Chapter 43: Pain Management Flashcards
Pain is a purely subjective ________ and _________ experience.
physical
psychosocial
Misconceptions about pain often result in ______ about the degree of the patient’s suffering and unwillingness to provide relief.
doubt
Knowledge of the _________ pain processes of the pain experience—transmission, transduction, perception, and modulation—provides guidelines for selecting pain-relief measures.
nociceptive
An interaction of psychological and cognitive factors affects pain __________.
perception
What are the four nociceptive pain processes of the pain experience? What does this provide guidelines for?
transmission, transduction, perception, and modulation
selecting pain relief measures
A person’s _______ background influences the meaning of pain and how it is expressed.
cultural
It is ___________ for older patients not to report pain.
common
Patients who are in ________ pain are unlikely to show behavioral changes.
chronic
The difference between acute and chronic pain involves the concept of ______. Acute pain is protective, thus preventing the harm; chronic pain is no longer protective.
harm
_______ pain is protective, thus preventing harm.
_______ pain is not protective.
Acute
Chronic
Do not collect an in-depth pain ________ when the patient is experiencing severe discomfort.
history
Pain causes physical signs and symptoms similar to those of other ________.
diseases
Individualize pain interventions by collaborating closely with the ________, using assessment findings, and trying a variety of interventions.
patient
Eliminating sources of painful _______ is a basic nursing measure for promoting _______.
stimuli
comfort
Using a regular schedule ________ for analgesic administration is more effective than an _________ schedule in pain control.
Around The Clock ATC
as needed PRN
________ is an adverse effect of opioids that always precedes respiratory depression (which is rare).
Sedation
A ________ device gives patients pain control with low risk of overdose.
Patient Controlled Analgesia PCA
While caring for a patient who receives local anesthesia, protect him or her from ______.
injury
Nursing implications for administering epidural analgesia include preventing _______ and monitoring closely for __________.
infection
respiratory depression
________ rarely occurs in patients who take opioids to relieve pain.
Addiction
The goal of _______ is to anticipate and prevent pain rather than treat it.
pain management
Pain ________ includes measuring the changing character of pain, the patient’s response to interventions, and the patient’s perceptions of the effectiveness of a therapy.
evaluation
According to the American Bar Association, _________ is a basic right of people who are seriously ill. Nurses are legally and ethically responsible for managing pain and relieving suffering.
pain management
Pain uses a person’s ______. It interferes with personal relationships and influences the meaning of life. You cannot measure it objectively. Only the patient knows whether pain is present and how the experience feels. It is not the responsibility of patients to prove that they are in pain; it is a nurse’s responsibility to ______ their report
energy
accept
Thermal, chemical, or mechanical stimuli usually cause _______.
pain
__________ converts energy produced by painful stimuli into electrical energy This begins in the periphery when a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an ____________.
Transduction
action potential
Once transduction is complete, ________ of the pain impulse begins. These pain-sensitizing substances surround the pain fibers in the extracellular fluid, creating an “inflammatory soup,” spreading the pain message and causing an inflammatory response. The pain stimulus enters the spinal cord via the _________ and travels one of several routes until ending within the gray matter of the spinal cord. At the dorsal horn __________ is released, causing a synaptic transmission from the afferent (sensory) peripheral nerve to spinothalamic tract nerves, which cross to the opposite side.
transmission
dorsal horn
substance P
Nerve impulses related to painful stimuli travel along _________ (sensory) peripheral nerves. Two types of peripheral nerve fibers conduct painful stimuli: the fast, myelinated _______ fibers and the very small, slow, unmyelinated ________.
afferent
A-delta
C fibers
Along the _______ tract pain impulses travel up the spinal cord. After the pain impulse ascends the spinal cord, the thalamus transmits information to higher centers in the brain, including the ________ formation, _______ system, somatosensory cortex, and association cortex.
spinothalamic
reticular
limbic
Cellular damage caused by thermal, mechanical, or chemical stimuli results in the release of what four excitatory neurotransmitters?
prostaglandins, bradykinin, substance P, and histamine.
The ____ fibers send sharp, localized, and distinct sensations that specify the source of the pain and detect its intensity.
