Exam 2: Pain (unit 4) Flashcards
Pain is ?
Whatever the person experiencing the pain says it is
What are 3 Barriers to Effective Pain Management ?
- Tolerance
- Physical dependance
- Addiction
__________ barrier to effective pain management, requires a need for an increased dose to maintain the same degree of pain control ?
Tolerance
- Rotate drug if tolerance develops, as increasing the dose could lead to hyperanalgesia
_____________ is the expected response to ongoing exposure to pharmacologic agents manifested by withdrawal syndrome when blood levels drop abruptly ?
physical dependence
In regards to physical dependence, what should be done to avoid withdrawal ?
Drug should be tapered off
What 2 Barriers to Effective Pain Management, DO NOT mean Addiction ?
- Tolerance
- Physical dependence
___________ is a neurologic condition with the drive to obtain and take substance for other than the prescribed therapeutic value ?
Addiction
What is the best description of pain ?
Subjective descriptions of pain !
- patients experience and self report is essential
___________________ are descriptions of pain that are also acceptable for special populations ?
Non-verbals, such as Behaviors
What is Nociceptive Pain ?
Damage to somatic or visceral tissue
What are 2 types of Nociceptive pain ?
- Somatic pain
- Visceral pain
Nociceptive pain usually responds to what types of medications ?
Opioid and nonopioid medications
Examples of Nociceptive Pain ?
- surgical incision
- broken bone
- arthritis
What type of Nociceptive pain does not involve nerves ?
Somatic pain !
Somatic pain presents as ?
Aching or throbbing
Somatic pain is _________ ?
Localized
Somatic pain arises from what ?
- bone
- joint
- muscle
- skin
or - Connective tissue
What type of Nociceptive pain is associated with tumor involvement or obstruction ?
Visceral pain
Visceral pain arises from what ?
Internal organs such as the intestines and bladder.
Visceral pain feels like what ?
Cramping
What is an Example of Visceral pain ?
Pancreatitis
Neuropathic pain results from what ?
Damage to peripheral nerves or CNS
Neuropathic pain presents as what ?
- Burning
- Shooting
- Stabbing
- or electrical in nature
What type of pain is sudden, intense, short-lived, or lingering ?
Neuropathic Pain
What are examples of neuropathic pain ?
- Diabetic Peripheral Neuropathy (DPN)
- Phantom limb pain
- Post-Herpetic Neuralgia (PHN)
What type of pain has a sudden onset, lasts less than 3 months or for the time it takes for normal healing to occur ?
Acute pain
The intensity of Acute Pain ranges from _______ to ________ .
Mild to Severe
What type of pain generally has a precipitating event or illness that can be identified (“because of something”) ?
Acute Pain
In what type of pain does the course of pain decrease over time and goes away as recovery occurs ?
Acute Pain
What is the treatment goal of Acute Pain ?
Pain control with eventual elimination
With Acute Pain manifestations reflect what ?
Sympathetic Nervous System activation
What are objective signs that we may see with Acute Pain ?
- Increased heart rate
- Increased respiratory rate
- Increased BP
The onset of chronic pain may be _________ or _________ ?
Gradual or sudden
For pain to be classified as chronic, the duration is what ?
Greater than 3 months
What type of pain May start as acute pain, but continues past normal recovery or healing time ?
Chronic Pain
With Chronic Pain, the cause of pain may be what ?
unknown
What type of pain can be disabling and accompanied by anxiety and depression ?
Chronic Pain
What are treatment goals for Chronic Pain ?
- Control to the extent possible
- Focus on enhancing function and quality of life
What type of pain does not go away, and is characterized by periods of waxing and waning ?
Chronic Pain
In regards to chronic pain, vital sign changes are what ?
NOT likely !
What type of pain is associated with behavioral manifestations such as:
- Decreased physical movement/activity
- Fatigue
- Withdrawal from others and social interaction
- Vital sign changes not likely
Chronic Pain
What is the best way to do a pain assessment ? (using what technique?)
OLDCARTS
What is Breakthrough pain ?
occurs beyond treated pain
Breakthrough pain can be what ?
Transient & moderate to severe
What is the onset time for Breakthrough pain ?
rapid onset
What type of pain has a brief duration with variable frequency and intensity ?
Breakthrough pain
What is an example of Breakthrough pain ?
Working with PT getting up out of bed etc.
Pain scales are considered what type of data (subjective or objective) ?
Subjective data !
Why is it important to use observational skills when assessing a patients pain ?
Not everybody will be able to rate their pain !
- Examples: Pt’s who are non-verbal, are confused, have dementia, etc.
What pain assessment tool is used most often ?
0-10 Numeric Pain Intensity Scale
The Wong-Baker pain face skill is good tool for which type of individuals ?
Good for those who don’t understand the numerical scale & for kids (3-4yrs who can’t read yet) !
What two pain assessment tools aren’t used as much ?
- Simple descriptive pain intensity scale
- Visual analog scale (VAS)
What is the most important thing to do first before treating pain ?
ALWAYS get an accurate assessment first!
