Chapter 9: Pain Flashcards
unpleasant sensory and emotional experience, primarily associated with tissue damage
Pain
What is pain
-Pain is WHATEVER the patient says it is
Physiologic pain response:
-Anxiety, sleeplessness, confusion, fear
-Facial grimace, cries/moans
-Tachycardia, tachypnea, decreased GI & renal
-Objective indicators can be used if patient report not possible (unconscious, sedated)
-Acute pain=
Less than 6 months
-Chronic pain=
Greater than 6 months
Ways to access Pain
Interview patient about pain symptoms
(COLDSPA)
Ways to access Pain
Interview patient about pain symptoms
(COLDSPA)
What’s COLDSPA
-Character: describe pain (sharp,throbbing)
-Onset: when did it start?
-Location: where is it? Does it radiate/spread?
-Duration: how long? Does it recur?
-Severity: rate the pain (0 - 10 scale)
-Pattern: continuous or intermittent? frequency?
-Associated factors: other symptoms w/pain?
-Factors that relieve/increase pain?
-Any treatment thus far? Effective?
What does the “C” stand for in COLDSPA
-Character: describe pain (sharp, throbbing, etc.)
What does the “O” stand for in COLDSPA
-Onset: when did it start?
What does the “L” stand for in COLDSPA
-Location: where is it? Does it radiate/spread?
What does the “D” stand for in COLDSPA
-Duration: how long? Does it recur?
What does the “S” stand for in COLDSPA
-Severity: rate the pain (0 - 10 scale)
What does the “P” stand for in COLDSPA
-Pattern: continuous or intermittent? frequency?
What does the “A” stand for in COLDSPA
-Associated factors: other symptoms w/pain?
-Factors that relieve/increase pain?
-Any treatment thus far? Effective?
Emotional or mental pain; refers to pain originating from the persons psychological dimensions and has been found in underlying suicidal behavior. This mental pain is separate from criteria for depression, but depression can cause emotional pain as well.
Psychological pain
The process of somatization, when psychological pain becomes physical.
Somatization involves transferring or converting uncomfortable feelings into physical symptoms, which may be more tolerable. Examples include limb paralysis, sensory loss, seizures (often called pseudoseizures).
Psychosomatic or psychogenic pain
Pain caused by nerve receptors detecting harmful stimuli. The receptors react to mechanical, chemical, or thermal stimuli that may cause damage to skin, muscles, bones, or connective tissue. Nociceptive pain is the most common type of pain. It may be somatic, visceral, or radicular, depending on the location.
Nociceptive pain
Results from damage or dysfunction of any level of the nervous system (peripheral nerves, spinal cord, or brain). Nerve function may change at the site of the damage, affecting one or more nerves or the central nervous system. About 30% of neuropathies are caused by diabetes.
Neuropathic pain
Has two aspects: inflammatory and immune responses accompanying and causing both nociceptive and neurologic pain; and inflammatory pain syndromes, such as back pain, shoulder pain, arthritis, rheumatoid arthritis, fibromyalgia, and migraine. In many types of pain, inflammatory pain is involved and may enhance the sensation of pain.
Inflammatory pain
Occurs when nerves in the internal organs in the chest, abdomen, intestines, or pelvis are stimulated. Visceral pain
feels vague, not localized, with a sensation of a deep squeeze, pressure, or aching
Visceral pain
Generated by stimuli at the nerve root at its connection to the spinal nerves.
Radicular pain
A sensation of pain in a body region distant from the actual source of the painful stimulus.
Referred pain
Pain in a part of the body that has been removed, such as a leg.
Phantom pain
Is more than one type of pain. Cancer may have little to no pain. When pain occurs, the first pain is often related to tumor pressure on nerves, bones, or other body organs. Cancer treatments (chemotherapy and radiation) also cause their own pain responses. Cancer pain may be acute or chronic. Types of pain in cancer include nerve pain, bone pain, tissue pain, and the pain may be referred or phantom (pain in a part of the body that has been removed). Inflammatory pain is often a significant part of cancer pain, both nociceptive and neuropathic.
Cancer pain
Acute (occurs suddenly and does not last longer than 6 months) versus chronic (persistent, ongoing; lasts longer than 6 months)
Classification Categories for Pain
Duration
Central (develops from spinal cord or brain injury, stroke, or multiple sclerosis versus peripheral (originates from the peripheral part of the nervous system, i.e., trigeminal neuralgia, polyneuropathies, or radiculopathies
Classification Categories for Pain
Location
What VS findings would you expect with a patient who is reporting pain sharp,
8/10 abdominal pain?
-High Heart rate/pulse
-High Respiratory rate
-High Blood pressure
Is the patient still having pain if vitals are all “normal”?
How would these factors impact your pain assessment?
-Acute v. chronic pain
-Cognitive/mental status
-Patient culture
-Patient developmental level
