Lecture 9: Pain assessment and Management Flashcards
who has the highest prevalence of persistent pain
indigenous people
consequences of untreated pain
- unnecessary suffering
- physical dysfunction and psychosocial distress
- impaired recovery from acute illness and surgery
- immunosuppression
- sleep disturbances
what is addiction
complex neurobiological condition that is a drive to obtain and take substances for other than the prescribed therapeutic value
- opioid addiction in acute care clients w no history of substance abuse is <1%
why is pain undertreated (among healthcare providers)
- if pt’s pain doesn’t seem as severe as it appears or pt is not reporting pain - can be a result of a bad assessment.
- or pt has an addiction
- bad assessment
- misconception
- not reporting
why is pain undertreated (among pt)
- fear of addiction
- beliefs and attitudes regarding pain
drug tolerance
need for an increased dose to maintain same degree of pain control
what can be confused with addiction
- drug tolerance
- physical dependence
what is physical dependence
physiological response to ongoing exposure to pharmacological agents that is manifested by a withdrawal syndrome that occurs when drug is abruptly stopped
- drug should be tapered off
what are some withdrawal sympt, how long can they last w opioids
muscle pain, sweating, diarrhea, vomiting, abdominal cramps, chills, anxiety, insomnia, tremor
can last for 3-10 days w immediate release opioids; 10-20 days with controlled-release or slow-release opioids.
what is the relationship btwn tolerance, physical dependence and addiction
tolerance and physical dependence are not indicators of addiction, but result from chronic exposure to certain drugs
what is the most serious side effect of opioids
respiratory depression is the most serious side effect of opioids
what reverses the resp effect of opioids
narcan (naloxone)
what is a common concern about providing drug to relieve pain
will participate the death of a terminally ill person
- rule of double effect
what is the rule of double effect
if an unwanted consequence occurs as a result of an action taken to achieve a moral good (i.e. pain relief), the action is justified bc the nurse’s intent is to relieve pain and not hasten death
what are the dimensions of pain
- physiological
- affective
- behaviours
- sensory
- cognitive
nociception
physiological process that communicates tissue damage to the CNS
what are the mechanisms by which pain is perceived
- transduction (stim cause cell damage with release of sensitizing chemicals, substances activate nociceptors and lead to generation of action potential)
- transmission (action potential continues site of injury to spinal cord, etc)
- perception (conscious experience of pain)
- modulation (neurons originating in the brainstem descend to the spinal cord and release substances that inhibit nociceptive impulses)
what are the sensory-pain elements
Pattern
Area
Intensity
Nature
emotional response to pain experience
anger
fear
depression
anxiety
3 dimensions of pain
- Behavioural
- Cognitive
- Sociocultural
Classification of Pain
By underlying pathology
- nociceptive pain
- neuropathic pain
By temporal nature
- acute
- persistent/chronic
what is nociceptive pain?
+ 2 types
caused by damage to tissue
- somatic pain: from bone, joint, muscle, skin or connective tissue. usually aching and throbbing, well localized.
- visceral pain: arises from internal organs. tumor involvement (aching and well localized). obstruction of hollow organ: intermittent cramping and poorly localized)
neuropathic pain
- damage to nerve cells or changes in spinal cord processing
- described as burning, shooting, stabbing, or electrical in nature
- can be sudden, intense, short-lived
- management: opioids, anticonvulsants and antidepressants
acute pain
- sudden onset
- mild to severe
- within normal time for healing
- manifestations reflect SNS activation
- treatment goal: pain control w eventual elimination
