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Health Assessment > Pain > Flashcards

Pain Flashcards

1
Q

What are the 2 main pathways for pain ?

A

Can be either nociceptive and/ or neuropathic processing

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2
Q

why do we need to do a pain assessment ?

A

Better able to develop non-pharmacologic and/or pharmacologic strategies to obtain improved clinical results

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3
Q

where does pain originate ?

A

in the CNS PNS or both

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4
Q

pain signal will come from where

A

nociceptors which are specialized nerve endings needed to detect pain- can be found everywhere except in bone

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5
Q

nerves that transmit signals from the brain are called

A

efferent nerves or motor nerves - exiting the brain and message might require movement

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6
Q

nerves that transmit from the body to the CNS are called

A

afferent or sensory nerves in which will pick up that something has been impacted and will send message to brain

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7
Q

what is the substantia gelatinosa ?

A

Specific area of cord in which fibers synapse with interneurons , also considered to be lamina II in which sensor information is received from various parts of the body

  • ** it is also the area where the nerves have to cross over to the other side of the spinal cord and go up to the brain via the anterolateral tract
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8
Q

what are the 4 phases of nociception ?

A

transmission, transduction, perception, modulation

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9
Q

nociceptive pain will develop when,

A

when functioning and intact nerve fibers in the periphery and CNS are stimulated

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10
Q

what happens in transduction ?

A

release of various chemical mediators ( histamine , prostoglandins, serotonin ) and the neurotransmitter will deliver pain message .

sensory afferent nerve fiber –> spinal cord—> dorsal horn

second set of neurotransmitters will carry signal across synaptic cleft( ATP, substance P, glutamate)

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11
Q

What happens in transmission ?

A

pain signal move from spinal cord to brain and impulse goes to thalamus ,where it will then start to be processed.

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12
Q

true or false ? there are opioid receptors in the synaptic cleft at the spinal cord that can block pain

A

True- if pain isnt blocked it will move to thalamus

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13
Q

what takes place during peception?

A

signal gets disperse to cortical areas ( limbic, and somatosensory areas ), pain dispersed to these areas allows for the sensation of pain to be identified

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14
Q

what happens in modulation ?

A

to dial down or turn off pain - descending pathways will release 3rd set of neurotransmitters( GABA, Serotonin,norepinephrine ) to induce analgesic effect

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15
Q

what is meant by the fact that nociceptive processing can be protective ?

A

can be a warning signal that injury is about to or has taken place.

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16
Q

when does neuropathic pain take place

A

when there is actual damage to the nerves that takes place and it implies that there is an abnormal processing of the pain message and will often turn into a chronic condition

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17
Q

True or false, nociceptive pain cannot turn into neuropathic pain?

A

False Nociceptive pain can change into a neuropathic pain overtime when pain has been poorly controlled

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18
Q

conditions that lead to neuropathic pain ?

A

Diabetes mellitus, herpes zoster (shingles), HIV/AIDS, sciatica, trigeminal neuralgia, phantom limb pain, and/or chemotherapy

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19
Q

Example of neuropathic pain ?

A

Pain felt with phantom limb

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20
Q

why is diagnosis of neuropathic pain hard ?

A

cannot be recognized on MRI, CT or Xray scans

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21
Q

what tools can possibly be used to diagnose neuropathic pain ?

A

Electromyography and nerve-conduction studies are needed

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22
Q

propsoed mechanisms of neuropathic pain

A

Spontaneous and repetitive firing of nerve fibers, almost seizure like in activity

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23
Q

True or false ? In neuropathic pain, minor stimuli can lead to significant pain

A

true

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24
Q

What is visceral pain ?

A

originates from larger interior organs.
Stems from direct injury to organ or from stretching of organ from tumor, ischemia, distention, or severe contraction

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25
Q

visceral pain can be described as ?

A

dull, deep, squeezing or cramping

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26
Q

transmission of visceral pain ?

A

transmitted by ascending nerve fibers along with nerve fibers of autonomic nervous system

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27
Q

presentation of visceral pain

A

Presents with autonomic responses such as vomiting, nausea, pallor, and diaphoresis

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28
Q

what is deep somatic pain ?

A

comes from sources such as blood vessels, joints, tendons, muscles, and bone

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29
Q

presentation of deep somatic pain ?

A

nausea, sweating, tachycardia, and HTN due to ANS response.

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30
Q

deep somatic pain is often described as

A

as aching or throbbing

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31
Q

deep somatic pain can result from what kind of injuries ?

A

pressure, trauma, or ischemia.

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32
Q

Is deep somatic pain usually well localized and identifiable ?

