Pain Flashcards
Definition of pain:
An unpleasant sensory and emotional experience associated
with actual or potential tissue damage
How is pain classified?
Primary: not associated with illnesses
-Tension headache -> Stress (chronic or episodic)
-Migraine headache (with or without aura)
-Cluster headache
-Medicinal overuse headache
Secondary: symptoms of a condition
-sinus/congestion, head trauma, stroke, substance withdrawal/abuse, bacterial/viral diseases, the disorder of craniofacial structure
Location of headaches:
-Sinus: behind eyebrows and cheekbones
-Cluster: in and around one eye
-Tension: like a band on the forehead
-Migraine: on one side of the face
-temporomandibular joint: on the side (temple)
Patient presentation of tension headache
-Bilateral
-Gradual onset
-diffuse -> tight, pressing, compressing pain
-minutes to days
-Triggers: stress, emotional imbalance (anxiety, depression,
etc), lack of sleep
Patient presentation for Migraine:
-Pain unilateral, throbbing, and more severe than a tension headache
-Sudden onset
-with or without aura
-hours to days
-symptoms: nausea, vomiting, constipation, diarrhea, lightheadedness, light/sound/movement
sens
to remember: SULTANS
Patient presentation for Sinus headache:
- localized to the face, forehead, and periorbital areas
-Onset simultaneous with nasal symptoms
-Dull bilateral pain, pressure behind the eye or face
-last days resolves with sinus symptoms
-symptoms: nasal discharge; congestion, fever
Medication overuse:
-use of offending agent more than twice weekly
for ≥3 months
-Onset within hours of stopping agent
-Symptoms: continuous pain, upon awakening
-Potential causative agents: acetaminophen, aspirin, caffeine,
triptans, opioids, butalbital, and ergotamines
Pathophysiology of pain
Cell damage -> release of chemicals to depolarize nociceptors and prompt pain transmission
bradykinin, histamine, serotonin, prostaglandins,
potassium, substance P, calcitonin gene-related peptide
(CGRP)
When are patients referred? NO otc TREATMENT
-secondary headache except for sinus headache
-severe pain, severe symptoms (nausea, vomiting)
-a headache for more than 10 days
-severe infection (green/brown discharge, stiff neck)
- under 8 y of age
-significant liver problems or alcoholic consumption bc the liver doesn’t work to metabolize drugs
Exclusion by type of headache:
-if they have symptoms of migraine -> refer to check if it is a -migraine
-if it is ongoing
-if it is a cluster headache -> behind the eye (bc of severe pain excluded)
-medication overuse -> they have to stop the medication they are taking
What are the 3 types of systemic analgesics?
-Salicylates (Aspirin -> acetylsalicylic acid, non acetylsalicylics)
-Acetaminophen
-NSAIDS
-> refer to mild (1-3) and moderate (4-6)
What are the Non-Drug Treatment Approaches
Avoid stressors, aerobic, hot or cold compresses on forehead (trick pain pathway)
Which of the 3 analgesics has the longest Onset?
Aspirin with 1-2hr
Acetaminophen: 30 min
NSAID (ibuprofen and Naproxen) :15-30 min
What happens when a long-acting drug is given to an older person?
The drug will be in the system longer, which makes the dose higher
Why don’t want a long-acting drugs in kids?
Bc it takes so much time to get excreted, we don´t a lot of exposure of the drug to the kid -> least amount of drug for the shortest duration in kids and older people bc the kidney and liver decline
