Lecture 5.1 - Pain Flashcards
What is the IASP definition of pain?
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
What timeframe separates acute and chronic pain?
Acute - less than 3 months
Chronic - Over 3 months
What is the etiology of acute pain?
Related to underlying tissue damage - is protective
–> Pain proportionate to tissue damage
What is the etiology of chronic pain?
Related to central sensitization (non-productive)
–> May be out of proportion to physical findings
How does anxiety, worry, and depression affect pain perception?
Opening the gate and increasing pain
How does distraction, relaxation, and positive emotion affect pain perceptions?
Close gate and decrease pain perception
What is central sensitization?
A pathological process where the CNS changes in a way that alters processing of pain/other stimuli
–> Heightened pain response
What is the goal of assessment of acute pain?
Confirm the etiology
What is the goal of assessment with chronic pain?
Rule out secondary sources of pain
What are different causes of cancer pain?
Disease process, treatment, or diagnostic tests
–> Peripheral neuropathy seen with chemotherapy
What kinds of pain are associated with surgical pain?
Inflammation, neuropathic, myofascial, phantom limb, dressing changes
What is allodynia?
When a non-painful stimulus induces pain signal
–> e.g., light touch producing pain
What is myofascial pain?
Stemming from the myofascial system
–> Described as stiff, tight, tense, sharp, radiating
What is hyperalgesia?
When a painful stimulus causes severe pain out of the proportion to the stimulus
–> BP cuff/venipuncture causes severe pain
What are the element of the biopsychosocial model of pain?
Biological, social, physical
What are relevant Hx questions related to pain to ask a patient?
Surgical history
History of similar pain
Complex pain diagnosis - diabetes, neuropathic pain
What are some red flags with pain assessment?
Pain associated with fever
Weight loss
Waking during the night
Associated with neuro deficits/radiculopathy
When is a self-report pain rating scale appropriate?
For children 3-4+ years of age
When would a behavioural pain assessment tool be useful?
For infants or children under 4, or for children and teens who are over 4 and nonverbal
With what age group is the Wong-Baker scale appropriate?
Children older than 3
With what population can the numeric rating scale be used to assess pain?
Children 5+ who are able to count
Most often used in children 8+
What are some limitations of self-report pain rating scales?
Assesses quantity, but non quality or features
What are the challenges of behavioural pain measures?
It can be hard to discriminate pain from anxiety or another distressing factor.
Must consider developmental age of child, as well as parental input of their child’s pain behaviour
What population is the NIPS used for? How long should the pt be assessed for?
up to 1 year of age
–> Monitor for minimum of 30-60 seconds
What age group is the FLACC scale used for? How long should you assess the patient for?
2 months-7 years
–> Observe for minimum of 3-5 minutes
What things are observed with a FLACC scale?
Face, legs, activity, cry, consolability
What population can be assessed with the revised FLACC scale?
populations 4-21 years with a cognitive impairment or are non-verbal
How does the revised FLACC scale differ from the original?
Different populations (2months-7years compared to 4-21 with cognitive impairment)
Revised FLACC has a column for individual pain behaviours
With what age group is the adolescent pediatric pain tool used with?
8+
–> Useful for pain location, intensity, and quality (multidimensional)
What kind of pain is the DN4 used for?
Neuropathic pain
What are the common co-morbid diagnoses with chronic pain?
Anxiety, Depression, Somatization/Functional Neurological Disorder, Dysautonomia like POTS
What is the 3P approach to pain management?
Pharmacological
Physical
Psychosocial
What is the three step process of pharmacological pain management?
Step 1 - Non-opioid analgesia + adjuvant
Step 2 - Weak opioid + non-opioid + adjuvant
Step 3 - Strong opioid + non-opioid + adjuvant
What is multimodal analgesia?
Use of 2+ analgesic medication in different classes with different mechs of ac that work synergistically
–> Increased analgesia effects with less side effects
–> Reduced opioid requirements
What are some physical strategies to reduce pain?
Skin-to-skin
Swaddling, cuddling
Weighted blanket
Non-nutritive sucking
Breastfeeding
Sucrose
Heat/Cold
What are some psychological strategies to treat pain in children?
Parental presence
Mindfulness, meditation, yoga
CBT
Distractions
–> Fidgets, coloring, bubbles, pet therapy, screen time
What are the 3Vs of pain validation?
Verify
–> All secondary sources have been ruled out
Vocalize
–> the pathophysiology of chronic pain and central sensitization
Validate
–> Patient and family’s pain experience
What are the consequences of invalidation of pain?
Lack of pain validation leads to a threat to self identity and guilt, shame and anxiety.
It also leads to loss of social support –> Diminished coping resources
Both of these lead to psychological stress which exacerbate chronic pain
What are some important questions to ask a patient with chronic pain?
Take a good history
–> PQRSTU
–> Functional Interference + impact on mental health
What are the most commonly used behavioural pain measures?
Neonatal Infant Pain Sale (NIPS)
FLACC (Face, Legs, Activity, Cry, Consolability)
Revised FLACC
What is the purpose of the neonatal infant pain scale?
To determine if the child is experiencing any pain
–> Score 0-7
3+ indicates moderate to severe pain
Why is codeine not recommended for treatment of pain in children under 12?
Safety and efficacy problems related to genetic variability in biotransformation
–> Metabolized differently by different people, difficult to standardize a dosage
