MODULE 3: PATIENTS WITH PAIN Flashcards
Four basic categories of pain?
1) Acute
2) Procedural
3) Chronic (non-cancer)
4) Cancer-related
Acute pain =
Indicates?
What does it “teach” a person?
When will it decrease?
- Can last days to 6 months (controversial timelines)…generally, if persists beyond expected healing time, is then considered chronic
- Indicates damage or injury has occurred
- Draws attention to itself to teach person to avoid similar situations
- If no lasting damage + no systemic disease, will decrease as healing occurs
What % of adults have moderate to severe pain after surgery?
& of hospitalized children with same?
½ adult
1/3 of hospitalized children
Procedural pain =
- Brief, intense arises from dianostic, therapeutic or preventative procedure
- Lasts seconds to hours, can continue to become acute if sig damage occurs
Common source = needle puncture
Chronic (non-cancer) pain
1) Constant or intermittent?
2) Does it typically have defined onset?
3) Is it easy to treat? Why or why not?
Is this kind of pain “useful” in the way that acute pain is?
1) Can be either
2) May have poorly defined onset
3) Origin often unclear = difficult to treat
- Pain becomes own problem (unlike usefulness of acute as warning)
- -> Can become pt primary disorder
3 TYPES OF CHRONIC PAIN based on patho?
1) Nociceptive
2) Neuropathic
3) Mixed-type (Neuropathic + nociceptive)
Chronic Nociceptive Pain =
Examples?
Pain quality?
Constant stimulation of pain receptors, signals tissue damage in the skin, bone, joints, or viscera
eg) arthritis, fibromyalgia
Typically aching or throbbing quality
CHronic Neuropathic pain =
1) What is it?
2) What % of the population experiences it?
3) What causes it?
4) What is the quality of pain?
1) Triggered by severe nerve damage or malfunction of CNS or PNS
2) 8% of pop
3) May begin with injury, or due to nerve compression by tumours, nerve inflammation by infection, or nerve impairment from systemic disease such as diabetes;
4) Burning, tingling, or piercing quality
Allodynia =
Examples?
Pain arising from nonpainful stimulus (ex: breeze) = characteristic of neuropathic pain
Ex: neuralgia, diabetic neuropathy, phantom limb pain
Examples of mixed-type chonic pain?
Migraines
What is typically the most feared outcome for cancer patients?
Pain (because is so ubiquitous)
Is cancer pain acute or chronic?
Can be either
What is cancer pain due to?
Can be:
1) Directly associated with cancer
2) Result of cancer treatment
3) Not associated (ex: post-surgical pain)
***Most direct result or tumour
- Describe the harmful effects of acute pain (beyond the discomfort of pain itself)
- If unrelieved, can affect pulmonary, cardiovascular, GI, endocrine + immune systems
- Widespread endocrine, immunological + inflammatory changes with stress
- Stress response = inc metabolic rate + CO, impaired insulin response, inc cartisol, inc retention of fluids → inc risk of MI, pulmonary infec, venous thromboembolism
- Primarily harmful in those whose health is already compromised by age, illness or injury (can’t handle stress on breathing, decreased mobility, etc.)
- Negative impacts of procedural pain beyond the experience of pain itself?
What kind of cognitive response can procedural pain lead to?
- Can give rise to cycle of pain, anxiety, and fear that leads to avoidance of procedure → poor medical care
- More often dread anxiety assoc with procedure than actual pain
- Leads to catastrophizing: negative cognitive response marked by preoccupation with pain stimulus, inflation of potential threat + sense of helplessness
Negative impacts of chronic pain beyond the pain itself?
- Can suppress IR ⇒ promotes tumour growth
- Often results in depression + disability
- Has effects on all aspects of life
Is a gradual increase in pain meds for chronic patients safe? Is it more or less safe to inadequately treat pain?
Safe to gradually inc dosage of pain meds to control progressive chronic pain – unsafe to inadequately treat pain as has other negative effects
Pain causing substances referred to as?
Algogenic
Do the large internal organs contain neurons that respond specifically to painful stimuli?
No, pain originating in these areas d/t intense stimulation of receptors that have other purposes – pain here from stretch, inflammation, ischemia, dilation, etc.
2 examples of morphine-like endogenous neurotransmitters?
1) Endorphins
2) Enkephalins
Involvement of what parts of the neuro system are responsible for the individual variations in the perception of noxious stimuli? (by way of being involved in the conscious perception of pain)
The reticular formation, limbic, and reticular activating systems
How does distraction inhibit pain?
