PAIN Flashcards
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
Health
An integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable within the environment where he is functioning (DUNN)
High-Level Wellness
The failure of a person’s adaptive mechanisms to adequately counteract stimuli and stresses, resulting in functional or structural disturbances
Disease
Response a person has to a disease. Integrates pathophysiologic alterations; psychologic effects of those alterations; effects on roles; relationships and values; and spiritual, cultural beliefs.
Illness
Disenabling response to disease, a mismatch between a person’s needs and the resources available to meet those needs.
Health & Illness
The way people cope with the alterations in health and function by a disease.
Illness behaviors
What are the 4 Models of Health?
- Clinical Model
- Role-performance (Functional) Model
- Adaptive Model
- Eudaimonistic Model
Being healthy means being able to function well in all roles.
Role-Performance (Functional) Model
Being healthy means being free from any clinical signs and symptoms of ill.
Clinical Model
Health is defined as exuberant well-being. Becoming all that one is capable of becoming.
Eudaimonistic Model
Defined health as the ability to adapt to the expectations and challenges of the environment, both the normal day-to-day events and also the unexpected events.
Adaptive Model
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (Int’l Association for the Study of Pain)
Pain
Is a free nerve endings that are widely distributed throughout the periphery in skin, fascia bone periosteum, skeletal muscle, ligaments and mucous membranes.
Nociceptors
Cell wall destruction (Injury, ulceration, tumor invasion, cell necrosis) Inflammation, Infection, Nerve Injury and Extravascation of plasma from the circulatory system associated with edema, ischemia, occlusion of vasculature
Chemically-mediated
Most potent pain-producing chemical released when cell walls are destroyed and when plasma leaks from the vasculature
Bradykinin
Physiology of pain that results from cell wall destruction sensitize receptors making them more responsive to other chemical, thermal, and mechanical stimuli.
Prostaglandins
Chemical Mediators of Pain
Bradykinin
Prostaglandin
Substance P
Serotonin
Histamine
Leukotrienes
Hydrogen Ions
Nerve Growth Factor
The Gate Control Theory
Facilitates release of plasma by increasing vascular permeability, resulting in bradykinin availability. Further enhances pain responses by contributing to prostaglandin release.
Substance P
Increases vascular permeability, contributing to bradykinin activity and edema. Facilitated by release of substance P
Histamine
Released in the periphery by platelets and mast cells. Causes pain by altering Na+ flow in the receptive neuron membrane. Sensitizes receptors to the effect of bradykinin.
Serotonin
Produced by cell-wall destruction contributes pain by attracting to neutrophils to an area of injury. Neutrophil causes cell wall destruction which releases bradykinin.
Leukotrienes
Released as a result if ischemia and hypoxia cause Na+ channel to open which activates neurons in the pain pathway. Enhances neurotransmitter release.
Hydrogen Ions
Released when neurons are injured. Causes new nerves to sprout new axons and dendrites in greater number than existed before. Facilitate increase substance P.
Nerve Growth Factor
There is an interaction between pain and other sensory modalities and that stimulation of fibers that transmit non-painful sensations are able to block the transmission of pain impulses thru an inhibitory gating circuit.
The Gate Control Theory
What are the two types of pain?
Fast Pain and Slow Pain
Carried by small myelinated nerves (A-delta fibers) sharp and is well localized and is generally associated with damage to the skin and muscles. Results in activation of the sympathetic nervous system.
Fast Pain
Carried by small, umyelinated nerves (C-fibers) Characteristic of damage to the skin, muscles, and internal organs. Characterized by dull, burning sensation.
Slow Pain
Patterns of Pain
Acute Pain & Chronic Pain
Short duration (less than 6 months), and has an immediate onset
Acute Pain
Last for more than 6 months (or 1 month beyond the normal end of the condition causing the pain)
Chronic Pain
What are the 3 types of Chronic Pain?
Chronic Persistent Pain
Chronic Intermittent Pain
Chronic Malignant
Complex mix of physical and psychological manifestations. Physical component is often a nociceptive or neuropathic problem.
Chronic Persistent Pain
Refers to exacerbation or recurrence of the chronic condition. Pain occurs only at specific periods; at other times, the client is pain-free.
