Pain Flashcards
If the patient is sleeping, can they be in pain?
Yes
Is pain an expected part of aging?
No
What is Pain?
- an unpleasant sensory and emotional experience associated with actual or potential tissue damage
Pain is:
- always a personal experience that is influenced by biological, psychological, and social factors
- Pain and nociception are different phenomena. Pain can not be inferred solely from activity in sensory neurons
- individuals LEARN the concept of pain
- A persons report of an experience as pain should be respected
- It has adverse effects on function and social and psychological well-being
- Verbal description is only 1 of several behaviours to express pain; (inability to communicate does not negate the possibility that a human experiences pain)
Why is pain important to nursing:
- It is a universal symptom experienced by all
- Is a primary reason clients access healthcare in Canada
- It can impact a client’s function, quality of life, relationships, and financial stability
- Nurses are assess and help manage patients pain
What are the 4 Domains of Pain?
- Sensory/physical
- Action in pain nerves and effect on physiological status
- Severity
- Location
- Quality - Emotional/affective
- How the pain makes us feel
- How it affects our mood
- Fears that the pain elicits
- The effect of pain on behaviour - Cognitive
- How we understand the pain (knowledge)
- Coping strategies used - Social
- Our behaviour, how we react, how we respond
What 5 Factors Affect Pain?
- Past Experience with Pain
- Anxiety
- Culture
- Age
- Biological Sex
How does Past Experience with Pain affect Perception of Pain?
- The more experience a person has had with pain, the more frightened they are about subsequent painful events.
- This person may be less able to tolerate pain - they may want relief from pain sooner and before it becomes severe
- This reaction is likely to occur if the person has received inadequate pain relief in the past.
- A person with repeated pain experiences may learn to fear the escalation of pain and its inadequate treatment.
- Someone who has never had severe pain may have no fear of such pain
How does Anxiety influence Pain?
- Anxiety related to the pain may increase the patient’s perception of pain.
- Ex. a patient who was treated 2 years ago for breast cancer and now has hip pain may fear that the pain indicates metastasis.
How does Culture influence pain?
- Beliefs about pain and how to respond to it differ from one culture to the next.
- Early in childhood, individuals learn from others what responses to pain are acceptable or unacceptable.
Ex. A patient’s cultural expectations may be to moan and complain about pain or to refuse pain relief measures that do not cure the cause of the pain.
How does age affect pain?
Older Adults:
- many elderly are reluctant to seek help even when in severe pain because they consider pain to be part of normal aging.
- Older adult may be afraid to report pain for “fear of being a bad patient” or concerns over being a burden or losing independence.
Infants and Children:
- unrecognized and under treated pain is prevalent in newborns, infants and children.
- Infants and children may exhibit physiological responses to pain including increased heart rate, respiratory rate, blood pressure, and sweating.
- Because a preverbal infant cannot self-report pain the nurse relies on these physiologic and behavioural indicators
How does Sex affect pain?
- Societal expectations related to how males versus females express pain impacts a patient’s experience with pain.
- There is a societal expectation that men should “shake it off” or “take one for the team”
- Society normalizes women’s biological circumstances (ie.menstrual pain or labour and delivery).
- The experience of pain does not physiologically differ from one sex to another.
What is the Gate control Theory
1) Transduction
- noxious stimulus (stimuli that elicit tissue damage) on a nociceptor causes the “gate” to open through depolarization of the nerve (ie. finger on a hot cup)
2) Transmission
- The noxious stimulus passes from the peripheral nervous system to the central nervous system up the afferent nerve pathways
- afferent nerve pathway: sends stimulus to brain
3) Perception
- The pain stimulus passes up through and across the dorsal horn of the spine to the structures of the brain (limbic system and cerebral cortex).
- This is where the stimulus is identified as pain.
4) Modulation
- In the cerebral cortex, the stimulus is identified as pain and a response is created
- once generated the response passes down the efferent pathways causing a response (removing finger from hot cup)
- efferent nerve pathway: carries info from CNS to body
What is the difference between Acute and Chronic Pain?
Acute: Results from actual or potential tissue damage (ie. injury or surgery)
- Has a purpose: to alert and protect the body from further harm
- Shorter in duration: <6 months
- Has more physiologic changes associated with it’s presence:
Tachycardia, Tachypnea, Diaphoresis, vomiting, anxiety/restlessness
Chronic: Pain that persists past normal healing times and lacks the acute warning
- Does not have a purpose
- Longer in duration: > 6 months
- Has more emotional changes in association with it’s presence: Depression, Apathy/Lethargy, Withdrawal from activities/functions, relationship issues, Sleep disturbances, Reduced concentration
Pain is classified in which 4 ways:
1) Duration - Acute Vs. Chronic
2) Frequency
- Continuous: Pain that is present all the time (ie. Arthritis)
- Intermittent: Pain that comes and goes. (ie. nerve impingement)
- Episodic: Pain associated with particular events or cycles. (ie. Headaches
3) Form
a. Nociceptive Pain: pain that is in response to actual or potential injury and results in activation of nociceptors
- Includes Visceral, Somatic, Cutaneous, Referred, or Parietal pain
b. Neuropathic Pain: pain caused by disease or lesion in either the peripheral or central somatosensory nervous system.
- Unlike nociceptive pain there is no external cause or stimulus provoking the pain impulse
4) Associated with cancer
- pain associated with cancer or its treatment
