Pain Flashcards
What is the most reliable indication of pain?
pt’s self-report
What is the difference between acute pain and chronic pain?
– acute pain: usually localized; serves a biological purpose (a warning signal); actives SNS
– chronic pain: persistent pain with a location that is difficult to pinpoint; exceeds 3 months; gradual onset; interferes with ADLs
- chronic cancer pain
- bone metastasis is one of the most painful things
- chronic non-cancer pain
What is the difference between neuropathic pain, intractable pain, and phantom pain?
– neuropathic pain: damage/abnormal function of peripheral nerves or CNS
– intractable pain: pain resistant to therapy
– phantom pain: pain for parts of body that are no longer there
Differentiate between nociceptive pain and neuropathic pain.
– nociceptive pain: normal processing of pain; either visceral or somatic
- visceral: organs and lining of body cavity
- somatic: cutaneous, bone, BVs, and connective tissues
– neuropathic pain: results from nerve injury
- described as burning, shooting, stabbing, or pins and needles
What are the 4 terms of pain according to location?
- localized pain: confined to site of origin
- projected pain: pain along specific nerves
- radiating pain: diffuse pain around site of origin; not well localized
- referred pain: pain perceived in an area distant from site of origin
What is pseudoaddiction, tolerance, and physical dependence in regards to pain medication?
– pseudoaddiction: iatrogenic (result of diagnostic and therapeutic procedure) syndrome created by undertreatment of pain
- characterized by anger and escalating demands for pain meds
– tolerance: state of adaptation in which exposure to drug results in decrease of the drug’s effects over time
– physical dependence: adaptation to a drug manifested by withdrawal syndrome produced by abrupt cessation
What are the 2 specific fibers that transmit periphery pain?
- A delta fibers
- C fibers
What are the risks for older adults in terms of pain?
greater risk for undertreated pain due to inappropriate beliefs about pain sensitivity, tolerance, and ability to take opioids
How do you assess for pain? (PQRST)
- precipitating or palliative
- quality or quantity
- region or radiation
- severity scale
- timing – what was the pt doing at the time of pain
What is the first line of therapy for mild to moderate pain?
– non-opioid analgesics
- most common are aspirin (acetylsalicylic acid) and acetaminophen (Tylenol)
- most are NSAIDs
- can cause GI disturbances
Discuss acetaminophen.
- available in liquid form as well as tablet
- can be taken on an empty stomach
- preferred for pts who may experience GI bleeds
- long-term – can cause renal or liver toxicity
- daily dose = no more than 3600 - 4000 mg
- 2400 mg for older adults
What is the mainstay in management of all types of pain? How does it work?
– opioid analgesics
– block release of neurotransmitters in spinal cord
What are some side effects of opioids?
- N/V
- constipation
- sedation
- respiratory depression
- start low, go slow
- unlike to see with acute problems
- morphine is used to help people breathe in EOL
What does it mean to “start low and go slow”?
especially for older adults, initially use no more than half recommended dose
What is the recommendation for pain medication administration according to the WHO?
-
level 1 = pain 1 - 3
- use of non-opioids
-
level 2 = pain 4 - 6
- use of weak opioids alone or in conjunction with adjuvants
-
level 3 = pain 7 - 10
- use of strong opioids
