Lecture 5: Pain Management Flashcards
5th vital sign
pain
goals for clinicians in terms of pain management
eliminate source
teach function within limitations
improve pain control with physical/physiological questions
treat overall well being
improve support systems
optimal pain management does what
helps pt understand their symptoms, adhere to treatment plan, and return to normal lives
problem with passive meds
opioid crisis
doctors now prescribing less
problem with passive modalities
often waste of time for only short term relief
some clinicians dont use any modalities
helpfulness of subjective vs objective pain report
subjective = self report; most reliable
pain scales = quantitative rating of intensity
objective measures for pain
verbal rating
numerical rating
visual analogue scale
picture or face scale
what should you consider when choosing a type of objective pain measure
symptom duration
pt cognitive abilities
time needed
complexity of measure/sensitivity to change
nonverbal pain indicators
facial expression
sounds; i.e. groans, cries, etc
bracing/guarding
restlessness
rubbing area
vital sign response
the anterolateral spinothalamic pathway provides primary sensation for what
nondiscriminative/crude touch, pain, and temp
what is acute pain
less than 30 days
well localized and defined
what is chronic pain
longer than 3-6 month duration
nociceptive, neuropathic
CNS PNS SNS
what is referred pain
perceived as coming from a site different from source
i.e. visceral pain
anterolateral spinothalamic pathway receives signals from
mechanoreceptors
nociceptors
thermoreceptors
type of fibers in the anterolateral spinothalamic pathway
C fibers (peripheral n)
small/unmyelinated
what is nociception
neural process of encoding noxious stimuli
pain is NOT nociception
transmission can be facilitated or inhibited along the way before it reaches the brain (i.e. modalities can inhibit)
pain is an output of the brain triggered by the action potential of what and converted to what
triggered by action of a potential nociceptor and converted to conscious understanding of that stimulus
what is the perception of nociception by the cerebrum
pain
questions to ask pt about pain
location
intensity
type (can help determine structure)
radiates
duration
aggravating/relieving
effects on daily activities
sleep patterns
psychosocial effects
what are the 3 dimensions of the experience of pain
sensory discriminative = where pain is and what it feels like
motivational affective = how pt feels about P! emotionally
cognitive-evaluative = what pt thinks about pain intellectually and what they expect
characteristics of sensory receptors
at distal ends of afferent n
specific and sensitive for the type of stimulus they were designed to sense
free nerve endings are
type of nociceptor/mechanoreceptor that “sense” pain
nociceptors are triggered by
intense thermal, mechanical, or chemical stimuli
exogenous source: brick, acid, bleach, fire
endogenous source: fx bone, inflammation, etc
types of nociceptors for afferent neurons
C fibers (80%)
A delta fibers (20%)