Module 3: Pain Flashcards
pain=
• Pain=unpleasant sensory and emotional exp assoc w actual or potential tissue damage
types of pain:
- acute pain
- procedural pain
- chronic (noncancer pain)
- cancer related pain
what type of pain can seldom be associated w a specific injury?
chronic pain
what type of pain usually dec as healing occurs
acute pain
as long as no lasting damage has occured and no systemic disease exists
what type of pain can last from days to 6 months but usually is gone within 6 weeks
acute pain
is cancer related pain acute or chronic?
may be both
what percentage of CA pts have pain?
70-90%
one reason chronic pain is difficult to treat?
its origin is often unknown
chronic pain definition
• Constant or intermittent pain that persists beyond the expected healing time ad can seldom be attributed to a specific cause or injury
3 types of chronic pain according to their patho
nociceptive
neuropathic
mixed type
hat type of pain is a migraine
chronic nociceptive and neuropathic pain
chronic nociceptive pain=
?2 examples
arises from chronic stimulation of pain receptors-aching throbbing quality) eg arthritis and fibromyalgia
if healing is expeted within 3 weeks and the pt is still in pain what type of pain is it?
now chronic
what do nurses lack/have that leads to poor assessment and uncontrolled pain
misconceptions and lack of knowledge
T or F almost all cancer pain can be relieved
T
T or F almost all acute pain can be relieved
T
T or F most pts w chronic noncancer pain cant be helped
F. they can be helped
who does the best approach to pain mgmt involve?
pt, family, HCW
what should you inform a pt and family in pain because Tx of pain is a basic human right
theyve a right to the best pain care possible
-encourage them to communicate the severity of their pain
____type of pain is
• Brief intense pain from diagnostics, therapeutic and preventive processes
procedural pain
how long does procedural pain last
• Lasts seconds-hrs
effects of procedural pain
• Effects of
o Often long lasting physiological and psychological effects
o May lead to avoidance of procedure d/t anxiety
effects of acute pain
• Effects of acute pain
o Pulmonary, endocrine, immune sys mostly due to stress response
o Stress response: inc metb rate, inc CO, impaired insulin response, Inc retention of fluids, Inc prod of cortisol
-the stress response may inc the risk of physiological disorders eg MI and has other neg effects
-may inc fatigue
effects of chronic pain (noncancer)
• Effects of:
o Suppression of immune fx may lead to tumor growth
o Depression and disability
o Poor quality of life
what type of pain May begin with an injury or may be due to nerve compression by tumors, nerve inflammation by infection, or nerve impairment from systemic diseases like diabetes. or chemicals or drugs
neuropathic pain
what type of pain is this?? pain arising from a nonpainful stimulus such as a breeze or light touch of clothing or bedding
eg diabetic neuropathy, phantom limb pain and sensation, posttherapeutic neuralgia
allodynia
an example of mixed pain sndromes
migraine
what is visceral pain
nociceptive pain that involves organs
fibromyalgia=
primariy effects?
a chronic pain syndrome char by generalized musculoskeletal pain trigger points stiffness fatigability sleep disturbances aggravated by stres affects mostly young women
_____ pain is caused by malfunction in the nerves, spinal cord or brain
neuropathic pain
? antidepressants and antieleptic drugs are used as adjuvants for treatment of
neuropathic pain
which type of pain problem is assoc w complications of chickenpox and shingles?
postherpetic neuralgia
?who does postherpetic neuralgia frequently occur in?
o adults
?what type of pain syndrome affects up to 80% of stroke pts?
hemiplegia-assoc shoulder pain
hemiplegia-associated shoulder pain may result from?
how is it preventable
uncompensated gravity on shoulder joint
functional electrical stimulation of involved shoulder muscles
what type of pain may arise following injury to a limb?
symptoms
complex regional pain syndrome
symptoms: pain
changes in affected limb eg color temp etc
abn sweating
are those affected w neuropathic pain gnerally slightly or significantly incapacitated
significantly
generally the most feared outcome of cancer is
pain
most cancer pain is assoc w
tumor involvement
what is it about the procedure that adult pts usually dread
the anxiety not the pain
poorly managed pain may lead to catasphrophizing in vulnerable individuals (in reference to procedural pain what does this entail?)
its a neg cognitive response marked by preoccupation w the pain stimulus, inflation of its potentia threat, and a sense of helplessness
is it easier to prevent or manage procedural pain?
prevent
is it safer to not administer gradually inc doses of opioid meds because of their side effects?
no. failure to admin adequate pain relief may be unsafe because of the onsequences of unrelieved pain
what aspects of life can chronic pain affect
all even socioeconomic
• neurologic transmission of pain is referred to as
nociception
• because of connection between various parts of nervous sys involving pain signals what type of effects (broad terms) accompany pain?
vasomotor, autonomic and visceral effects accompany pain eg dec or ceased peristalsis in pt w sever pain
algogenic=
causing pain
as a result of the conscious perception of pain how may people report the same stimulus
people may report the same stimulus differently based on their anxiety level, past exp, and expectations
for pain to be consciously perceived what must happen?
neurons in the ascending system must be activated. this happens as a result of input from nociceptors
whats the decending control system and how can it be affected to relieve pain?
