Pain Flashcards
What are some misconceptions of pain?
Attention seeking/complaining, drugs, need to be able to see the source of pain, exaggerated pain response
What is the number one reason individuals seek medical care?
Pain
What is nociception?
Activation of the primary afferent nociceptors that respond differently to noxious stimuli
If noxious stimuli is blocked, pain will not be perceived
What four components are part of the physiological dimension of pain?
Transduction, transmission, perception, and modulation
What is transduction?
the conversion of a mechanical, thermal, or chemical stimulus to a neuronal action potential
What is transmission?
the movement of pain impulses from the site of transduction to the brain
What is perception?
recognition of, definition of, and response to pain by the individual experiencing it
What is modulation?
involves the activation of descending pathways that exert inhibitory or facilitatory effects on the transmission of pain
What is the sensory-discriminative dimension of pain?
deals with PQRSTUV, pattern, intensity, location, and nature of the pain
What is the motivational-affective dimension of pain?
emotional responses to pain (varietal – anger, fear, etc.) can intensify the pain
What is the behavioural dimension of pain?
observable actions that patient is doing to express or control the pain (i.e., guarding, lashing out, positioning, holding)
What is the cognitive-evaluation of pain?
own beliefs of the pain, attitudes about pain, and memories of lived pain experience or what they have seen loved one’s experience
What is the sociocultural dimension of pain?
who is supporting the individual, social roles, past pain experiences, cultural aspects/beliefs about pain
What is somatic and visceral pain?
Somatic - aching/throbbing, well-localized, arises from bone, joint, muscle, skin, or connective tissue
Visceral - from internal organs
What type of medication treatment are visceral and somatic pain responsive to?
Both non-opioid and opioid
Define neuropathic pain
Damage to nerve cells or changes in the CNS, describe as burning, shooting, stabbing, electric, sudden, intense, short-lived or lingering
How is neuropathic pain typically treated?
It is difficult to treat
Management is multi-modal - using combination of adjuvant analgesics and different drug classes
What is a OPQRSTUV assessment?
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
What are the five sections of a secondary-discriminative pain assessment?
Pattern, area, intensity, nature, motivational-affective/behavioural/cognitive-evaluative/sociocultural
What does pattern mean in a secondary assessment?
When did it start? What is the duration?
What group has high rates of chronic pain?
Indigenous populations
What are the 12 basic principles of pain management?
- Routine assessment
- Unrelieved pain can complicate recovery – more complications, longer hospital stays
- Get patients to self-report their pain
- HCP have a responsibility to assess pain routinely, to accept patients’ pain reports, to intervene on pain, and to document them
- Involve the patient, families, and HCPs
- 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
- 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.)
- Treatment should be a combination of pharmacological and non-pharmacological therapies
- Multidimensional and interprofessional approach is necessary for pain management
- All therapies must be evaluated to ensure they are meeting the patient’s goals
- Prevent and/or manage adverse effects
- Teaching should be a cornerstone of the treatment plan
What is an equianalgesic dose? Why do we use it?
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
What is the benefit of scheduling analgesics?
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)
