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NSG 2321 - Theory Exam 2 > Pain > Flashcards

Pain Flashcards

1
Q

What are some misconceptions of pain?

A

Attention seeking/complaining, drugs, need to be able to see the source of pain, exaggerated pain response

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2
Q

What is the number one reason individuals seek medical care?

A

Pain

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3
Q

What is nociception?

A

Activation of the primary afferent nociceptors that respond differently to noxious stimuli

If noxious stimuli is blocked, pain will not be perceived

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4
Q

What four components are part of the physiological dimension of pain?

A

Transduction, transmission, perception, and modulation

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5
Q

What is transduction?

A

the conversion of a mechanical, thermal, or chemical stimulus to a neuronal action potential

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6
Q

What is transmission?

A

the movement of pain impulses from the site of transduction to the brain

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7
Q

What is perception?

A

recognition of, definition of, and response to pain by the individual experiencing it

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8
Q

What is modulation?

A

involves the activation of descending pathways that exert inhibitory or facilitatory effects on the transmission of pain

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9
Q

What is the sensory-discriminative dimension of pain?

A

deals with PQRSTUV, pattern, intensity, location, and nature of the pain

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10
Q

What is the motivational-affective dimension of pain?

A

emotional responses to pain (varietal – anger, fear, etc.) can intensify the pain

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11
Q

What is the behavioural dimension of pain?

A

observable actions that patient is doing to express or control the pain (i.e., guarding, lashing out, positioning, holding)

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12
Q

What is the cognitive-evaluation of pain?

A

own beliefs of the pain, attitudes about pain, and memories of lived pain experience or what they have seen loved one’s experience

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13
Q

What is the sociocultural dimension of pain?

A

who is supporting the individual, social roles, past pain experiences, cultural aspects/beliefs about pain

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14
Q

What is somatic and visceral pain?

A

Somatic - aching/throbbing, well-localized, arises from bone, joint, muscle, skin, or connective tissue

Visceral - from internal organs

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15
Q

What type of medication treatment are visceral and somatic pain responsive to?

A

Both non-opioid and opioid

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16
Q

Define neuropathic pain

A

Damage to nerve cells or changes in the CNS, describe as burning, shooting, stabbing, electric, sudden, intense, short-lived or lingering

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17
Q

How is neuropathic pain typically treated?

A

It is difficult to treat

Management is multi-modal - using combination of adjuvant analgesics and different drug classes

18
Q

What is a OPQRSTUV assessment?

A

o O – onset
o P – palliative/provocative
o Q – quality of pain
o R – region of the body/radiation
o S – severity of pain
o T – time/treatment
o U – understanding
o V – values

19
Q

What are the five sections of a secondary-discriminative pain assessment?

A

Pattern, area, intensity, nature, motivational-affective/behavioural/cognitive-evaluative/sociocultural

20
Q

What does pattern mean in a secondary assessment?

A

When did it start? What is the duration?

21
Q

What group has high rates of chronic pain?

A

Indigenous populations

22
Q

What are the 12 basic principles of pain management?

A
  1. Routine assessment
  2. Unrelieved pain can complicate recovery – more complications, longer hospital stays
  3. Get patients to self-report their pain
  4. HCP have a responsibility to assess pain routinely, to accept patients’ pain reports, to intervene on pain, and to document them
  5. Involve the patient, families, and HCPs
  6. Caution with vulnerable populations, diverse backgrounds, limited communication, those with past or current substance use problems – as their pain management may end up being suboptimal or inappropriate
  7. Treatment must be based on the patient’s goals (i.e., taking pain from a 10 to a 3, being able to toilet without pain, etc.)
  8. Treatment should be a combination of pharmacological and non-pharmacological therapies
  9. Multidimensional and interprofessional approach is necessary for pain management
  10. All therapies must be evaluated to ensure they are meeting the patient’s goals
  11. Prevent and/or manage adverse effects
  12. Teaching should be a cornerstone of the treatment plan
23
Q

What is an equianalgesic dose? Why do we use it?

A

Dose of one analgesic that produces pain relieving effects equivalent to those of another analgesic

Why? A different analgesic causes ineffective or intolerable adverse effects, these are approximate, carefully monitor and adjust dosing

24
Q

What is the benefit of scheduling analgesics?

A

prevent/ongoing control of pain rather than providing analgesics after a patient’s pain becomes moderate-to-severe, before procedures/activities that produce pain, around the clock scheduling (a patient in constant pain)

25
Q

What are the three steps of the analgesic ladder?

A
  1. Mild pain
  2. Mild to moderate pain
  3. Moderate to severe pain
26
Q

What is the pain scale for mild pain (step 1 analgesic ladder) and how do we treat?

A
  • Pain scale 1-3
  • Non-opioids, have a ceiling effect (increasing the dose beyond an upper limit provides no greater analgesia), no tolerance/physical dependence, OTC
27
Q

What is the pain scale for mild to moderate pain (step 2 analgesic ladder) and how do we treat?

A
  • Pain scale 4-6
  • Opioids, have a ceiling effect, physical dependence concerns
  • Often opioid and non-opioid, such as codeine plus acetaminophen (T3) or tramadol - often due to inflammation management
28
Q

What is the pain scale for moderate to severe pain (step 3 analgesic ladder) and how do we treat?

A
  • Pain scale 4-10 or when step 2 medications do not work
  • Potent, no-ceiling, delivered via many routes
29
Q

What is adjuvant medication therapy?

A

Medications used in conjunction with opioids and nonopioids

30
Q

What three ways do adjuvant med therapy enhance pain therapy?

A
  • Enhance the effects of opioids and nonopioids
  • Possess analgesic properties of their own
  • Counteract the adverse effects of other analgesics
31
Q

What are examples of adjuvant medications?

A

antidepressants, antiseizure medications, corticosteroids, local anaesthetics, ketamine

32
Q

What are nerve blocks?

A

temporarily or permanently interrupt transmission of nociceptive input

33
Q

What is a therapeutic nerve block?

A

one-time/continuous infusion of local anaesthetics, interrupt afferent and efferent transmission to the affected area and thus are not specific to nociceptive pathways

34
Q

Do therapeutic nerve blocks block specific nociceptive pathways?

A

They do not

35
Q

What is neuroablative therapy?

A

The destruction of nerves to treat severe pain not responsive to all other therapies

36
Q

What is neuroaugmentation?

A

electrical stimulation of the brain and spinal cord

37
Q

What are three non-pharmacological treatments for pain?

A

Heat, cold, and TENS (electrical current applied to skin over painful region, trigger points, or peripheral nerves)

38
Q

What are three barriers to medication management of pain?

A

Tolerance, substance misuse, and physical dependence

39
Q

What is the double effect?

A

Principle that using medications that have adverse effects (i.e., hastening death) is just to treat pain

40
Q

Review cannabis notes

A

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NSG 2321 - Theory Exam 2 (5 decks)

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