module 3: pain Flashcards
what is an analgesic?
relieves pain without causing loss of consciousness
what is an opioid?
any drug natural or synthetic that has actions similar to morphine
what is an opiate?
applied only to compounds present in opium
endogenous opioid peptides?
- enkephalins, endorphins, dynorphins
- NT, neurohormones, neuromodulators
- CNS and peripheral tissue
what are opioid receptors?- Mu and Kappa
- opioids dont interact with delta
- Mu receptors: activation linked to physical dependence (analgesica, resp depression, euphoria, sedation)
- Kappa receptors (analgesia, sedation, psychotomimetric effects)
3 classifications of drugs that act at opioid receptors?
- pure opioid agonists
- agonist-antagonist opioids
- pure opioid antagonists
what are pure opioid agonists?
-activate mu and kappa. analgesia, euphora, sedation, resp depression, physical depedence, constipation (codeine)
what are agonist-antagonist opioids?
-antagonize analgesia caused by pure agonist
what are pure opioid antagonists?
-do not produce analgesia or anything. used to reverse resp and CNS depression (nalaxon)
other strong opioids?
none are better than opiods
what are adjuvant analgesics and off-label uses?
- complement the effects of opioids (combination)
- enhance analgesia
- treat side effects caused by opioids
- neuropathic pain
- pain relief= limited and less predictable
antidepressants?
- AMITRIPTYLINE
- can reduce pain or neuropathic origin
- elevate mood
- dosing at bedtime is best
- effects start after 1-2 weeks, max after 4-6
antiseizure drugs?
- can help relieve neuropathic pain
- acute pain such as sharp, darting, burning pain
- GABAPENTIN
marijuana?
- most commonly used illicit drug
- cannabis sativa: the source of marijuana (indian hump plant)
psychoactive component of marijuana?
THC (high lipid solubility), highest concentration in female flowers in the flowering tops
pain is… the 5th..
vital sign
who decides what pain is?
what the patient says it is!
-most common reason for seeking health care
basic physiology of pain?
-travels up neuroreceptors through spinal cord–> brain–> brain back to area of pain
different types of pain (4)?
acute pain- fall down stairs and break a leg
procedural pain- get appendix removed
chronic pain- persistent, starts acute and can cause chronic pain
cancer- related pain, can be chronic but is its own category
factors influenced the pain response?
- past experience
- anxiety and depression
- culture
- age (elderly neurons less)
- gender
- genetics
- expectations
pain assessment?
NOPRQRSTUV norma onset provoking quality region/radiation severity treatment understanding values
Interventions (non-pharmacological) for pain?
- acupuncture
- massage
- heat
- cold
- meditation
- relaxation therapy
- art/music therapy
- physical care
- support persons
WHO analgesic ladder?
bottom of ladder: nonopioid +/- adjuvant
middle of ladder: pain persisting or increasing, opioid +/- nonopioid, adjuvant
top of ladder: pain persisting or increasing, opioid for moderate to severe pain
what is actually a definition of pain?
unpleasant sensory and emotional experience associated with actual or potential tissue damage
most common reason for seeking health care?
pain
what disables and distresses more than any single disease?
pain
what is acute pain?
recent onset, specific injury
- usually decreases as healing occurs if no lasting damage or systemic disease
- can last from days to 6 months
what can lead to poor assessment or uncontrolled pain?
lack of knowledge and misconceptions regarding pain
what is procedural pain?
brief intense after diagnostic, therapeutic and preventative procedures
- seconds to hours, may become acute pain
- needle puncture or wound debridement and cleaning
what is chronic pain?
constant or intermittent pain that persists beyond the expected healing time, usually not attributed to a specific cause or injury
-unrelieved= socioeconomic burdens
3 categories of chronic pain?
-nocireceptive, neuropathic, and mixed type
chronic nocireceptive pain?
-arises from constant stimulation of pain receptors and signals tissue damage in skin, bone, joints, or viscera (arthritis, fibromyalgia)
what is allodynia?
pain arising from a nonpainful stimulus such as a breeze or light touch of cling or bedding. postherpetic neuralgia, diabetic neuropathy, phantom limb pain/sensation
mixed chronic pain?
mix of neuropathic and niciceptive- migraine pain
what is neuropathic chronic pain?
Triggered by nerve damage or malfunction of peripheral & central nervous systems resulting in abnormal signaling. May be due to nerve compression by tumors, nerve inflammation by infection, nerve impairment from systemic disease such as diabetes. Burning, tingling, piercing.
harmful effects of acute pain
changes to pulmonary, CV, GI, endocrine, immune systems
- more harmful to those who: age, illness, injury
- stress response
- unable to deep breath, fatigued, decreased mobility
harmful effects of procedural pain
-cycle of pain, anxiety, fear that leads to avoidance of procedure
harmful effects of chronic pain
- suppression of immune system- promote tumor growth
- depression, disability, low quality of life, can disrupt life
what are nociceptors?
neurologic transmission of pain
do large organs have nociceptors?
no, you feel pain in these organs from intense stimulation of receptors that have other purposes (stretch, spasm, ischemia, dilation)
culture and pain?
ppl learn from early childhood how to respond to team. no stereotyping! understand cultural differences
gerontological considerations and pain?
- loss of fibres- decreased nerve function- diminished pain perception (secondary to disease process, not really a part of normal aging)
- smaller doses may be okay because slower metabolism
- confusion may mean pain
- dont base pain relief on age