A-Delta
The _____ fibers relay impulses that are poorly localized, burning, and persistent.
C-Fibers
For example, after stepping on a nail, a person initially feels a sharp, localized pain, which is a result of ___-fiber transmission. Within a few seconds the pain becomes more diffuse and widespread, until the whole foot hurts because of ___-fiber innervation’s
A
C
Once a pain stimulus reaches the _______, the brain interprets the quality of the pain and processes information from past experience, knowledge, and cultural associations in the perception of the pain
cerebral cortex
• Generated from the breakdown of phospholipids in cell membranes
• Thought to increase sensitivity to pain
What neurotransmitter is this?
Prostaglandins
• Released from plasma that leaks from surrounding blood vessels at the site of tissue injury
• Binds to receptors on peripheral nerves, increasing pain stimuli
• Binds to cells that cause the chain reaction producing prostaglandins
What neurotransmitter is this?
Bradykinin
• Found in the pain neurons of the dorsal horn (excitatory peptide)
• Needed to transmit pain impulses from the periphery to higher brain centers
• Causes vasodilation and edema
What neurotransmitter is this?
Substance P
• Produced by mast cells causing capillary dilation and increases capillary permeability
What neurotransmitter is this?
Histamine
• Released from the brainstem and dorsal horn to inhibit pain transmission
What neurotransmitter is this?
Serotonin
• Are natural supply of morphine-like substances in the body
• Activated by stress and pain
• Located within the brain, spinal cord, and gastrointestinal tract
• Cause analgesia when they attach to opiate receptors in the brain
• Present in higher levels in people who have less pain than others with a similar injury
What neurotransmitter is this?
Neuromodulators (Inhibitory)
______ is the point at which a person is aware of pain. The ________ cortex identifies the location and intensity of pain, whereas the association cortex, primarily the ________ system, determines how a person feels about it. There is no single pain center
Perception
somatosensory
Limbic
Once the brain perceives pain, there is a release of what four inhibitory neurotransmitters which work to hinder the transmission of pain and help produce an analgesic effect.
endogenous opioids,
serotonin,
norepinephrine,
gamma aminobutyric acid (GABA),
This inhibition of the pain impulse is the fourth and last phase of the nociceptive process known as _______.
modulation
A ________ reflex response also occurs with pain reception. ________ fibers send sensory impulses to the spinal cord, where they synapse with spinal motor neurons. The motor impulses travel via a ______ along efferent (motor) nerve fibers back to a peripheral muscle near the site of stimulation, thus bypassing the brain. Contraction of the muscle leads to a protective withdrawal from the source of pain.
protective
A-delta
reflex arc
For example, when you accidentally touch a hot iron, you feel a burning sensation, but your hand also reflexively withdraws from the surface of the iron.
This theory first suggested that pain has emotional and cognitive components in addition to a physical sensation. According to this theory, mechanisms located along the central nervous system regulate or even block pain impulses. Pain impulses pass through when a gate is open and are blocked when a gate is closed. Closing the gate is the basis for _______ pain- relief interventions. You gain a useful conceptual framework for pain management by understanding the physiological, emotional, and cognitive influences on the gates.
Gate-Control Theory of Pain
non-pharmacological
Factors such as stress and exercise increase the release of _______, often raising an individual’s pain threshold (the point at which a person feels pain). Because the amount of circulating substances varies with every individual, the response to pain varies.
endorphins
As pain impulses ascend the spinal cord toward the brainstem and thalamus, the stress response stimulates the ________ nervous system. Pain of low to moderate intensity and superficial pain elicit the ________ reaction of the general adaptation syndrome. Stimulation of the sympathetic branch of the autonomic nervous system results in physiological responses. Continuous, severe, or deep pain typically involving the visceral organs (e.g., with a myocardial infarction or colic from gallbladder or renal stones) activates the _________ nervous system. Sustained physiological responses to pain sometimes seriously harm individuals. Except in cases of ________, which causes a person to go into shock, most people adapt to their pain, and their physical signs return to normal. Thus patients in pain do not always have changes in their vital signs. Changes in ______ more often indicate problems other than pain.
