objective 8 Flashcards
Referred to as the 5th
vital sign
Assessment should be
automatic
Treatment of pain is a
basic human right
pain
- Whatever and whenever the
person experiencing pain says it is - Unpleasant sensory and emotional
experience associated with actual
or potential tissue damage - Multidimensional and entirely
subjective - Pain can be experienced in the
absence of identifiable tissue
damage.
pain
what are the dimensions of pain and the pain process?
- Multidimensional experience
- Physiological
- Sensory–discriminative
- Motivational–affective
- Cognitive–evaluative
Physiological process that
communicates tissue damage to the central nervous
system
nociception
what are the mechanisms of which pain is percieved?
- Transduction
- Transmission
- Perception
- Modulation
- Conversion of a mechanical,
thermal, or chemical stimulus into
a neuronal action potential - Occurs at the nociceptors
transduction
The movement of pain
impulses from the site of
transduction to the brain.
transmission
what are the 3 segment’s involved in transmission?
- Transmission along peripheral nerve fibres to
spinal cord - Dermatomes
- Dorsal horn processing
- Transmission to thalamus and cerebral cortex
what are the causes of pain?
by underlying pathology
by duration
what are the types of pain?
nociceptive
neuropathic
acute
persistent
- Damage to somatic or
visceral tissue - Surgical incision, broken
bone, or arthritis - Usually responsive to
opioid and nonopioid
medications - Aching or throbbing
- Localized
- Arises from bone, joint,
muscle, skin, or connective
tissue - Tumour involvement or
obstruction - Arises from internal organs
such as the intestine and
bladder
nociceptive pain
- Damage to peripheral nerve or central nervous system
- Burning, shooting, stabbing, or electrical in nature
- Sudden, intense, short-lived, or lingering
- Difficult to treat
- Opioids, antiseizure,
antidepressant medications - Can be central or peripheral in origin
neuropathic pain
- Sudden onset
- Usually within the normal time for healing
- Mild to severe
- Generally can identify a precipitating event or illness
Course of pain decreases over time and goes away as
recovery occurs
acute pain
what are the manifestations that reflect SNS activation?
- Increased heart rate
- Increased respiratory rate
- Increased blood pressure
Gradual or sudden onset
May start as acute injury but continues past the normal time for
healing to occur
Mild to severe
Cause may be unknown; original cause of pain may differ from
mechanisms that maintain the pain
Persists and may be ongoing,
episodic, or both
persistent pain
what are the behavioral manifestations of persistent pain?
- Changes in affect
- Decreased physical movement/activity
- Fatigue
- Withdrawal from others and social interaction
- specialized medical care for
people living with a serious
illness - care is focused on providing
relief from the symptoms and
stress of the illness - goal is to improve quality of
life for both the patient and
the family.
palliation/relief measures
- Comprehensive pain centres
treat patients on an inpatient or
outpatient basis. - The goal of palliative care is to
learn how to live life fully. - Hospices are programs for end-
of-life care
pain clinics, palliative care, hospices
what are the basic principles of pain treatment?
Routine assessment is
essential for effective
management.
Unrelieved acute pain
complicates recovery.
Clients’ self-report of pain
should be used whenever
possible.
HEALTH PROVIDERS HAVE A
RESPONSIBILITY TO ASSESS
PAIN ROUTINELY, TO ACCEPT
CLIENTS’ PAIN REPORTS, TO
DOCUMENT THEM, AND TO
INTERVENE IN ORDER TO
MANAGE PAIN.
THE BEST APPROACH
TO PAIN
MANAGEMENT
INVOLVES CLIENTS,
FAMILIES, AND
HEALTH PROVIDERS.
what are the barriers to effective pain management?
- Tolerance
- Dependence
- Addiction
- Need for increased dose to maintain same degree of pain control
- Not as common as once thought
- Rotate drug if tolerance develops
- Drug tolerance is not synonymous with addiction
tolerance
- Expected response to ongoing exposure to pharmacological agents
manifested by withdrawal syndrome when blood levels drop
abruptly - To avoid withdrawal, drug should be tapered
physical dependence
- A primary, chronic, neurobiological disease, with genetic,
psychosocial, and environmental factors influencing its
development and manifestations - Characterized by impaired control over drug use, compulsive use,
continued use despite harm, and craving - Tolerance and physical dependence are not indicators of addiction.
addiction
what is PQRSTU?
provocative/palliative factors
quality
region/radiation
severity
timing
how is pain affecting U
A cognitive and/or physical
strategy
relaxation
A cognitive strategy that creates
a positive psychophysiological
response
guided imagery
Application of touch and movement to
muscles, tendons, and ligaments without
manipulation of the joints
massage
Applications of heat and cold relieve
pain and promote healing
heat and cold
A cognitive strategy that refocuses
attention away from the pain
distraction
- A catheter is placed into the epidural
space below the second lumbar
vertebra, where the spinal cord ends - Require much smaller doses of opioids
to achieve the same pain relief - Highly effective for controlling acute
pain during labor; after surgery; or after
trauma to the chest, abdomen, pelvis or
lower limbs - Provide excellent pain relief, minimal
side effects, and high patient
satisfaction
epidural analgesia
Used for selected medications (e.g., opioids, insulin)
Benefits patients with poor venous access
* Provides pain relief to patients who are unable to
tolerate oral pain medications
* Allows patients greater mobility
* Onset of action about 20 minutes
* Better pain control than intramuscular injections
* Lower rates of infection
1500 mls in 24 hours max
hypodermoclysis continuous subcutaneous meds
used to reduce pain by temporarily or permanently
interrupting transmission of nociceptive input
* generally involve one-time or continuous infusion of local
anaesthetics into a particular area to produce pain relief. Such relief is
also referred to as regional anaesthesia
* often are used during and after surgery to manage pain.
nerve blocks
are performed for severe pain that is
unresponsive to all other therapies.
* destroy nerves, thereby interrupting
pain transmission
neuroablative interventions
involves electrical stimulation of the brain and
the spinal cord
neuroaugmentation