Cognitive processes may stimulate endorphin production in the descending control system –> this system is suppresses the ascending transmission of painful stimuli –> if activated, less noxious stimuli transmitted to consciousness
Gate control theory was first theory to propose…
That psychological factors play a role in the perception of pain
- brought about use of cognitive behavioral pain management techniques
- explains use of distraction or music therapy to relieve pain
Outline the Gate Control Theory.
- Proposed that stimulating of the skin evokes nervous impulses that are then tramistted by three systems located in spinal cord: substantia gelatinosa in dorsal horn, dorsal column fibres, and central transmission cells → act to influence nocicceptive impulses
- Stimulation of large-diameter fibres inhibits transmission of pain = “closing” the gate
- Stimlation of small fibres = “opening” of gate
- Influenced by nerve impulses that descend from the brain
List 7 factors influencing the pain response
1) Past experiences with pain
2) Anxiety
3) Culture
4) Age
5) Gender
6) Genetics
7) Expectations about pain relief
* *Can all decrease or increase pain
How does past experience with pain influence pain perception?
- if more experience, likely to have more anxiety about subsequent events
- may have less tolerance (want to relieve sooner for fear it will become more intense)
- likely worse is poorly managed in past
How does anxiety affect pain perception?
- not all anxiety makes pain worse, but if r/t to pain may inc perception
- if anxiety unrelated pain, may serve as distraction from pain
Is it more effective to direct pain treatment at the pain itself or the anxiety?
Most effective to treat pain – giving antianxiety (as tends to happen) may cause sedation and inhibit ability to report pain, take deep breaths, get out of bed, cooperate with treatment plan
Are psychological, sociocultural, or biological mechanisms responsible for cultural differences in pain?
All of them!
Factors that help explain differences in pain experience/response in cultures?
- Age
- Gender
- Education Level
- Income
- Degree to which a person identifies with cultural influences and adopts new health behaviors or relies on traditional health beliefs and practices
- Nature of past interactions with healthcare (may have frustration with hc if pain was not adequately acknowledged before - could be due to issues of racism, etc.)
Should a nures react to a person’s perception of pain, or their behavior?
Perception - cannot reply on behavior as is customary to avoid outward expression of pain in some cultures
What should be communicated to patients for nurse to better be able to evaluate pain when cultural differences exist?
Pt needs to be instructed on how + what to communicate about pain
Describe the mechanism by which aging causing dec/inc perception in pain:
Loss of myelinated and unmyelinated fibres with age → dec in myelinated partily responsible for dec in expression of myelin proteins, causing gradual reduction in blood flow → reduced peripheral nerve fx + perception of pain
–> Some claim age related loss likely due to disease process, not just “aging” (lack of strong evidence in this regard…)
Why is pain more difficult to assess in elderly?
Elderly more reluctant to report pain b/c see as part of aging process; less able to describe due to cognitive changes
Why will smaller doses of pain meds possibly be more effective + last longer in older adults than young?
b/c greater fat to muscle ratio + slower metabolism
Reasons that elderly don’t seek pain relief?
- May see as normal process of aging
- May fear addiction
- May fear that pain indicates serious illness, or pain meds = loss of independence
Should a nurse judge adequacy of pain treatment based on age?
No, should be based on pt report of pain + pain relief!
Risk factors for chronic pain in Canadian women?
1) Age
2) Education
3) Marital status
T/F: The prevalence of of many conditions associated with pain (ex: migraine, IBS, osteoarthritis, fibromyalgia) are more prevalent in men than women.
F
T/F women more likely to report pain, frustration + fear.
T in some studies.
Common misconceptions about pain/barriers to pain management?
- Complaining about pain will distract my doctor from his responsibility: curing my illness
- Pain is a natural part of aging
- I don’t want to both the nurse
- Pain medicine can’t really control pain
- People get addicted to pain medication easily
- It is easier to put up with pain than with the side effects of pain meds
- Good patients avoid talking about their pain
- Pain medicine should be saved for when the pain gets worse
- Pain builds character - it’s good for you
- Patients should expect to have pain, it’s a part of almost every hospitalization
Is there a correlation between pain intensity and the stimulus that produced it?
No! Is individual.
Should you offer someone cues when asking about quality of pain?
Not unless pt cannot describe
- important to write down all words used by the pt
Important to ask about pain affect on:
- ADL’s
- Quality of sleep
- Level of anxiety
Are nonverbal + behavioral cues of pain reliable for determining intensity or presence of pain
No - not reliable or consistent
How is pain in unconscious people treated?
Is always assumed + treated
Is the use of physiological indicators (diaphoresis, tachycardia, etc.) reliable for pain assessment?
No, unrelieable - responses to initial stress, could also be due to hypovolemic shock
–> important to consider but a lack of pain indicators does not necessarily indicate a lack of pain!