(System of fibres that originate in the lower and midportion of the brain and terminate n the inhibitory interneuronal fibres in the dorsal horn of the spinal cord)
-Always active-prevents continuous transmission of painful stimuli partly through the action of endorphins
as nocicpetion of pain occurs what system is activated to inhibit pain?
descending control system
• chemicals that reduce or inhibit perception of pain
?how?
endorphins and enkephalins (both endogenous, morphine like substances)
by stimulating the inhibitor interneuronal fibres which reduce the transmission of noxious impulses via the ascending system
• prostaglandinds believed to inc the pain sensitivity of pain receptors by enhancing the pain provoking effect of _______
bradykinin
in the peripheral nervous sytem there are type A delta fibres transmit nociception rapidly-fast pain. Type c fires transmit second pain (dull aching burning)
if theres repeated type C pain what should the nurse do and why?
fi repeated type C pain theres greater response in dorsal horn network. Therefore, imp to treat pts w analgesic agents when they first feel pain.
the strategy of distraction works on which system?
is it long lasting
• Cognitive proc may stim endorphin prod in the descending control system and inc activity in the system
eg distraction amplifies this and pt may report less pain when visitiors there or when watching TV
once the distraction ends the activity in the descending control system ceases resulting in inc transmission of painful stimuli
which theory of pain was first to articulate the existence of a pain modulating system
gate control theory
gate control theory of pain
stimulation of the various sizes of nerve fibres have different effects eg stim of lg diameter fibres inhibits the transmission of pain and closes the gate. the mechanism of opening and closing the gate in influenced by nerve impulses that descend from the brain
the gate control theory of pain guided research towards…
identifying cognitive behavioural approaches to pain mgmt
it explains how distraction and music therapy relieve pain
Factors influencing the pain response
• May inc or dec perception, tolerance and also affect responses
past exp anxiety and depressio culture gender age
how does past exp influence pain
Past exp
• The more exp people have w pain, the more frightened they are likely to be and less able to tolerate, want relief sooner. Esp if pains been pooly managed in the past
• If past pain was constant and unrelenting they may become irritable, withdrawn and depressed
• Nurses should be aware of pts previous exp w pain
• If pain relieved promptly and adequately the person may be less fearful fo future pain and better able to tolerate it
how does anxiety influence pain
doenst nec inc it. sometimes it distracts the pt fromt he pain.
it is more effective to relieve pain by directing Tx at anxiety
no. treat the pain
how does Routine use of antianxiety meds affect pain
may prevent pts from reporting pain because of sedation and may impair their ability to take deep breaths, get out of bed and cooperate with tx plan
how can you alleviate depression assoc w pain
treat the pain
T or F people from diff cultures who exp the same intesity of pain wont report it the same way but will respond in the same way
F. both the response and reporting may be different
factors that help explain the diff between cultural groups
• Age, gender, education, income help explain hese diffs
the degree that the pt identifies with their cult
their interactions w the health care system
T or F sociocultural mechanisms are solely responsible for cult differences in pain
F • Psychological, sociocultural, biological mechanisms are responsible for cult differences in pain
are wait times in Canadian hospitals related to related to pt reports of pain
no
which ethnicity waits longer in ER vs __
• African Canadians waited longer to be seen than Caucasian pts
should the nurse react to the pts perception of pain or their behaviour and why?
• Nurse should react to the pts perception of pain and not the persons behaviour because the persons behaviour may differ from the nurses cultural expectations
how can the nurse be sensitive to how pain affects culture?
recognize how your values differ fromt he values of other cultures, this helps avoid falling into expectations or stereotyping
recog that cult diffs exist
be aware of power and communication issues that affect care outcomes
how can you educate a pt so their pain will be treated better
teach how and what to communicate abt their pain
what should a nurse be aware of in r/t older adults and Sx
• Older a must receive adequate pain relief after Sx or trauma. When olde pt becomes confused after Sx or trauma its often attributed to meds which are then discount but it might be from pain
what should the nurse assume abt a pt who is older and pain
dont assume! its not normal part of aging
• Judgments abt pain and the adequacy of Tx should be based on the pts report of pain and pain relief not age
what do older adults often fear surrounding pain and Tx
addiction
T or F older adults exp more pain
why?
