Chapter 5 Pain: The Fifth Vital Sign Flashcards
Define “pain”
An unpleasant sensory and emotional experience associated with actual or potential tissue damage; the most reliable indication of pain is the patient’s self-report.
Define “chronic cancer pain”
Persistent or recurrent pain that results from cancer or another progressive disease or life-threatening condition.
Define “chronic non-cancer pain”
Persistent or recurrent pain associated with a tissue injury that has healed or is not associated with cancer, such as arthritis.
Define “acute pain”
The unpleasant sensory and emotional experience associated with tissue damage that results from acute injury, disease, or surgery.
Define “preemptive analgesia”
The technique to decrease postoperative pain and the requirements for analgesia, improve morbidity, and decrease hospital stay by administering local anesthetics, opioids, nonsteroidal anti-inflammatory drugs in the preoperative, intraoperative, or postoperative period.
Define “chronic pain”
Pain that persists or recurs for indefinite periods (usually more than 3 months), often involves deep body structures, is poorly localized, and is difficult to describe. Also called “persistent pain”
Define “nociceptive pain”
Pain related to the skin, musculoskeletal structures, or body organs.
Define “neuropathic pain”
A type of chronic noncancer pain that results from a nerve injury. Examples of causes include diabetic neurpathy, postherpetic neuralgic, radiculopathy (spinal nerve damage), and trigeminal neuralgia. Neuropathy pain is described as burning, shooting, stabbing, and the sensation of “pins and needles.”
Define “A delta fibers”
Myelinated fibers that carry rapid, sharp, pricking, or piercing sensations. A person feeling these sensations can generally localize them readily to a fairly well defined area. Because these fibers respond mainly to mechanical rather than chemical or thermal stimuli, they are called mechanical nociceptors.
Define “C fibers”
Unmyelinated or poorly myelinated fibers that conduct thermal, chemical, and strong mechanical impulses. Pain conduction from C fibers is slow, more diffuse (widespread) and dull, burning, or achy-quite different from the sensations of A delta fibers. In contrast to the intermittent nature of A delta sensations, C fibers usually produce persistent pain.
Define “gate control theory”
A theory to explain the observed relationship between pain and emotion; a gating mechanism occurs in the spinal cord. Nerve fibers (A delta and C fibers) transmit pain impulses from the periphery of the body. The impulses travel to the dorsal horns of the spinal cord, specifically to the substantia gelatinosa. The cells of the substantia gelatinosa can inhibit or facilitate the pain impulses transmitted to the trigger cells (T-cell). When T-cell activity is inhibited, the gate is closed and impulses are less likely to be transmitted to the brain. When the gate is opened, pain impulses ascend to the brain.
Define “endorphins”
Morphine-like substances in the body that are released when the large-diameter nerve fibers are stimulated. They close the gate and decrease pain transmission.
Define “addiction”
A primary, chronic neurobiologic disease characterized by impaired control over drug use,compulsive use, continued use despite harm, and craving.
Define “pseudoaddiction”
An iatrogenic syndrome created by the undertreatment of pain and characterized by patient behaviors such as anger and escalating demands for more or different medications; results in suspicion and avoidance by staff. Pseudoaddiction can be distinguished from true addiction because the behaviors resolve when pain is effectively treated.
Define “tolerance”
A state of adaptation in which exposure to a drug induces changes that result in a decrease in one or more of the drug’s effects over time.
Define “physical dependence”
The adaptation manifested by a drug class-specific withdrawal syndrome. Manifestations can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, or administration of an antagonist.
Define “withdrawal syndrome”
Symptoms that occur when a patient who is physically dependent on opioids abruptly stops using them. Slowly tapering (weaning) the drug dosage lessons or alleviates the physical withdrawal symptoms in a patient who is opioid dependent. Also called “abstinence syndrome.”
Define “placebo”
Substance or action that produces an effect regardless of its known intrinsic value or specific physical or chemical properties.
Define “placebo effect”
The patient’s favorable response to a placebo.
What does PQRST stand for?
A mnemonic (memory device) that may help in the current problem assessment of patients with gastrointestinal tract disorders. The letters represent the following areas P, precipitating or probably palliative (what brings it on? What makes it better or worse?); Q, Quality or quantity (how does it look, feel, or sound?); R, region or mediation (where is it? Does it spread anywhere?); S, severity scale (how bad is it [On a scale of 1 to 10]? Is it getting better, worse, or staying the same?): T, timing (onset, duration, and frequency?).
