Lewis Ch 8 (Pain) Flashcards
complex, multidimensional experience that can cause suffering and decreased quality of life
pain
what is the most valid means of assessment with pain
self-report, subjective information
what are negative consequences of unrelieved acute pain related to cardiovascular system
increased heart rate
increased bp
what are negative consequences of unrelieved acute pain related to endocrine/metabolic system
increased cortisol
increased glucose levels
what are negative consequences of unrelieved acute pain related to GI system
decreased gastric mobility
what are negative consequences of unrelieved acute pain related to immunologic system
decreased immune response
increased risk of infection
what are negative consequences of unrelieved acute pain related to neurological system
impaired cognition
(dimension of pain) emotional responses include anger, fear, depression and anxiety; negative emotions impair patient’s quality of life
affective
(dimension of pain) observable actions (grimacing, irritability, coping skills) are used to express or control pain
behavioral
(dimension of pain) beliefs, attitudes, memories, and meaning attributed to pain influence the ways in which a person responds to pain
cognitive
(dimension of pain) genetic, anatomic, and physical determinants of pain influence how painful stimuli are processed, recognized, and described
physiologic
(dimension of pain) age and gender influence nociceptive processes and responses to opioids; families and caregivers influence patient’s response to pain through their beliefs, behaviors and support; culture affects pain expression, medication use, pain-related beliefs, and coping methods
sociocultural
what are the five dimensions of pain
affective behavioral cognitive physiologic sociocultural
Physiologic process that communicates tissue damage to the CNS
nociception
what are the four processes involved in nociception
- transduction
- transmission
- perception
- modulation
(1/4 processes in nociception) release of chemical mediators, Conversion of a noxious mechanical, thermal, or chemical stimulus into a chemical signal called an action potential
transduction
(1/4 processes in nociception) The process by which pain signals are relayed to the spinal cord and then the brain.
transmission
(1/4 processes in nociception) Conscious awareness of pain
perception
(1/4 processes in nociception) Activation of descending pathways that exert inhibitory or faciliatory effects on the transmission of pain
modulation
what five chemicals are released because of noxious stimuli during transduction
prostaglandins bradykinin serotonin substance P histamine
two types of classifications of pain according to underlying pathology
nociceptive (somatic or visceral)
neuropathic
1/2 types of pain according to underlying pathology
- damage to somatic or visceral tissue
- surgical incision, broken bone, arthritis
- usually responsive to opioid and nonopioid analgesics
nociceptive (somatic or visceral)
1/2 types of pain according to underlying pathology
- damage to peripheral nerves or CNS
- numbing, hot, burning, shooting, stabbing, or electrical in nature
- sudden, intense, short lived, or lingering
- due to trauma, inflammation, or metabolic diseases
- not well controlled by opioid or nonopioid analgesics
neuropathic
type of pain according to duration
- sudden onset
- lasts less than three months or time takes to heal
- mild to severe
- usually precipitating event or illness can be identified
acute pain
type of pain according to duration
- gradual or sudden onset
- longer than 3 month duration or normal healing time
- mild to severe
- cause may be unknown
chronic pain
typical physical and behavioral manifestations of acute pain
- increased heart rate, bp, and resp rate
- sweating, pallor
- anxiety, agitation, confusion
- urine retention
typical physical and behavioral manifestations of chronic pain
- flat affect
- decreased physical activity
- fatigue
- withdrawal from social interaction
two types of somatic pain (nociceptive)
superficial
deep
type of somatic pain: Arises from skin, mucous membranes, and subcutaneous tissues
superficial
type of somatic pain: Arises from bone, joint, muscle, skin, or connective tissue
deep
type of nociceptive pain: Activation of nociceptors in the internal organs and lining of the body cavities; respond to inflammation, stretching, ischemia
visceral pain
what are examples of adjuvant analgesics used to treat neuropathic pain
- antidepressants
- serotonin norepinephrine reuptake inhibitors (SNRI)
- antiseizure drugs
- transdermal lidocaine
- a2-adrenergic agonists
- NMDA receptor antagonists and a2-adrenergic agonists
The location of pain reported is different from site of injury or inflammation.
referred pain
common area referred pain for lungs and diaphragm
left side of neck (anterior and posterior)
common area referred pain for heart
jaw, middle of posterior shoulderblades, left arm
common area referred pain for liver
right side of neck (anterior and posterior)
sternum
mid-back on right side
common area referred pain for gallbladder
right shoulder
common area referred pain for ovaries
posterior and anterior sites lateral to umbilicus
common area referred pain for kidneys
low back on either side of spine
right lateral thigh
common area referred pain for ureters
anterior underwear region
common area referred pain for bladder
posterior inner thighs and buttocks
myelinated, rapidly conducting fibers that carry action potential from the nociceptors to spinal cord during transduction
A fibers
unmyelinated, slowly conducting fibers that carry action potential from the nociceptors to spinal cord during transduction
C fibers
increased susceptibility to nociceptor activation, ex: sunburn
peripheral sensitization
Nerves that carry pain impulses from the periphery to the spinal cord
primary afferent fibers
fibers that conduct pain rapidly and are responsible for the initial, sharp pain that accompanies tissue injury.