What response to pain is this?
autonomic fight-or-flight parasympathetic severe traumatic pain vital signs Physiological Response to Pain
If left untreated or unrelieved, ______ significantly alters quality of life. It usually interferes with every aspect of a person’s life, which supports why effective pain management is essential. It threatens physical and psychological well- being. Some patients choose not to ______ pain if they believe that it inconveniences others or if it signals loss of self-control, and some endure severe pain without assistance. Encourage your patients to ____ pain-relieving measures so they remain active and continue to maintain daily activities. In contrast, other patients seek relief before pain occurs, having learned that prevention is easier than treatment. A patient’s ability to tolerate pain significantly influences your perceptions of the degree of the patient’s discomfort. Patients who have a low pain tolerance (level of pain a person is willing to accept) are sometimes inaccurately perceived as _______. Teach patients the importance of reporting their pain sooner rather than later. _______ and facial expressions indicating pain include clenched teeth, holding the painful area, bent posture, and grimacing. Some patients cry or moan, are restless, or make frequent requests of a nurse. You soon learn to recognize patterns of behavior that reflect pain. This becomes especially important in patients who are unable to report their pain such as the _______ impaired. However, lack of pain expression does ______ indicate that the patient is not experiencing pain.
What response to pain is this?
pain report accept complainers Body movement cognitively not Behavioral Responses to Pain
Dilation of bronchial tubes and increased respiratory rate: Provides increased oxygen intake
This is the stimulation of what branch of the autonomic nervous system?
Sympathetic Stimulation
Diaphoresis: Controls body temperature during stress
This is the stimulation of what branch of the autonomic nervous system?
Sympathetic Stimulation
Increased heart rate: Provides increased oxygen transport
This is the stimulation of what branch of the autonomic nervous system?
Sympathetic Stimulation
Peripheral vasoconstriction (pallor, elevation in blood pressure) Elevates blood pressure with shift of blood supply from periphery and viscera to skeletal muscles and brain This is the stimulation of what branch of the autonomic nervous system?
Sympathetic Stimulation
Increased blood glucose level: Provides additional energy
This is the stimulation of what branch of the autonomic nervous system?
Sympathetic Stimulation
Dilation of pupils: Affords better vision
This is the stimulation of what branch of the autonomic nervous system?
Sympathetic Stimulation
Decreased gastrointestinal motility: Frees energy for more immediate activity
This is the stimulation of what branch of the autonomic nervous system?
Sympathetic Stimulation
Increased muscle tension: Prepares muscles for action
This is the stimulation of what branch of the autonomic nervous system?
Sympathetic Stimulation
Pallor: Causes blood supply to shift away from periphery
This is the stimulation of what branch of the autonomic nervous system?
Parasympathetic Stimulation
Muscle tension: Results from fatigue
This is the stimulation of what branch of the autonomic nervous system?
Parasympathetic Stimulation
Decreased heart rate and blood pressure: Results from vagal stimulation.
This is the stimulation of what branch of the autonomic nervous system?
Parasympathetic Stimulation
Rapid, irregular breathing: Causes body defenses to fail under prolonged stress of pain
This is the stimulation of what branch of the autonomic nervous system?
Parasympathetic Stimulation
_______ pain is protective, has an identifiable cause, is of short duration, and has limited tissue damage and emotional response. It eventually resolves, with or without treatment, after an injured area heals. Because this pain has a predictable ending (healing) and an identifiable cause, health team members are usually willing to treat it ________.
acute
aggressively
Unrelieved acute pain can progress to
_______ pain. Acute pain seriously threatens a patient’s recovery by resulting in prolonged _______, increased risks of complications from immobility, and delayed rehabilitation. Physical and psychological progress is delayed as long as acute pain persists because a patient focuses all energy on ______ relief. Efforts aimed at teaching and motivating the patient toward self-care are often hampered until the pain is successfully managed. ________ pain relief is not always achievable, but reducing pain to a tolerable level is realistic. Thus a primary nursing goal is to provide pain relief that allows patients to _____ in their recovery.
chronic hospitalization pain Complete participate
Examples of _______ non-cancer pain include arthritis, low back pain, myofascial pain, headache, and peripheral neuropathy.
chronic
_____ pain is usually non–life threatening. Sometimes an injured area healed long ago, yet the pain is ongoing and does not respond to treatment. The possible unknown cause of this type of pain, combined with the unrelenting nature and uncertainty of its duration, frustrates a patient, frequently leading to psychological depression and even suicide.
chronic
________ pain is a major cause of psychological and physical disability, leading to problems such as job loss, inability to perform simple daily activities, sexual dysfunction, and social isolation. The person with this type of noncancer pain often does not show obvious symptoms and does not ______ to the pain. Rather, he or she seems to suffer more with time because of physical and mental ________.
