Intro to Pain Flashcards
What information do we need to collect from the patient in regards to pain?
- Type
- Intensity
- Source
- Location
- Duration
- Time course
- Alleviating factors
- Aggravating factors
- Effect on daily living
- Effect on QOL
- Effect on functional capacity
What are the goals of assessment?
- Characterize pain
- Evaluate comorbidities
- Develop treatment plan
- Set goals for pain tx
What is the biggest take away point from the pain assessment tools we have?
No single test is better than the others. The most important point is that they provide more information about pain than just a number
What are the physical consequences of untreated pain?
- decreased mobility
- decreased sleep
- decreased concentration
- anorexia
What are the psychological consequences of untreated pain?
- depression
- feelings of loss
- fear of missing out
What are the social consequences of untreated pain?
- isolation
- dependence on others
- impaired relationships
What are the economic consequences of untreated pain?
- decreased income
2. increased healthcare costs
What are the endocrine consequences of untreated pain?
altered released of hormones, like cortisol, resulting in weight loss/gain, fever, and shock
What are the cardiovascular consequences of untreated pain?
increased HR, BP, oxygen demand, and hypercoagulation
What are the respiratory consequences of untreated pain?
decreased air flow which increases the risk of atelectasis or pneumonia
What are the immune consequences of untreated pain?
decreased immunity
What are the GI consequences of untreated pain?
decreased motility and gastric emptying
What are the musculoskeletal consequences of untreated pain?
muscle spasms resulting in immobility and weakness
Define pain
an unpleasant sensory and emotional experience associated with the actual or potential tissue damage
What is pain the combination of?
a destructive process and an emotional experience
What is nociceptive pain?
acute pain that is protective or physiologic pain
What are the two subclasses of nociceptive pain?
somatic and visceral
What is visceral pain?
pain associated with an organ
What is referred pain?
when pain from an organ is felt in another location. This is due to the decreased quantity of nociceptors involved
What is somatic pain
pain arising from skin, bone, joint, or connective tissue (localized)
What is neuropathic pain?
Pain arising from a compromised nervous system
What is acute pain?
Nociceptive pain that occurs for 30 days or less
What is chronic pain?
longer than 30 days
What are the 4 steps of pain?
- transduction
- transmission
- perception
- modulation
What is transduction?
Stimulation of nociceptors in the periphery
What can nociceptors distinguish between?
noxious stimuli vs. innocuous stimuli
What can nociceptors be triggered by?
mechanical, thermal, and chemical stimuli
What internal substances trigger nociceptors?
bradykinins, prostaglandins, histamine, interleukins, tumor necrosis factor, serotonin, and substance P
What is substance P?
an amino acid chain that causes vasodilation and allows for the recruitment of inflammatory mediators and mast cells
What are the three parts of a nerve ending?
primary sensory afferents, motor neurons, and sympathetic postganglionic neurons
What do A-beta fibers respond to?
touch or moving
What do A-delta and C fibers respond to?
intense pain to skin, deep tissue and visceral structures
What sends action potentials through afferent nerve fibers?
voltage gated sodium channels
What is sensitization?
the threshold to activate nociceptors is lowered
What pain medicines target transduction?
topical pain meds
When and where does transmission take place?
When there is a synapse on the dorsal horn of the spinal cord
Which pain meds mostly target transmission?
non-opioid pain meds
What is perception?
process of pain becoming a conscious experience in the brain
What role does the somatosensory cortex play in pain
location, intensity, and quality
What role does the cingulate gyrus play in pain?
emotional dimension of pain. Origination of fear of pain
Where are opioid receptors located?
the descending pathway
What are the clinician barriers to pain management?
- lack of training
- lack of assessment skills
- lack of attention to pt
- difficult to assess
- hesitancy to prescribe
What are the patient barriers to pain management?
- reluctance to report
- negative stigma
- poor compliance
- adverse effects
- difficulty getting meds
What is the role of the pharmacist in pain management?
- controlled substance med rec
- opioid stewardship
- dosing conversions
- med counseling
- monitoring med therapy
- developing policies
- providing education
