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NURS 220 > LEC 12: Chronic Pain > Flashcards

LEC 12: Chronic Pain Flashcards

1
Q

What is the problem with pain?

A
  • Perpetuation of myths
  • Lack of knowledge- pre professional, professional
  • Lack of interporofessionl collaboration
  • Knowledge transfer challenges
  • Challenge of pain assessment, particularly in children and older adults
  • Instatutional barriers
  • Everyone’s problem yet no ones problem
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2
Q

How is pain defined?

A
  • An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in term so such damage
  • Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does
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3
Q

Gate Control Theory of Pain

A

Proposed that neuro-gates in the spinal cord could be open or closed by signals descending from the brain as well as by ascending sensory information from the body

  • Research continues today around the world about this theory
  • Provided a shift away from the historical pathways of pain to the multi-neuronal idea of pain
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4
Q

Classifications of Pain

A
  1. Duration
    - Acute
    - Chronic
  2. Noceceptive, neuropathic, centralized pain
  3. Diagnosis: headache, lower back etc.
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5
Q

Acute Pain

A
  • Common with tissue damage
  • Results from noxious stimuli that activate nociceptors
  • Purposeful, tells use something is wrong
  • Lasts through the expected recovery period (few days, weeks, or months)
  • People are generally encourages to stay active and gradually get back to normal life
  • Untreated acute pain can lead to persistent or chronic pain
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6
Q

Chronic Pain

A

Can be described as ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or mote than 3 to 6 months, and which adversely affects the individual’s well-being
- Pain that continues when it should not lasting for more than 6 months

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7
Q

A New Classification for Chronic Pain

A
  1. Chronic primary pain
  2. Chronic cancer pain
  3. Chronic posttraumatice and post-surgical pain
  4. Chronic neuropathic pain
  5. Chronic headache and orofacial pain
  6. Chronic visceral pain
  7. Chronic musculoskeletal pain
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8
Q

What is nociceptive pain?

A
  • A physiological processing due to the simulation of nociceptors (nerves that transmit noxious stimuli)
  • Nociceptive pain can be categorized according to its origin as somatic or visceral
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9
Q

Somatic Pain

A

Originates in the skin, muscles, bone, or connective tissue

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10
Q

Visceral Pain

A

Resultes from the stimulation of pain receptors in the organs

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11
Q

What is neuropathic pain?

A
  • Results of injury to the nerve or an abnormal processing of stimuli by the nervous system
  • The nerves may be abnormal because of illness or injury
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12
Q

What is centralized pain?

A
  • Caused by damage to the CNS
  • Includes brain, brain stem, and spinal cord
  • Can be caused by stroke, MS, tumors, epilepsy, Parkinson’s, brain or spinal cord trauma
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13
Q

Assessment of Pain

A
  • Take into account sensory, cognitive, affective, behavioural, spiritual, sociocultural, political components of the pain
  • Take into consideration patient, family, and community barriers
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14
Q

Comprehensive Pain Assessment (RNAO)

A
  1. Routine Screening for Pain
    - At each health care visit or admission
    - After change in health status
    - When undergoing a procedure
  2. Postitive Screen
    - Pain hisotry
    - Characteristics of daily life
    - Impact of pain on daily life
    - Impact of pain on self or others, including depression/ anxiety
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15
Q

Who is at risk for inadequate pain assessment?

A
  • Neonate, infants, and young children
  • Older adults
  • Cognitively impaired or developmentally disabled individuals
  • Individuals with a history of addictive disease or current use of illicit substances
  • Individuals who speak a language other than that of the health care professional
  • Individuals unable to communicate effectively due to disease or treatment
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16
Q

OPQRSTUV

A 
O: Onset
P: Provoking, palliating
Q: Quality
R: Region/ radiation
S: Severity
T: Timing, treatment
U: Understanding, impact on you
V: Values
17
Q

Hierarchy of Pain Assessment

A
  • Self report
  • Behavioural indicators
  • Obtain proxy report
  • Physiological changes
  • Analgesia trial
18
Q

Reason for Denial of Pain

A
  • Fear of addiction
  • Concern about drug tolerance
  • Concern about or bothersome adverse effects
  • Fatalism re. ability to control pain
  • Belief that ‘good’ patients do not complain about pain
  • Belief that pain signifies disease progression
  • Fear of delayed discharge
  • Fear of injections
19
Q

What are the harmful effects of untreated pain?

A
  • Respiratory (lungs) compromise
  • Cardiovascular (heart) compromised
  • Increased stress hormones
  • Increased glucose secretion
  • Slowing of gastrointestinal/ genitourinary systems
  • Poor nutritional state
  • Muscle tension, spasm, and fatigue
  • Behavioural and psychological disturbances (PTSD)
  • Long term neurological effects
  • Chronic pain syndromes to untreated acute pain
20
Q

Unidimensional Pain Scales

A
  • The numeric rating scale (NRS)
  • The visual analog scale (VAS)
  • The verbal rating scale (VRS)
  • The Faces pain scale (FPS-R)
21
Q

What are the chronic pain management principles?

A
  • Use an interdisciplinary approach
  • Combine of pharmacological and non-pharmacological methods
  • Assess and manage opioid risk
  • Be knowledgeable about treatment for individuals who have opioid tolerance and pain exacerbation
  • Screen for substance use and make appropriate referral including pain and addiction specialist
22
Q

ISMP Canada Safety on Use of Transdermal Fentanyl

A
  • Not for use in acute or post-operative pain
  • Not for opioid-naive patients, Use should be in adults receiving opioid therapy of at least 60mg oral morphine equivalent
  • Only for use in adults requiring around the clock opioids
  • Only for use in other methods not feasible
  • A pharmacist should review all orders prior to use
  • Patients should be assessed for the presence of patahces
  • Proper disposal is required
23
Q

Chronic Pain Self-Managment

A
  1. Acceptance, then move on
  2. Build a support team
  3. Pacing- daily activities
  4. Prioritize and plan- set goals
  5. Learn relaxation
  6. Stretching and exercise
  7. Nutrition and sleep
  8. Keep a diary
  9. Be patient, have a set-back plan
  10. Putting it in to practice: repetition

NURS 220 (41 decks)

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