Chronic
adapt
exhaustion
Associated symptoms of _______ pain include fatigue, insomnia, anorexia, weight loss, apathy, hopelessness, and anger.
chronic
_______ pain creates the uncertainty of how one will feel from day to day. If there is no objective evidence to confirm the existence of pain, the “burden of proof” lies with the patient. Health care workers are usually ______ willing to treat chronic non-cancer pain with opioids, although a policy statement supports the use of opioids for it.
Chronic
less
In addition, the American Society of Anesthesiologists developed “Practice Guidelines for Chronic Pain Management,” which includes the use of ______. Often a person with chronic pain who consults with numerous health care providers is labeled a drug seeker, when he or she is actually seeking adequate pain relief. This situation is called _________. .
opioids
pseudoaddiction
Nurses need to ______ patients from having multiple health care providers for treating pain and refer them to pain specialists. Pain centers offer a ____approach to chronic pain using both non-pharmacological and pharmacological strategies for pain management.
discourage
holistic
Pain that occurs sporadically over an extended period of time is episodic pain. Pain episodes last for hours, days, or weeks. Examples are migraine headaches and pain related to sickle cell disease. What type of pain is this?
Chronic Episodic Pain.
Not all patients with ______ experience pain. For those who do, as many as 90% are able to have their pain managed with relatively ______ means. Some patients with cancer experience acute and/or chronic pain. The pain is ______ and/or________. What type of pain is this?
cancer
simple
nociceptive and/or neuropathic
Cancer Pain
A patient senses pain at the actual site of the tumor or distant to the site which is , called _____ pain. Assess reports of new pain by a patient with existing pain. Although the treatment of cancer pain has improved, _________ of cancer pain continues. What type of pain is this?
referred
undertreatment
Cancer Pain
Identifying the _____ of pain is the first step in successful treatment.
cause
This pain is usually caused by tumor progression and related pathological processes, invasive procedures, toxicities of treatment, infection, and physical limitations. What type of pain is this?
Cancer Pain
Nociceptive pain includes somatic aka ________ and visceral aka ______ pain. ________ pain arises from abnormal or damaged pain nerves. Each of these pathological processes has distinct pain ________. What type of pain is this?
musculoskeletal internal organ Neuropathic characteristics Pain by Inferred Pathological Process.
This is chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition. What type of pain is this?
Idiopathic Pain
An example of idiopathic pain is __________. Research is needed to better identify the causes of idiopathic pain, thus leading to a more effective treatment.
complex regional pain syndrome (CRPS)
The traditional model suggests that physical problems result from ______ causes. Thus pain is a physical response to _______ dysfunction.
physical
organic
When there is no obvious source of pain (e.g., the patient with chronic low back pain or neuropathies), _______ sometimes stereotype pain sufferers as malingerers, complainers, or difficult patients
health care providers
Studies of nurses’ attitudes regarding pain management show that a nurse’s personal opinion about a patient’s report of pain _______ pain assessment and titration of opioid doses. The amount of analgesia administered varied based on whether a patient is grimacing or smiling during the nurse’s assessment.
affects
Nurses with more than 6 years of work experience, higher job motivation, and perceived higher levels of pain-care skills in themselves often use more patient _________ skills in providing pain management for patient.
advocacy
Nurses’ _______ about patients in pain seriously limit their ability to offer pain relief. Biases based on culture, education, and experience influence everyone. Too often nurses allow misconceptions about pain to affect their willingness to ________.
assumptions
intervene
They do not believe a patient’s report of pain if he or she does not ______ in pain. You are entitled to your personal beliefs; however, you must accept a patient’s report of pain and act according to professional guidelines, standards, position statements, policies and procedures, and evidence-based research findings
look
Psychogenic pain is not real. True or false?
