
Breakthrough pain is moderate to severe pain that occurs despite treatment. Many patients with cancer experience breakthrough pain. It is usually rapid in onset and brief in duration, with highly variable intensity and frequency of occurrence.
what are the various strategies for pian managemnet
- Routine assessment is essential for effective management.
- Unrelieved acute pain complicates recovery. Unrelieved pain after surgery or injury results in more complications, longer hospital stays, greater disability, and potentially long-term pain.
- Adverse effects of medications must be prevented or managed. Adverse effects are a major reason for treatment failure
- All therapies must be evaluated to ensure that they are meeting the patient’s goals. Therapy must be individualized for each patient, and, often, achieving an effective treatment plan requires trial and error.
- Patients’ self-report of pain should be used whenever possible. For patients unable to report pain, a nonverbal assessment method must be used.
- Health care providers have a responsibility to assess pain routinely, to accept patients’ pain reports and document them, and to intervene in order to manage pain.
- The best approach to pain management involvespatients, families, and health care providers. Patients and families must be informed of their right to the best pain care possible and encouraged to communicate the severity of their pain.
- Many patients—in particular, vulnerable populations; ethnic minorities including infants, children, and adolescents; older adults, adults, and children with limited ability to communicate; and patients with past or current substance use problems are at high risk for suboptimal or inappropriate pain management. Health care providers must understand that adequate pain relief is a basic human right, must be aware of their own biases and misinformation, and must ensure that all patients are treated respectfully.
*Patients with a history of opioid tolerance or addiction may have higher opioid requirements following a new episode of acute pain. Care should be taken that these patients do not experience withdrawal due to undermedication. - Treatment plans should involve a combination of pharmacological and nonpharmacological therapies.
- A multidimensional and interdisciplinary approach is necessary for optimal pain management; multiple perspectives, from all members of the interprofessional team, should be incorporated.
Pro and cons for NSAID drugs
pros
Inhibit the chemical that activate the PAN, thus transduced less often or a larger stimulus is needed to produce transduction
Possess analgesic efficacy
cons
Higher risk for cardiovascular events like myocardial infarction, stroke, and heart failure (except Aspirin)
Pt who had heart surgery should not take
pros and cons for opiods for pain managment
pros
opioid medications travel through your blood and attach to opioid receptors in your brain cells, the cells release signals that muffle your perception of pain and boost your feelings of pleasure
cons
May cause respiratory distress
Methadone (may)causes:
Respiratory depression
Incrased dose = cardiac toxicity
Transdermal fentanyl is not for management of acute pain
Adverse Effect: Constipation
Sedation
Itching- administered via intraspinal routes
Cognitive impairment
5 considerations of pain
**Special Populations **
**Cognitively Impaired individuals **
Pain Assessment
Behavioural Indicators:
* Vocalization: moaning, grunting, crying, sighing
* Facial expressions: grimacing, wincing, frowning,
clenching teeth
* Breathing: noisy, laboured
* Body movements: restlessness, rocking, pacing
* Body tension: clenching fist, resisting movement
* Consolability: inability to be consoled or distracted
Patients with Substance Use Problems
Screening Tool:
Detailed hx
Physical Examination
Psychosocial Assessment
Diagnostic Workup
Goal: to make it easier to create a treatment plan that will help relieve or limit withdrawal
Older Adults
Most common source of Pain
Musculoskeletal Conditions:
Osteoarthritis
Low back pain
Previous fracture sites
analgesics
Analgesics are medications that relieve pain
analesic ceiling
the dose beyond which there is no additional analgesic effect
breakthrough pain
is moderate to severe pain that occurs despite treatment. Many patients with cancer experience breakthrough pain.
