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Lecture 5: Pain Management Flashcards

1
Q

5th vital sign

A

pain

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2
Q

goals for clinicians in terms of pain management

A

eliminate source

teach function within limitations

improve pain control with physical/physiological questions

treat overall well being

improve support systems

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3
Q

optimal pain management does what

A

helps pt understand their symptoms, adhere to treatment plan, and return to normal lives

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4
Q

problem with passive meds

A

opioid crisis

doctors now prescribing less

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5
Q

problem with passive modalities

A

often waste of time for only short term relief

some clinicians dont use any modalities

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6
Q

helpfulness of subjective vs objective pain report

A

subjective = self report; most reliable

pain scales = quantitative rating of intensity

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7
Q

objective measures for pain

A

verbal rating

numerical rating

visual analogue scale

picture or face scale

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8
Q

what should you consider when choosing a type of objective pain measure

A

symptom duration
pt cognitive abilities
time needed
complexity of measure/sensitivity to change

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9
Q

nonverbal pain indicators

A

facial expression
sounds; i.e. groans, cries, etc
bracing/guarding
restlessness
rubbing area
vital sign response

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10
Q

the anterolateral spinothalamic pathway provides primary sensation for what

A

nondiscriminative/crude touch, pain, and temp

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11
Q

what is acute pain

A

less than 30 days

well localized and defined

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12
Q

what is chronic pain

A

longer than 3-6 month duration

nociceptive, neuropathic

CNS PNS SNS

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13
Q

what is referred pain

A

perceived as coming from a site different from source

i.e. visceral pain

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14
Q

anterolateral spinothalamic pathway receives signals from

A

mechanoreceptors

nociceptors

thermoreceptors

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15
Q

type of fibers in the anterolateral spinothalamic pathway

A

C fibers (peripheral n)

small/unmyelinated

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16
Q

what is nociception

A

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)

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17
Q

pain is an output of the brain triggered by the action potential of what and converted to what

A

triggered by action of a potential nociceptor and converted to conscious understanding of that stimulus

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18
Q

what is the perception of nociception by the cerebrum

A

pain

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19
Q

questions to ask pt about pain

A

location
intensity
type (can help determine structure)
radiates
duration
aggravating/relieving
effects on daily activities
sleep patterns
psychosocial effects

20
Q

what are the 3 dimensions of the experience of pain

A

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

21
Q

characteristics of sensory receptors

A

at distal ends of afferent n

specific and sensitive for the type of stimulus they were designed to sense

22
Q

free nerve endings are

A

type of nociceptor/mechanoreceptor that “sense” pain

23
Q

nociceptors are triggered by

A

intense thermal, mechanical, or chemical stimuli

exogenous source: brick, acid, bleach, fire

endogenous source: fx bone, inflammation, etc

24
Q

types of nociceptors for afferent neurons

A

C fibers (80%)

A delta fibers (20%)

25
characteristics of C fibers
small/unmyelinated (slow) pain = dull/throbbing/aching/burning respond to noxious levels of stimulus slow onset, long lasting symptoms and diffusely local blocked by opioid meds at receptor emotional involvement
26
characteristics of A delta fibers
larger/myelinated (faster) more sensitive at high intensity mechanical stimulus pain = sharp, stabbing, pricking quick onset, short duration localized to where stimulus arose not blocked by opiods no emotional involvement
27
where are 1st and 2nd order neural cell bodies housed
1 = dorsal root ganglion 2 = dorsal horn
28
what neuro path does pain sensory travel
spinothalamic tract
29
where does the 3rd order neuron on the spinothalamic tract terminate in the brain to be percieved as pain
primary somatosensory cortex
30
describe the multifaceted preprogrammed response of the pain matrix
1- conscious perception of pain 2- motor responses (physical rxn) 3- homeostatic system respons (ANS, endocrine, and immune systems)
31
explain the gate control theory
stimulation of non-nociceptive fibers simultaneously with pain A beta fibers (inhibit pain transmission to higher centers) trump the other slower signals from C fibers brain only recieves A beta signals "closes the gate" to the pain signal
32
how do modalities follow the gate control theory
thermoreceptors send signal on A beta fibers to brain estim = electrical impuslse felt instead
33
examples of gate control theory that are often unconsciously preformed
rubbing a contusion, strain, sprain applying moist heat massaging sore muscles
34
how do opioids and opiopeptins (endorphins) work in the central and peripheral nervous systems
peripheral = have inhibitory actions causing presynaptic inhibition of nociceptive signal central = relieve pain naturally as they attach to reward centers in the brain
35
explain the endogenous opioid systems theory
act as neuromodualtors and have inhibitory actions on pain pathways release of opiopetins plays important role in controlling pain during emotional stress act of C fibers peripherally but NOT A delta explains paradoxical pain relieving effects of painful stimulation like acupuncture and TENS
36
pain management appraches act physiologically by doing what
controlling inflammation altering nociceptor sensitivity increased binding to opioid receptors modifying n conduction modulating pain transmission altering higher level aspects of pain perception management of psychological and social aspects
37
drawbacks to pharmacologial agents for pain management
adverse side effects may not be sufficient risk of dependence may need multidisciplinary treatment pt adherence
38
what are systemic analgesics and examples
primary method of pain management i.e. NSAIDs, acetaminophen, opiates, antidepressants, sedatives
39
what are spinal analgesia drugs and examples
epidural or subarachnoid space of spinal cord; bypass brain blood barrier and reduce systemic side effects opiods, local anestheics, corticosteroids
40
what are local injections/benefits
into structures or painful/inflamed areas short term pain relief used mainly for procedures
41
all pharmacological agents control pain by
modifying antiinflammatory mediators at periphery altering pain transmission from periphery to cortex altering central perception of pain
42
pt edu for pain management should include
info about neuophysiology of pain reassurance that pain with mvmt isn't a sign of further damage reassure that pain is normal post trauma complete elimination of pain is not generally achievable in short term pain is multifactorial pain almost always resolves with time
43
what modalities assist in pain management
thermo = cold/hot pack mechanical = US, traction, compresison EMT = ESTIM, laser light
44
what are the benefits of physical agents
reduce intensity (prevents acute turning chronic) give pt some control over symptoms pt can have autonomy reduced medical cost minimal risk of adverse side effects no risk of dependence no sedation opportunity to practice related pain management skills give pt therapeutic window
45
how does TENS control pain
stimulates A beta fibers and stimulates release of opiopeptins at spinal cord and higher levels

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