Chronic Intermittent Pain
(Cancer- related Pain) Have qualities of both acute and chronic pain. Encompasses neuropathic, deep visceral, and bone pain.
Chronic Malignant
What are the Sources of Pain?
Cutaneous (Superficial) Pain
Somatic Pain
Visceral Pain
Referred Pain
Neuropathic Pain
Phantom Limb Sensation
Psychogenic Pain
Originates from ligaments, tendons, bones, blood vessels, and nerves. Detected with somatic nociceptors but since the nociceptors are sparse, pain is dull and poorly localized.
Somatic Pain
Abrupt onset and a sharp stinging quality or by a slower onset and a burning quality. Easily localized because of the high concentration of nerve endings in the skin.
Cutaneous (Superficial) Pain
Originates from body’s viscera or organs. Greater scarcity of nociceptors in viscera/organs causes more aching and a longer duration than somatic pain.
Visceral Pain
A form of visceral pain and is felt in an area distant from the site of the stimulus. Occurs when nerve fibers serving an area of the body pass in close proximity to the stimulus.
Referred Pain
Caused by damage or injury to nerve fibers in the periphery or by damage to the CNS. Not attributable to nociceptor activation from injury.
Neuropathic Pain
Pain due to a stimulus that does not normally provoke pain
Allydonia
Experience sensations in the part amputated as if that part were still present or attached.
Phantom Limb Sensation
Sources of pain that is not caused by nociception, but by psychological factors. It is also called as Pain Disorder
Psychogenic Pain
Site some examples of Psychogenic Pain
Headache, Muscle pain, stomach pain and back pain
2 Perception of Pain
Pain thresholds
Pain Tolerances
Lowest intensity of a painful stimulus that is perceived by a person as pain
Pain thresholds
Duration or intensity of pain that the person is willing to endure
Pain Tolerances
Factors Affecting Pain (Sociocultural Factors)
Age
Gender
Meaning of Pain
Anxiety
Past Experience with Pain
Expectation and the Placebo effect
A pain rating scales that consist of a series of words commonly used to describe pain (e.g., no pain, mild pain, moderate pain, severe pain) patient reads the words and chooses the one that best describes the pain he or she is experiencing.
Verbal Rating Scales
A pain rating scales that usually consist of a series of numbers ranging from 0 to 10. The ends of the scale are labeled to indicate “no pain” and the “worst pain possible.” The patient chooses the number that best corresponds to the level of pain he or she is experiencing.
Numerical rating scales
Commonly consist of a vertical or horizontal line, 10 cm in length, with end points labeled “no pain” and the “worst pain,” or similar words.
Visual analogue scale
A set of faces depicting different levels of pain experience is presented to the patient. The patient chooses which face best describes his/her pain experience.
Faces Pain Rating Scale
What are the Non-Pharmacologic Pain Relief Measures
Comfort Measures
Cutaneous Stimulation
Massage
Heat and Cold Application
Transcutaneous Electrical Nerve Stimulation
Acupunture
Delivers electrical burst through the skin to superficial and deep nerves.
Transcutaneous Electrical Nerve Stimulation
Very thin mental needles are skillfully inserted into the body at designated locations and at various depths and angles.
Acupuncture
What are the Cognitive or Bio behavioral Interventions
Deep Breathing
Progressive relaxation
Rhythmic Breathing
Guided Imagery
Music
Biofeedback
Distraction
Therapeutic Touch
Meditation
Hypnosis
Humor
Magnets
Analgesics are given before the pain occurs, if it can be protected, or at least before it reaches a severe intensity.
Preventive Approach
Routes and Approached to Pain Managements
Intraspinal infusion of analgesics
Subcutaneous infusion of analgesics
Patient- Controlled Analgesia
PQRST
P-precipitating
Q-quality
R-Relieving
S-severity
T- Timing
5 Cardinal Signs of Inflammation
Calor
Rubor
Tumor
Dolor
Functio Laesa
Calor
Heat
Rubor
Redness
Tumor
Swelling
Dolor
Pain
Functio Laesa
Loss of function