Whats an important aspect to remember when treating pain ?
Every patient deserves adequate pain management !
- Ex: A frequent flyer in the ER–> Its our job to treat the patients pain. Not our job to determine if they are drug seeking
When treating a patients pain, its important to treat the pain based on what ?
The patients goals !
(Whatever makes them able to participate in ADLs, etc.. Not everybody has a goal of 0 out of 10 pain. Some individuals are just fine with a 3 or 4 out of 10 pain)
What is standard practice when treating pain ?
Using drug and non-drug therapies
when treating pain its important to use a what ?
Multidisciplinary approach
-Example: PT/OT if the patient is stiff
Anastisiologist if pt. has sever pain
Neurologist is pt. has neuropathic pain
etc.,
After giving medicine for pain, its important to do what ?
Go back and evaluate the pain
When treating pain its important to do what with the pt/family ?
Involve patient and family teaching through assessment and treatment
- Example: If a Pt. is taking an opioid medication, we want to inform the pt/family that opioids cause constipation & that they may want to take a stool softener with it.
What is the LAST thing we want to do after providing pain relief for a patient ?
Reassess and document the pain after we have performed an intervention.
- Within the hour, we should be documenting what our re-assessment was & if it was effective
What is the time frame for documenting oral medication pain relief ?
Document in an hour
What is the time frame for documenting/re-assessing pain relief administered through an IV ?
-Example: IV Morphine
Check back in 30 minutes
What is the time frame for re-assessing/documenting pain relief via a PCA pump ?
At least every 2hrs along with a few sets of vital signs since it is continuous pain.
In terms of pain relief medications, what are the 3 categories of medications ?
- Nonopioid
- Opioid
- Co-analgesics or adjuvant
What are examples of Nonopioid medications ?
- Acetaminophen
- Aspirin and other salicylates
- NSAIDS
What is an Analgesic ceiling ?
Increasing the dose above the upper limit produces no greater analgesia
What category of medications do not produce tolerance or addiction ?
Nonopioids
Many Nonopioid medications are _________ ?
Over the counter (OTC’s)
Aspirin and NSAIDS are not the same as what ?
Acetominophen
Tylenol is NOT an _______ ?
NSAID
Nonopioids are used for what ?
Mild to moderate pain
Nonopioids can be used in conjunction with what ?
Opioids
- to produce an opioid sparring effect, which helps to produce less side-effects
What are major side effects of NSAIDS ?
- Dispepsia
- Gastric ulcerations
- Possible hemorrhage
NSAIDS care considered ___ -_____________, but if used excessively can cause ___________ ?
- Ant-inflammatories
- Bleeding
What is a side effect/what do you want to watch for when taking Aspirin ?
Want to watch for GI bleeding also if used on chronic bases & on an empty stomach
With Tylenol what do you want to watch for ?
Watch how much is given, as it can lead to Hepatotoxicity.
potential to over tax the liver
What is an example of an opioid sparring effect ?
Percocet - is a combination of Oxycodone & Tylenol
How do opioids work in the body ?
Bind to receptors in the CNS
- inhibit the transmission of nociceptive input
Opioids alter what ?
Limbic activity (Balance & coordination may be off)
opioids are what type of agonists ?
Pure agonists
What are examples of Pure aganoists ?
- Morphine
- Oxycodone
- Codeine
True or False : Pure agonists are potent ?
True
Do Pure agonists have an analgesic ceiling ?
No
Do opioids allow for several routes of administration ?
Yes
Opioids are often combined with what for relief of moderate pain ?
nonopijoid analgesic’s
opioids are often available in ________ & ___________ release formulations ?
Immediate & Sustained
What does it mean when “ER” is located behind a medication name ?
Extended release
What does it mean when “SR” is located behind a medication name ?
Sustained release
What does it mean when “IR” is located behind a medication name ?
Immediate release
partial agonists also fall under which category of medications used to treat pain ?
opioids
What type of agonists are not used as often/almost never ?
Partial agonists
What are examples of Partial Agonists ?
- Pentazocine (Talwin)
- Butorphanol (stadol)
Why aren’t partial agonists used as often for treating pain ?
- Less respiratory depression
- Increased dysphoria, agitation, and hallucinations
- Have an analgesic ceiling
What is the MOST COMMON side effect of Opioids ?
Constipation
What are other side effects of opioids ?
- Constipation
- Nausea/vomiting
- Sedation
- Respiratory depression (RR < 8 is definitely cause for concern)
- Pruritus
- Some side effects resolve after the medication is taken for a period of time. (not constipation)
What is the Antidote for opioids ?
Narcan
- Reverses the binding of the opioid to the receptor; ultimately reversing the narcotics effects !
When giving Opioids, if the pt’s RR fall below 8bpm, what should be done ?
Need to get the Antidote (Narcan) on board immediately !
When is Adjuvant Therapy used ?
Used in conjunction with opioids and nonopioids
What is Adjuvant Therapy ?
Generally developed for other purposes, but also effective for pain control under certain circumstances.
What are Examples of Adjuvant Therapy ?
