Pain

Question 1

Pain; definition

Answer 1

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Question 2

Different definitions of pain

Answer 2

-Whatever and wherever the person experiencing pain says it is.
-Unpleasant sensory and emotional experience associated with actual or potential tissue damage.
-Multidimensional and entirely subjective.
-Pain can be experienced in the absence of identifiable tissue damage.
-Pain is not synonymous with suffering.
-Pain is subjective - it is entirely the clients experience and self report is essential.

Question 3

Pain

Answer 3

-A major problem that causes suffering and reduces quality of life.
-One major reason why people seek health care.
-Nurses have a central role in assessment and management of pain.
-Effective pain relief is a basic human right.

Question 4

Pain Management; an individuals rights

Answer 4

-Their pain to be acknowledged and expected.
-The best possible personalized evidence-based pain assessment and management including relevant bio-psychosocial components.
-Ongoing information and education about the assessment and management of pain.
-Involvement as an active participant in their own care in collaboration with the inter professional team.
-Communication and documentation among interprofessional team members involved in their care to monitor and manage their pain.

Question 5

Nursing intervention; pain

Answer 5

-Assess pain, document it, and communicate with other health care providers.
-Ensure delivery of adequate pain relief measures.
-Evaluate effectiveness of interventions.
-Monitor ongoing effectiveness of pain management strategies.
-Provide education to clients and their families.

Question 6

Consequences of untreated pain…

Answer 6

-Unnecessary suffering.
-Physical and psychosocial dysfunction.
-Impaired recovery from acute illness and surgery.
-Immuno-Suppression
-Sleep disturbances

Question 7

Dimensions of pain

Answer 7

-Physiological
-Sensory-Discriminative
-Motivational-affective
-Cognitive-evaluative
-Sociocultural

Question 8

Causes and types of pain; by underlying pathology

Answer 8

Nociceptive
-Somatic
-Visceral

Neuropathic

Question 9

Causes and types of pain; by duration

Answer 9

-Acute
-Persistent

Question 10

Acute pain

Answer 10

-Sudden onset
-Usually within the normal time for healing
-Mild to severe
-In general, a precipitating illness or event can be identified
-Lowers over time and goes away as recovery occurs
-Manifestations reflect sympathetic nervous system activation:
•Increased HR
•Increased RR
•Increased BP
•Diaphoresis, Pallor
•Anxiety, agitation, confusion
NOTE: responses normalize quickly owing to adaptation
-Goal is pain control with eventual elimination.

Question 11

Persistent Pain

Answer 11

-Gradual or sudden
-May start as acute injury but continues past the normal time for healing to occur
-Mild to severe
-cause may not be known; original cause of pain may differ from mechanisms that maintain the pain
-Typically, pain persists and may be ongoing, episodic, or both -predominantly behavioural manifestations:
•Changes in affect
•Decrease in physical movement and activity
•Fatigue
•Withdraw from other people and social interaction
-Goal is minimizing pain to the extent possible; focusing on enhancing function and quality of life

Question 12

Nursing assessment of pain

Answer 12

Assess for the presence or risk of pain
•on initial assessment and all subsequent assessments
• Each time vital signs are completed
•Prior to, during and after a procedure
•Prior to and following using pharmacological and non-pharmacological treatment for pain

Assessment: the patients pain goal or expectations of comfort and pain relief
Characteristics: intensity, timing, location, quality
Aggravating or reliving factors
Behaviours associated with the pain

Question 13

Assesment

Answer 13

-PQRST
-Wong-baker FACES pain rating scale

Question 14

Pain assessment; components

Answer 14

-Effects of pain on clients sleep and daily activities, relationships, physical activity, and emotional well-being should be assessed.
-Past pain experiences, meaning of pain for the client, ways client expresses the pain, and clients pain-Control strategies should all be included.

Question 15

Pain Treatment: basic principles

Answer 15

-Routine assessment is essential for effective management
-Unrelieved acute pain complicates recovery
-Clients self-report of pain should be used whenever possible
-Health providers have a responsibility to assess pain routinely, to accept clients pain reports, to document them, and to intervene in order to manage pain.
-The best approach to pain management involves clients, families, and health providers.

Question 16

Pain treatment: basic principles continued

Answer 16

-Many clients at high risk for suboptimal pain management - all clients should have assailants pain relief
-Treatment based on clients and family’s goals for pain treatment
-Combination of drug and non drug therapies
-Multidimensional and interdisciplinary approach
-Evaluation of therapies
-Prevent or manage adverse effects
-Client and caregiver teaching is the cornerstone of the treatment plan.

Question 17

Drug therapy for pain

Answer 17

-Equianalgesic dose
-Scheduling analgesics
-Titration

Question 18

Drug therapy for pain: analgesic ladder 1-3

Answer 18

Mild pain
-1-3 on a scale of 1-10
“Step 1” drugs
•nonopioid analgesics (aspirin and other salicylates, other NSAIDs, and acetaminophen (Tylenol))
-ceiling effect: increasing the dose beyond and upper limit provides no greater analgesia, no tolerance or physical dependence, many available without a prescription.

Question 19

Drug therapy for pain: analgesic ladder 4-6

Answer 19

Mild to moderate pain
-4-6 on a scale of 1-10, or mild but Presistent despite nonopoid therapy
-“step 2” drugs
•Mu: morphine, oxycodone, hydromorohone, methadone
•opioid agonists (morphine)
•antagonists (naloxone)
•mixed (pentazocine, butorphanol)

Question 20

Drug therapy for pain: analgesic ladder (severe pain)

Answer 20

Opioid analgesics commonly used for severe pain
-Morphine
-Morphine-like agonists (hydromorohone (dilaudid), methadone (metadol), fentanyl (duragesic), meperidine (Demerol) (not recommended))
-Mixed agonists - antagonists (butorphanol (stadol))

Question 21

Adjuvant analgesic therapy

Answer 21

-used in conjunction with opioids and nonopioids
-Sometimes called coanalgesics
-Enhance pain therapy through one of three mechanisms:
1.enhancing the effects of opioids and non opioids
2.possessing analgesic properties of their own
3. Counteracting adverse effects of other analgesics

Question 22

Non-pharmacological therapy

Answer 22

-Massage
-Therapeutic exercise
-TENS
-Application of heat
-Application of cold
-Cognitive techniques
•Distraction
•Relaxation strategies
•Self-management

Question 23

Tolerance

Answer 23

A persons diminished response to a drug, which occurs when the drug is used repeatedly and the body adapts to the continued presence of the drug

Question 24

Addicition

Answer 24

Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and sue despite adverse reactions

Question 25

Dependence

Answer 25

Use of drugs of alcohol that continues even when significant problems related tot here use have developed

Question 26

Trends and changes in the treatment of pain

Answer 26

-Clinicians confuse physical dependence, tolerance, and addiction and are more likely to assess pain by observing behaviours rather than believing or eliciting a clients report.
-Growing interest in inter professional educational intervention trials for practicing health care providers that target common pain-related misconceptions.

Question 27

Trends and changes in the treatment of pain continued

Answer 27

-International association of the study of pain has published a core curriculum plan
-Provincial organizations such as the RNAO have also developed evidence informed practice guidelines on pain
-Opioid crisis and recent legal outcomes for pharmaceutical companies.