A fibers
fibers that transmit painful stimuli more slowly and produce pain that is typically aching or throbbing.
C fibers
what are the three segments are involved in nociceptive signal transmission
(1) transmission along the peripheral nerve fibers to the spinal cord
(2) dorsal horn processing
3) transmission to the thalamus and cerebral cortex
areas on the skin that are innervated primarily by a single spinal cord segment.
dermatomes
neurons that project to the thalamus
second-order neurons
Increased sensitivity and hyperexcitability of neurons in the CNS
central sensitization
pain from a stimulus that is not typically painful
allodynia
processes that allow neurons in the brain to compensate for injury and adjust their responses to new situations or changes in their environment
neuroplasticity
type of neuropathic pain: Caused by primary lesion or dysfunction in the CNS
Examples: Poststroke pain, pain associated with multiple sclerosis
central pain
type of neuropathic pain: Pain felt along the distribution of 1 or many peripheral nerves caused by damage to the nerve
Examples: Diabetic neuropathy, alcohol-nutritional neuropathy, trigeminal neuralgia, postherapeutic neuralgia
peripheral neuropathies
type of neuropathic pain: Pain resulting from a loss of or altered afferent input
Examples: Phantom limb pain, postmastectomy pain, spinal cord injury pain
deafferentation pain
type of neuropathic pain: Pain that persists secondary to autonomic nervous system dysfunction
Examples: Phantom limb pain, complex regional pain syndrome
sympathetically maintained pain
occurs when pain is recognized, defined, and assigned meaning by the person experiencing the pain
perception
transient, moderate to severe pain that occurs in patients whose baseline persistent pain is otherwise mild to moderate and fairly well controlled
breakthrough pain
pain that occurs before the expected duration of a specific analgesic
end-of-dose failure
increasing the dose beyond an upper limit provides no greater analgesia
analgesic ceiling
what nonopioid analgesic is liver toxic
acetaminophen (tylenol)
what nonopioid analgesic presents a great risk for GI bleeding
aspirin
what is the max daily oral dose of tylenol
300 mg
what are some examples of NSAIDs (5)
- celebrex
- diclofenac K
- ibuprofen
- ketorolac
- aleve
what are two examples of salicylates
aspirin
trilisate
what salicylate is used more often in low doses as a cardioprotective measure than for its analgesic properties
aspirin
what are examples of pure opioid agonists(6)
- oxycodone
- hydrocodone
- codeine
- methadone
- dilaudid
- levorphanol
what two opioids are very likely to cause respiratory depressions
morphine
dolophine
what class of opioids (physiologic action) are these in:
- codeine
- fentanyl
- hydrocodone with acetaminophen
- dilaudid
- levorphanol
- dolophine
- morphine
- oxycodone
- nucynta
- oltram
agonists
what class of opioids (physiologic action) are these in:
- butorphanol
- talwin
mixed agonist-antagonist
what class of opioids (physiologic action) are these in:
- buprenorphine
- suboxone
partial antagonist
what opioid is largely avoided now because of its neurotoxicity and tendency to cause seizures
demerol
what is the most common side effects of opioids
constipation
what are the five levels of sedation in the POSS
sleep
- awake and alert
- slightly drowsy
- frequently drowsy
- somnolent
dose adjustment based on assessment of the adequacy of analgesic effect versus the side effects produced
analgesic titration
dose of 1 analgesic that is equivalent in pain-relieving effects to a given dose of another analgesic
equianalgesic drug
method that allows the patient to self-administer preset doses of an analgesic within a prescribed time period by activating an infusion pump
patient-controlled analgesia (PCA)
physical nondrug therapies to treat pain (5)
- heat and cold
- TENS unit
- acupuncture
- massage
- exercise
cognitive nondrug therapies to treat pain (4)
- distraction
- hypnosis
- imagery
- relaxation strategies
common examples of barriers to pain management by patient
- fear of addiction
- fear of tolerance
- fear of side effects
- desire to be stoic
early responses (12-24 hours) of opioid withdrawal
- anxiety
- lacrimation
- sweating
- shaking, chills
- dilated pupils
late responses (48-72 hours) of opioid withdrawal
- excitation
- diarrhea
- restlessness
- fever
- nausea and vomiting
- hypertension
- tachycardia
- insomnia