F
• Loss of un/myelinated fibres in peripheral n sys—may lead to diminished pain perception. Some say d/t a disease proc
gerontologic considerations influencing the pain response
- Loss of un/myelinated fibres in peripheral n sys—may lead to diminished pain perception. Some say d/t a disease proc
- Some older a believe pain is normal part of agin
- They may not know how to describe it
- Older a have slower metb and greater ratio of body fat-muscle mass-smaller doses may be sufficient to treat
- Many fear addiction
- Older a must receive adequate pain relief after Sx or trauma. When olde pt becomes confused after Sx or trauma its often attributed to meds which are then discount but it might be from pain
- Judgments abt pain and the adequacy of Tx should be based on the pts report of pain and pain relief not age
pain is more prevalent in which gender
wmen
risk factors for women assoc w chronic pain
age
education
marital status
factor in gender differences in pain experience
socialization
which gender report higher pain intensity, unpleasantness, frustration and fear
women
Common concerns and misconceptions abt pain/analgesia
- Will distract dr from responsibilities
- Natural part of age
- Pain meds cant really control pain
- Addiction 2 easy
- Easier to put w pain than side e of meds
- Good pts don’t talk abt pain
- Pain builds char
- Pain meds should be saved for other worse off pts
- Pts should expect to have pain
considerations in pain assessment
- Believe pts who report pain and investigate those who aren’t when most would eg person having had joint replaced denies pain but says they feel immense P. After this you should use their words eg do you have any pressure (not pain)
- Some deny pain out of fear of addict others fear the Tx that may result
- Ass. What level of pain relief the pt believes is nec, pts expectatiosn and misconsceptions, why theyre denying they are in pain
- Pts who understand that pain relief not only contributes to comfort but also speeds recovery are more likely to agree to Tx or self-administer
factors to consider in a complete pain assessment
location quality quantity timing setting assoc symptoms alleviating factors aggravating factors ENVIRONMENTAL FACTORS SIGNIFICANCE TO THE PT PT PERSPECTIVE PAIN MGMT GOAL FUNCTIONAL GOAL
referred pain=
pain that radiates
whats the correlation between reported intensity of pain and the stiumuls that produced it
none
how can you understand the pts reported pain intensity or quantity
ask abt present pain and least and worst pain intensity
use a scale
sudden pain that rapidly reaches max intesity is indicative of ______ and requires ____
tissue damage and needs immediate intervention
timing of ischemic pain
gradually inc and becomes intense over a longer time
when is rheumatoid arthritis pain worst
at night
how does discussion of pain exp w pt help the clinician
gives understanding of how th pt is affected and ths helps in planning Tx
to gain insight into how a persons financial situation, work is affected, disease my be worsening its imp to ask
how is your daily life affected by pain
some may be able to continue to work
how dyou treat unconscious pt in regards to pain
• In unconscious pts pain should be assumed to be present and be treated
how should physiologic responses to pain be used
theyre not reliable as theyre short lived because the body adapts to stress
they may signify a change in the pts condition eg hypovolemia
which pts may find it difficult to use a visual analogue scale?
what use instead?
young kids
oder adult who re visually impaired or cognitively impaired
use a descriptive pain intensity scale or numeric
if pt has diff w 0-10 scale what can you do?
use 0-5 scale
or another scale
when should teaching of how to use a pain scale occur?
before a painful Tx or Sx
physiologic reactions to pain
• Physiologic responses to pain o Tachycardia o Pallor\ o Diaphoresis o Tachypnea o Mydriasis (ilation of the pupil of the eye.) o Hypervigilance o Inc muscle tone o All of the above are r/t activation of the autonomic n sys
sensitization=
• Sensitization-a heightened response seen after exposure to a noxious stim. Reponse to the same stim is to feel more pain
some ways to provide nursing care to pt in pain
- To improve pt comfort keep them comfy and brush hair etc
- Teaching in advance may dec anxiety
- Learning about ways to dec pain in advance can empower them
- Many pts believe that they shouldn’t request pain relief until they cant tolerate the pain. Explain to them value of early Tx
considerations for pain at end of life
Pain at end of life
• Pain is one of most feared symp at EOL
• Barriers: addiction fears and lack of edu
• Requires comprehensive ass and mgmt which can be difficult bec of confusion, delirium, unconsciousness
• Caregivers are taught to observe for signs of restlessness or facial expressions as a prox indicator of pain
• Neuropathic pain requires a diff type of Tx than acute pain
a method to dec anxiety r/t pain Tx
teach the pt what degree of relief from each tx theyre likely to experience
End of life tx of pain and opioids
- Ass for resp depression-rate depth and LOC monitored. A resp rate of 6 or greater is usually enough to not be depression.
- If resp depression occurs a dec in dose may be nec as well as freq stim to do deep breath exercises until metb of opioid. Comfort should be priority when EOL.
- Bowel regimen and other side e must be managed
what is the goal of pain mgmt strategies
to completely relieve pain. not reduce it to bearable levels
whats a surprising thing you should assess when treating pain pharmacologically
Pharmacologic interventions
• Ass pts rcial and ethnic background (genetics plays role in varied responses to NSAIDS and opioids esp w codeine where they don’t get its analgesic effect
pt has pruritus in response to opioids. are they allergic?
probably not. this is common side e
how can you know wehn to inc dose of opioid
• Ass vitals including pain score before giving opioid and if within half hr pain is still present but resps bp etc are good then some change in analgesia is nec
opioid tolerance and addiction
- Theres no known max safe dose of opioids or easily identifiable therapeutic serum level
- All individual
- Tolerance dev in almost all pts taking them for a time
- Pts tolerant of lg doses of morphine may benefit from switching to diff opioid
- Symptoms of dependence may occur when the opioids are discontinued. Dependence often occurs w opioid tolerance and doesn’t indicate an addiction
- Ddiction is very negigiblewhen giving therapeutic doses
- When caring for pt w hx of addiction consider that ea person has right to be treated for pain
