PAIN Flashcards
transduction
convert noxious stimuli to electrical impulses. ex. mechanical (skim knee) thermal (burns) chemical (chemical reaction)
histamine
inflammatory response
lactic acid
nociceptor activation
bradykinin
vasodilator. Important with mediating pain response at the site before the signal gets to the central nervous system.
prostaglandins
send pain stimuli to the CNS
substance P
synthesized receptors to feel pain. Makes nerves more sensitive and quick to respond
serotonin
smooth muscles and promote vasoconstriction
transmission
a- fibers: acute localized pain is sent to the CNS
ex. stub a toe
c- fibers: defuse aching burning type pain
reflex arc: reflex from the pain
perception
Individual interpretation of stimuli.
Increased Sensitivity to Thermal Pain and Reduced Subcutaneous Lidocaine Efficacy in Redheads
threshold
lowest intensity of stimulus that causes recognition of pain
modulation
Regulation or inhibition of pain sensation
neuromodulators
they inhibit the production of pain-transmitting nerves. Both pain and stress activate these modulators. (endogenous opioid compounds)
endorphins
produced at neuro synapsis. Released when things like relaxation techniques are used.
ex. Pain medicine (morphine) through IM injection then IV. causes a distraction which will improve pain response.
enkephalins
less potent and thought to reduce pain by inhibiting substance P. (what our body produces to help manage pain.)
gate control theory
Provides ideas for pain relief emphasizing multiple dimensions of pain and; relationship between pain and emotions. The motor receptor will be accepted first.
ex. sensory, emotional, behavioral, cognitive
cutaneous: superficial
paper cut
somatic: diffuse/ scattered
sprained ankle
visceral: body organs due to stretch/ spasm
cholangitis –> Often guard/ splinting and when you touch them their muscles contract because they are protecting themselves
Nociceptive pain
feels sharp, aching, or throbbing. normally external injury
ex. stubbing toe, sport injury, dental procedure
neuropathic pain
Abnormal function of peripheral nervous system or central nervous system
ex. Burning, electric, tingling, stabbing
Allodynia
pain after non-painful stimuli
touch and it shouldn’t hurt but it does. The majority is feet and fingers
phantom pain
amputation but still experience pain even though its not there.
psychogenic
Physical cause of the pain can not be identified. Results from a mental event may be more severe than a physical event.
ex. Think of ‘Never have I ever. Devi dad died, ended up in wheelchair
intractable pain
intractable. cause cannot be removed.
ex. headaches, migraines
PQRST PAIN ASSESSMENT
P: provokes
Q: quality
R: radiates
S: severity
T: time
Interventions
Remove or alter the source of pain.
Alter factors that contribute to pain tolerance
Fatigue
Misunderstanding of cause of pain
Fear
Establish trusting relationship
Nonpharmacologic Interventions
Establish trusting relationship & acceptable pain level
Distraction/ Humor
Music/ Imagery/Relaxation
Cutaneous stimulation
Acupuncture/ Massage/therapeutic touch
Heat/Cold
Elevation
Pet therapy
Pharmacologic Interventions
giving meds to relieve pain
non-opioids: more local reaction to pain. scheduled
Aspirin (ASA)
Analgesic
Anti-inflammatory
NSAIDs
Analgesic
Anti-inflammatory
Acetaminophen
Analgesic
Corticosteroids
Anti-inflammatory
Adjuvant Analgesics
Tricyclic antidepressants
Antihistamines
Caffeine
Muscle relaxants
Anticonvulsants
Antiemetic
opioid analgesics: alter perception of pain
morphine, codeine, oxycodone, meperidine, fentanyl, hydromorphone
hydromorphone
1 mg of hydromorphone ≈ 7-10 mg of morphine!
So, your ordered dose of hydromorphone should be 7-10 times less than that of morphine
opioid antagonist
naloxone
INVASIVE pain management
PCA: patient controlled analgesia
IV: nerve block, epidural, intrathecal
used to control post-op pain, chronic pain, severe
cancer pain
Opioid Side effects
Most Serious:
Respiratory Depression
Apnea
Respiratory Arrest
Circulatory Depression
Hypotension/ Shock
Common:
Constipation
↓ peristalsis
↓ intestinal secretions
Nausea & Vomiting
Sedation
Dizziness
Pruritus
Headache
Dry Mouth
Numeric Sedation Scale POSS
S: sleep, easy to arouse: no action necessary
1: awake and alert; no action necessary
2: occasionally drowsy, but easy to arouse; no action
necessary
3: frequently drowsy, drifts off to sleep during
conversation; reduce dosage
4: somnolent with minimal or no response to stimuli;
discontinue opioid, consider use of naloxone
break through pain
need another intervention to break through pain.
opioid concerns
reluctant to take pain medication r/t fear of addiction
physical dependence
withdrawal syndrome arises if drug discontinued, dose substantially reduced, or antagonist administered
tolerance
greater amount of drug needed to maintain therapeutic effect, or less of effect over time
pseudoaddiction
behavior suggestive of addiction; caused by undertreatment of pain
addiction( psychological dependence)
a psychiatric disorder characterized by continued compulsive use of substance despite harm