false
Patients who abuse substances ex use alcohol or drugs overreact to discomforts. True or false
false
Patients with minor illnesses have less pain than those with severe physical alteration. true or false
false
Administering analgesics regularly does not lead to drug addiction. true or false
true
The amount of tissue damage in an injury does not accurately indicates pain intensity. true or false
true
health care professionals are the best authorities n the nature of a patients pain. true or false
false
chronic pain is not psychological. true or false
true
Patients who are in the hospital will experience pain. true or false
false
Patients who cannot speak can still feel pain. true or false
true
Normal processing of stimuli that damages normal tissues or has the potential to do so if prolonged; usually responsive to nonopioids and/or opioids.
What type of pain classification by inferred pathology is this?
Nociceptive pain
This pain comes from bone, joint, muscle, skin, or connective tissue; is usually aching or throbbing in quality and well localized. What type of nocioceptive pain pathology is this?
Somatic pain
This pain arises from visceral organs such as the gastrointestinal tract and pancreas. What type of nocioceptive pain pathology is this?
Visceral pain
This pain is sometimes subdivided: 1. Tumor involvement of organ capsule that causes aching and fairly well–localized pain 2. Obstruction of hollow viscus, which causes intermittent cramping and poorly localized pain. What type of nocioceptive pain pathology is this?
Visceral Pain
This pain is the abnormal processing of sensory input by the peripheral or central nervous system; treatment usually includes adjuvant analgesics. What type of pain classification by inferred pathology is this?
Neuropathic pain
This is a central nervous system generated pain that is the injury to either the peripheral or central nervous system.
Examples: ________ pain indicates injury to the peripheral nervous system; burning pain below the level of a spinal cord lesion reflects injury to the central nervous system. What type of neuropathic pain pathology is this?
Phantom
Deafferentation Pain
This is a peripherally generated pain felt along the distribution of many peripheral nerves. Examples: Diabetic neuropathy, alcohol-nutritional neuropathy, and Guillain-Barré syndrome.
Painful Polyneuropathies
This is a central nervous system generated pain that is associated with impaired regulation of the autonomic nervous system.
Examples: Pain associated with ________, type I, type II. What type of neuropathic pain pathology is this?
complex regional pain syndrome (CPRS)
Sympathetically maintained pain
This is a peripherally generated pain usually associated with a known peripheral nerve injury; pain felt at least partly along the distribution of the damaged nerve. Examples: Nerve root compression, nerve entrapment, trigeminal neuralgia.
Painful mononeuropathies
Age influences _____, particularly in infants and older adults.
pain
Pain is not an inevitable part of aging. True or false
true
Example, chest pain does not always indicate a heart attack; it also is a symptom of ______ of the spine or an abdominal disorder. When older adults experience cognitive impairment and confusion, they have difficulty recalling pain experiences and providing detailed explanations of their _____.
arthritis
pain
_____ heightens the perception of pain and decreases coping abilities. If it occurs along with sleeplessness, the perception of pain is even ______. Pain is often experienced less after a restful sleep than at the end of a long day.
Fatigue
greater
Research on healthy human subjects suggests that genetic information passed on by parents possibly increases or decreases the person’s sensitivity to pain and ______ pain threshold or pain tolerance.
determines
Any factor that interrupts or influences normal pain reception or perception (e.g., spinal cord injury, peripheral neuropathy, or neurological disease) affects the patient’s ________ of and response to pain. Some pharmacological agents (analgesics, sedatives, and anesthetics) influence pain perception and response and thus require close ________.
awareness
monitoring
Increased attention is associated with increased pain, whereas _______ is associated with a diminished pain response. This concept is one that nurses apply in various pain-relief interventions such as relaxation, guided imagery, and massage.
distraction
Prior experience does not mean that a person accepts pain more easily in the future. Previous frequent episodes of pain without relief or bouts of severe pain cause anxiety or fear. In contrast, if a person repeatedly experiences the same type of pain that was relieved successfully in the past, the patient finds it easier to interpret the pain sensation. true or false
true
