Pain Flashcards
3 ways to classify pain
1) Cause: Cancer, cardiac
2) Pathophysiology: Nociceptive, physiologic, neuropathic
3) Duration:Acute pain(lasting less than six months),chronic pain(lasting more than six months)
Diversity Considerations: Gender Culture, Ethnicity, Religion Disability Morphology Age
Gender
• Women report being in more pain than men (due to estrogen level)
• Women seek help for pain more often
• Women given sedatives, men given analgesics
Culture, Ethnicity, Religion
• White adults report more pain
• African Americans and Hispanics are undertreated
Disability
• Patients with impaired cognition may not be able to communicate pain.
Morphology
• obese people tend to experience more pain in more locations
Age
• Young children generally display pain by crying
• Older adults who are depressed or cognitively impaired may be unable to accurately describe their pain
Behavioral and psychological responses to pain include
Behaviour: grimaces, clenched teeth, agitation, and restlessness.
Verbalization: crying, moaning, or screaming.
Psychological: anger, irritability, hopelessness, or anxiety.
3 Functions of Pain
1) Protective
• A warning signal about an unmet need, or malfunction of the nervous system secondary to a disease process
• A motor or sensory, or emotional response to a subjective feeling
2) Warning
• Warning about a disease or condition: symptom
• Disease entity that can be treated
3) Response
• Thermal injuries, e.g., sunburn
• Mechanical injury, e.g., fracture
• Chemical injury, e.g., inhalation of toxic fumes
• Ischemic injury, e.g., lack of oxygen to body tissues
Variety of Nociceptors density
Low
Med
High
Low - internal organs
Med - joints and tissues
High - skin
Nociception four steps
Transduction - Nociceptors identify pain stimuli and convert it into an electrical impulse.
Transmission - Pain signal transmitted through afferent nerve to spinal cord and brain.
Perception - Brain translates afferent nerve signals as pain.
Modulation - brain can change the perception of pain by sending inhibitory signals via the spinal cord.
Non-pharmacologic treatment measures that can be used to relieve pain.
These include massage, guided imagery, muscle relaxation, and distraction.
Distraction lessens patient’s focus on and awareness of pain.
Positioning enhances comfort and relaxation.
Massage promotes relaxation, decreases muscle tension and pain perception.
intensity of pain
Rated using scales, adjusted to client age and cognitive ability Numerical (0–10) Verbal descriptors Visual analogue Smiling or crying faces
nature of pain
Quality or characteristics of the pain
Assists in identifying the type of pain
Neuropathic: burning, cold, shooting, stabbing, or itchy
Nociceptive: sharp, aching, throbbing, and cramping
Adjuvant analgesic therapy
Used in conjunction with opioids and nonopioids
Enhance pain therapy through one of three mechanisms:
1. Enhancing the effects of opioids and nonopioids
2. Possessing analgesic properties of their own
3. Counteracting adverse effects of other analgesics
Ex. Antidepressants Antiseizure agents Muscle relaxants Anaesthetics Psychostimulants Cannabinoids
Benefits of variable routes
Target a particular source
Achieve therapeutic blood levels rapidly
Avoid certain adverse effects
Provide analgesia when clients cannot swallow
older adults treatment caution
Metabolize drugs more slowly Greater risk for adverse effects Risk of GI bleeding with NSAIDs Multiple drug use (interactions) Cognitive impairment and ataxia can be exacerbated