- Antidepressants
- Antiseizure drugs
- 2-Adrenergic agonists
- corticosteroids
- Local anesthetics
In regards to Adjuvant Therapy, Antidepressents can help control pain how ?
High levels of serotonin & Norepinephrine can block nociceptive singles to the CNS, so it blocks the pain signals. So it may help I that respect!
- Will not directly help with the pain, but it might help send out those feel good neurotransmitters, to block pain signals to our CNS.
In regards to Adjuvant Therapy, how can Corticosteroids help with pain control ?
They can help reduce swelling
Good for pt’s with spinal cord pain/injuries
Overall, what is the takeaway of Adjuvant Therapy ?
Other categories of drugs may be helpful when treating pain, in conjunction with pain medications !
In regards to administration of pain meds, Constant pain requires what ?
Requires around-the-clock administration (Not PRN)
In regards the administration of pain meds, Its important to do what ?
Stay AHEAD of pain NOT behind it !!
- Don’t want to be chasing pain
- Much harder to catch up on pain than to keep up on it
What type of drugs should be used for Breakthrough pain ?
Fast-acting drugs
*If take an ER medication, the pt. may need Breakthrough pain medication to fill the gaps
What is Titration ?
Dose adjustment based on assessment of analgesic effect versus side effects.
What do you want to keep in mind when administering pain medications ?
Use the smallest dose to provide effective pain control with the fewest side effects
What is Equianalgesic dosing ?
Dose of one analgesic that is equivalent in pain relieving effects compared with another analgesic
- Example In Text: Table 8-12
What are the different kinds of routes for medication administration ?
- Oral
- Sublingual and Buccal
- Intranasal
- Rectal
- Transdermal
- Parenteral routes (IV, SQ, IM, etc.)
- PCA
- Intraspinal delivery
What is the medication route of choice if there is a functioning GI tract ?
Oral
What are different types Oral administration ?
- IR (immediate release)
- Regular onset of action
- Delayed release
what is the buccal route ?
in the cheek
What medication route Exempts drugs from the first-pass effect ?
Sublingual and Buccal
- because it gets absorbed directly into the bloodstream, as opposed to the oral route where this a first pass effect
What kinds of patients are rectal meds best for ?
- Pt’s who can’t take PO meds (i.e.: N/V)
- decreased level of consciousness
- can’t swallow properly
Who do transdermal pain patches work ?
You can place the medication at a specific site
What type of pain are transdermal patches used for ?
Chronic pain
What should you never use a transdermal patch for ?
An immediate pain need
When dealing with transdermal patches what do you want to make sure to do ?
Document where you put the patch and also that you removed it
What are parenteral routes ?
Anything that is injectable
What is the most common parenteral route ?
IV
What are Examples of Parenteral routes ?
- IV
- SQ
- IM
Which route of administration is highly potent, and thus requires smaller doses ?
parenteral routes
Which parenteral rout is fast acting ?
IV route
when giving meds through the IV route, what should you monitor for ?
Respiratory depression
What parenteral route does not work as quickly and is not used as often ?
SQ route
Which parenteral route is not recommended because of variable time for absorption and effectiveness
IM route
How do Nerve blocks work ?
They interrupt any signals going up to the brain or down to the extremities
When are nerve block used ?
During and after surgery to manage pain
What is an example of Nerve blocks ?
C-section: Pt’s are alert and awake but they don’t feel anything from the waste down
If you have had a nerve block, you automatically get what ?
A Foley catheter !
What are examples of NONdrug therapies ?
- massage
- exercise
- TENS or PENS
- acupuncture
- heat or cold therapy
- cognitive therapies (distraction, hypnosis, imagery, relaxation)
How do TENS units work ?
Block pain through electrical impulses
When patients report pain, how do we want to perceive it ?
We need to believe it and not perceive it as “complaining”
What is a major ethical issue related to pain management ?
Fear of hastening death by administering analgesics
- Big Myth* - There is actually evidence that opioids will haste the death of a terminally ill patient
- It is actually our moral obligation to provide comfort and pain relief
True or False : The use of placebos in pain assessment and treatment is extremely un-ethical ?
True
- We NEVER give a placebo, instead of pain medications
Chronic pain often results in ?
- Depression
- Sleep disturbances
- Decreased mobility
- Decreased health care utilization
- Physical and social role dysfunction
What are the most common painful musculoskeletal conditions of the gerontology population ?
- Osteoarthritis
- Low back pain
- Previous fracture sites
What barriers do gerontologic pt’s face in terms of pain ?
- Believe that pain is inevitable for aging
- Greater fear of using opioids
- Use words like aching, soreness, or discomfort instead of pain
What age population metabolizes drugs more slowly ?
Gerontologic population
- Start low and go slow !
What age population is at greater risk for adverse effects ?
Gerontologic population
What is the drug of choice for mild aches in the elderly ?
Tylenol
Pt’s with a history of substance abuse still have the right for what ?
the right to receive effective pain management
For Pt’s with a history of substance abuse, increased pain may be a trigger for what ?
re-lapse
