Intro to Pain

Question 1

What information do we need to collect from the patient in regards to pain?

Answer 1

1. Type
2. Intensity
3. Source
4. Location
5. Duration
6. Time course
7. Alleviating factors
8. Aggravating factors
9. Effect on daily living
10. Effect on QOL
11. Effect on functional capacity

Question 2

What are the goals of assessment?

Answer 2

1. Characterize pain
2. Evaluate comorbidities
3. Develop treatment plan
4. Set goals for pain tx

Question 3

What is the biggest take away point from the pain assessment tools we have?

Answer 3

No single test is better than the others. The most important point is that they provide more information about pain than just a number

Question 4

What are the physical consequences of untreated pain?

Answer 4

1. decreased mobility
2. decreased sleep
3. decreased concentration
4. anorexia

Question 5

What are the psychological consequences of untreated pain?

Answer 5

1. depression
2. feelings of loss
3. fear of missing out

Question 6

What are the social consequences of untreated pain?

Answer 6

1. isolation
2. dependence on others
3. impaired relationships

Question 7

What are the economic consequences of untreated pain?

Answer 7

1. decreased income

2. increased healthcare costs

Question 8

What are the endocrine consequences of untreated pain?

Answer 8

altered released of hormones, like cortisol, resulting in weight loss/gain, fever, and shock

Question 9

What are the cardiovascular consequences of untreated pain?

Answer 9

increased HR, BP, oxygen demand, and hypercoagulation

Question 10

What are the respiratory consequences of untreated pain?

Answer 10

decreased air flow which increases the risk of atelectasis or pneumonia

Question 11

What are the immune consequences of untreated pain?

Answer 11

decreased immunity

Question 12

What are the GI consequences of untreated pain?

Answer 12

decreased motility and gastric emptying

Question 13

What are the musculoskeletal consequences of untreated pain?

Answer 13

muscle spasms resulting in immobility and weakness

Question 14

Define pain

Answer 14

an unpleasant sensory and emotional experience associated with the actual or potential tissue damage

Question 15

What is pain the combination of?

Answer 15

a destructive process and an emotional experience

Question 16

What is nociceptive pain?

Answer 16

acute pain that is protective or physiologic pain

Question 17

What are the two subclasses of nociceptive pain?

Answer 17

somatic and visceral

Question 18

What is visceral pain?

Answer 18

pain associated with an organ

Question 19

What is referred pain?

Answer 19

when pain from an organ is felt in another location. This is due to the decreased quantity of nociceptors involved

Question 20

What is somatic pain

Answer 20

pain arising from skin, bone, joint, or connective tissue (localized)

Question 21

What is neuropathic pain?

Answer 21

Pain arising from a compromised nervous system

Question 22

What is acute pain?

Answer 22

Nociceptive pain that occurs for 30 days or less

Question 23

What is chronic pain?

Answer 23

longer than 30 days

Question 24

What are the 4 steps of pain?

Answer 24

1. transduction
2. transmission
3. perception
4. modulation

Question 25

What is transduction?

Answer 25

Stimulation of nociceptors in the periphery

Question 26

What can nociceptors distinguish between?

Answer 26

noxious stimuli vs. innocuous stimuli

Question 27

What can nociceptors be triggered by?

Answer 27

mechanical, thermal, and chemical stimuli

Question 28

What internal substances trigger nociceptors?

Answer 28

bradykinins, prostaglandins, histamine, interleukins, tumor necrosis factor, serotonin, and substance P

Question 29

What is substance P?

Answer 29

an amino acid chain that causes vasodilation and allows for the recruitment of inflammatory mediators and mast cells

Question 30

What are the three parts of a nerve ending?

Answer 30

primary sensory afferents, motor neurons, and sympathetic postganglionic neurons

Question 31

What do A-beta fibers respond to?

Answer 31

touch or moving

Question 32

What do A-delta and C fibers respond to?

Answer 32

intense pain to skin, deep tissue and visceral structures

Question 33

What sends action potentials through afferent nerve fibers?

Answer 33

voltage gated sodium channels

Question 34

What is sensitization?

Answer 34

the threshold to activate nociceptors is lowered

Question 35

What pain medicines target transduction?

Answer 35

topical pain meds

Question 36

When and where does transmission take place?

Answer 36

When there is a synapse on the dorsal horn of the spinal cord

Question 37

Which pain meds mostly target transmission?

Answer 37

non-opioid pain meds

Question 38

What is perception?

Answer 38

process of pain becoming a conscious experience in the brain

Question 39

What role does the somatosensory cortex play in pain

Answer 39

location, intensity, and quality

Question 40

What role does the cingulate gyrus play in pain?

Answer 40

emotional dimension of pain. Origination of fear of pain

Question 41

Where are opioid receptors located?

Answer 41

the descending pathway

Question 42

What are the clinician barriers to pain management?

Answer 42

1. lack of training 2. lack of assessment skills 3. lack of attention to pt 4. difficult to assess 5. hesitancy to prescribe

Question 43

What are the patient barriers to pain management?

Answer 43

1. reluctance to report 2. negative stigma 3. poor compliance 4. adverse effects 5. difficulty getting meds

Question 44

What is the role of the pharmacist in pain management?

Answer 44

1. controlled substance med rec 2. opioid stewardship 3. dosing conversions 4. med counseling 5. monitoring med therapy 6. developing policies 7. providing education