Comfort and Pain Management Flashcards
Definition of Pain:
It is whatever the patient says it is
What is pain influenced by
Pain is a personal experience influenced by biologic, psychological and social factors
How is pain learned?
Learned through an individual’s life experiences
What does pain serve as?
An adaptive role
Gate Control Theory of Pain describes what
Describes the transmission of painful stimuli and recognizes a relationship between pain and emotions
What do the small and large nerve fibers do in the Gate Control Theory or Pain?
Small- and large-diameter nerve fibers conduct and inhibit pain stimuli toward the brain
Gating mechanism determines the impulses that reach the brain
What does the gating mechanism do in the Gate Control Theory of Pain?
Gating mechanism determines the impulses that reach the brain
What is pain a reflection of?
Pain is a reflection of nervous system functioning
How can you control the transmission of pain?
Transmission of this type of stimuli, you can control it by recognizing the connection between emotions and the actual pain.
What are the steps of the pain process? Four steps to the physiology of pain:
- Transduction
- Transmission
- Perception of pain
- Modulation
Transduction
Activation of pain receptors (nosireceptors) by three different stimuli
What are the pain receptors that are activated during transduction?
Nocireceptors
Three types of stimuli that activation nocireceptors
- Thermal stimuli
- Mechanical stimuli
- Chemical stimuli
Example of Thermal Stimulus
Putting hand on the stove
Mechanical stimulus for nocireceptors
You are walking and tripped and fell on the ground.
Women is in labor and has a contraction
Example of chemical stimulus of activation of nocireceptors?
If there is an inflammatory response in the body, like appendicitis
Transmission
Conduction along pathways (A-delta and C-delta fibers)
Myelination
sheet that covers nerve fibers
What happens to the information if you have a myelin sheet around a nerve fiber?
That information travels very fast
Putting hands on hot stove, does the info get to brain via myelinated or unmyelinated nerve transmission?
myelinated nerve transmission
What kind of transmission is protective aka for acute pain?
Myelinated
Chronic pain is myelinated or unmyelinated?
Chronic pain is not protective
Transmission to brain is slower
This is pain that is transmitted along unmyelinated fibers
Perception of pain:
awareness of the characteristics of pain
How does perception of pain work?
information is in the brain, in the thalamus, thalamus sends information to the limbic system (how we emotionally interpret pain), it goes to the cortex and the somatic sensory system (which is how we physically feel pain)
How do we emotionally interpret pain?
Thalmus sends a message to the limbic system
Modulation:
Inhibition or modification of pain
What is local management of pain?
Putting something on the site of pain.
What is central management of pain?
Taking medication
What are the two types of fibers associated with transmission?
A-Delta
C-Delta
A-Delta fiber
myelinated- for acute pain
C-Delta fiber
unmyelinated- for chronic pain
What is acute pain indicative of?
Usually indicates tissue damage and resolves with healing of injury
What does acute pain stimulates what
Stimulates nocireceptors and is protective
Chronic pain:
Continues past the expected point of healing
Provides no protective function
Continuous or intermittent , with or without periods of exacerbation or remission
Impairs a person’s ability to function
Types of pain based on etiology
- Nociceptive
- Neuropathic
Nociceptive pain
Nervous system functioning is intact
Examples of nociceptive pain
chemical burns, sunburn, cuts, appendicitis, bladder distention
Neuropathic pain
Due to malfunctioning of the peripheral or central nervous system
Examples of neuropathic pain
Post traumatic and post surgical peripheral nerve injuries,
pain after spinal cord injury
metabolic neuropathies
phantom limb pain after amputation
post stroke pain
Two locations of pain
- Somatic pain
- Visceral pain
Somatic pain
Develops in the tissues
Two types of somatic pain?
- Superficial pain
- Deep pain
Somatic: Superficial pain
Cutaneous, stimulation of nocireceptors in skin, subcutaneous tissue, or mucous membranes.
Are well localized
Somatic: Deep pain
Involves the muscles, tendons, joints, fasciae, and bones
Factors affecting the pain experience
Cultural and ethnicity variables
Environment and support people
Anxiety and other stressors- you feel more pain because you are afraid
Past pain experience
Cultural and ethnicity variables that affect pain include:
Family
biologic sex
gender
age variables
religious beliefs/spirituality
Terms to describe QUALITY of pain
Sharp
Dull
Diffuse
Shifting
Terms to describe SEVERITY of pain
Severe or excruciating
Moderate
Slight or mild
Terms to describe PERIODICITY of pain?
Continuous
Intermittent
Brief or transient
Assessment parameters for pain
Psychological
Sociocultural
Spiritual
Physiologic
General Assessments of Pain (1-4)
- Pt’s verbalization and description of pain
- Onset and duration of pain
- Etiology or mechanism of injury, if known
- Location of pain
General Assessments of Pain (5-9)
- Quality, character and intensity of pain
- Aggravating or causal factors
- Alleviating or relieving causal factors
- Effect on function
- Pain management goal
Basic Methods of Assessing Pain
- Patient self-report
- Identify pathologic conditions or procedures that may be causing pain; consider physiologic measures (increased blood pressure and pulse)
- Report of family member, other person close to the patient or caregiver familiar with the person
- Nonverbal behaviors: restlessness, grimacing, crying, clenching fists, protecting the painful area
- Physiologic measures: increased blood pressure and pulse
- Attempt an analgesic trial and monitor the results
Pain assessment Tools #1
- 0-10 Numeric Rating Scale
- Adult Nonverbal Pain Scale (NVPS)
- Behavioral Pain Scale (BPS)
- Checklist of Nonverbal Indicators
- COMFORT Behavior Scale
- CRIES Instrument
Pain Assessment Tools #2
Critical-Care Pain Observation Tool (CPOT)
Faces Pain Scale- revised FPS-R
FLACC Behavioral Scale
Iowa Pain Thermometer (IPT) and Revised IPT-R
Oucher Pain Scale
Pain Assessment in Advanced Dementia Scale (PAINAD)
Wong-Baker FACES
Which pain assessment tool do we usually use for children?
Wong-Baker Assessment- one with the faces
Which pain assessment tool do we use for babies?
FLACC Pain Scale
Is used especially after babies have procedures
FLACC Pain Scale
F-Faces
L-Legs
A-Activity
C-Cry
C-Consolability
Nursing Interventions for Pain
Establishing trusting nurse–patient relationship
Manipulating factors affecting pain experience
Initiating complementary health approaches and integrative health care
Managing pharmacologic relief measures
Ensuring ethical and legal responsibility to relieve pain
Understanding the placebo controversy
Complementary Health Approaches and Integrative Health Care
Distraction
Humor
Music
Imagery
Mindfulness practice
Cutaneous stimulation
Acupuncture
Hypnosis
Biofeedback
Healing/therapeutic touch
Animal-assisted intervention
Pharmacologic Pain Relief Measures
Analgesic administration:
Opioid
Adjuvant
Nonopioid
Numeric Sedation Scale
S: sleep, easy to arouse: no action necessary
1: awake and alert; no action necessary
2: occasionally drowsy, but easy to arouse; no action necessary
3: frequently drowsy, drifts off to sleep during
conversation; reduce dosage
4: somnolent with minimal or no response to stimuli; discontinue opioid, consider use of naloxone
General Principles for Analgesic Administration
Ongoing assessment
Management of breakthrough pain
Concern about prescription analgesic abuse
Pain Management Regimens for Cancer or Chronic Pain
Give medications orally if possible
Administer medications ATC rather than PRN
Adjust the dose to achieve maximum benefit with minimum side effects
Allow patients as much control as possible over the regimen
Pain Treatment in Special Populations
Children
Older adults
-Communication difficulties
-Denial of pain
-Altered physiologic response to analgesics
Additional Methods for Administering Analgesics
Patient-controlled analgesia
Epidural analgesia and peripheral nerve blocks
Topical anesthesia
Teaching About Pain
Should include family members or caregivers
Explanation about pain scales
Safety: avoid driving, operating machinery, alcohol or other CNS depressants
Keep diary of pain and medications taken
Diet: do not take on an empty stomach
Do not breastfeed without checking with provider