A

Yes, most people can pinpoint directly which area is hurting with this kind of pain, Unlike Visceral pain

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33
Q

cutaneous pain

A

derived from skin surface and subcutaneous tissues, the injury is considered superficial. accompanied with a sharp burning sensation

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34
Q

Reffered pain is

A

felt at a particular site but originates from another location
- happens because both sites are innervated by the same spinal nerve - brain cant tell the difference
- can originate from either visceral or somatic structures
Gallbladder and shoulder is an example

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35
Q

acute pain :Short-term and self-limiting:

A

Often follows a predictable trajectory and dissipates after an injury heals. Eg. surgery, trauma and kidney stones

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36
Q

acute pain : Self-protective purpose

A

Acute pain warns individual of actual or potential tissue damage.

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37
Q

acute pain:Incident pain

A

Type of acute pain that occurs predictably with certain movements. Eg. pain in the lower back on standing

38
Q

chronic pain is diagnosed when ?

A

The pain continues for more than 6 months

39
Q

chronic pain : Malignant :

A

often parallels pathology created by tumor cells.

40
Q

chronic Non Malignant pain :

A

Associated with musculoskeletal conditions, such as arthritis, low back pain, or fibromyalgia

41
Q

what is breakthrough pain?

A

Transient spike in pain level with moderate to severe intensity in an otherwise controlled pain syndrome

42
Q

when can breakthrough pain happen

A

End of dose medication failure: patient taking a long-acting opioid

43
Q

treatment for breakthrough pain ?

A

Shorten interval dosing and/or increase medication

44
Q

Preverbal infants are at high risk for ?

A

under treatment of pain

45
Q

repetitive and poorly controlled pain in infants (daily heel sticks, venipunctures) can result in

A

in lifelong adverse consequences such as neurodevelopmental problems, poor weight gain, learning disabilities, psychiatric disorders, and alcoholism.

46
Q

by 20 weeks of gestation ,

A

Ascending pathways are in place bu perception of pain may only be seen at 30 weeks because the cortex is immature

Inhibitory neurotransmitters are in insufficient supply until birth at full term( high sensitivity to painful stimuli

47
Q

Does pain sensitvity get reduced as we age ?

A

NO - No evidence exists to suggest that older individuals perceive pain to a lesser degree or that sensitivity is diminished

48
Q

Does Dementia has an impact on the ability to feel pain ?

A

Dementia does not impact ability to feel pain, but it does impact person’s ability to effectively use self-report tools.
- we look at body language instead of verbal communication

49
Q

gender differences and pain are due to the ?

A

influenced by societal expectations, hormones, and genetic makeup

50
Q

how are hormonal changes linked to pain ?

A

Women are two to three times more likely to experience migraines during childbearing years, are more sensitive to pain during premenstrual period, and are six times more likely to have fibromyalgia.

51
Q

what is the problem with giving opioids?

A

-Effective against severe pain but can cause serious side effects
-Effects range from pain relief to euphoria.
Use can lead to physical dependence

52
Q

side effects of opioids

A

Mu receptors in brainstem lead to possible respiratory depression , MU receptors in the small intestine can lead to constipation, MU receptors in dorsal horn and modulate perception of pain

53
Q

Subjective pain report is considered ?

A

The gold standard of pan assessment

54
Q

when performing the initial pain assessment,

A

Qualify all information in the patient’s own words

55
Q

Questions to ask in pain assessment ?

A

Do you have pain, where is the pain, when did the pain start, what does the pain feel like ? how much pain do you have now , does the pain limit your functioning, how do you react usually when you are in pain, what makes the pain better or worse

56
Q

pain is :

A

multidimensional in scope, encompassing physical, affective, and functional domains

57
Q

Standardized overall pain assessment tools are more useful for what kind of pain ?

A

chronic pain conditions or particularly problematic acute pain problems.

58
Q

How should you select the type of pain assessment ?

A

based on its purpose, time involved in administration, and patient’s ability to comprehend and complete tool.

59
Q

what is an initial pain assessment ?

A

Clinician asks patients eight questions concerning location, duration, quality, intensity, and aggravating/relieving factors.
Furthermore, clinician adds questions about manner of expressing pain and effects of pain that impairs one’s quality of life.

60
Q

what is a brief pain inventory?

A

Clinician asks patient to rate pain within past 24 hours on graduated scales (0 to 10) with respect to its impact on areas such as mood, walking ability, and sleep

61
Q

what is the short form McGill pain questionaire?

A

Clinician asks patient to rank list of descriptors in terms of their intensity and to give an overall intensity rating to his or her pain

62
Q

pain rating scales should be used to?
They can also do what ?

A

intended to reflect pain intensity.
- indicate a baseline intensity, track changes, and give some degree of evaluation to a treatment modality

63
Q

Numeric rating scales

A

patient to choose a number that rates level of pain, with 0 being no pain and highest anchor 10 indicating worst pain.

64
Q

Verbal descriptor scales

A

have the patient use words to describe pain.

65
Q

Visual analog scales

A

have the patient mark the intensity of the pain on a horizontal line from “no pain” to “worst pain.”

66
Q

older adults respond better to using what kind of scale ?

A

when words are selected

67
Q

PQRST Method of Pain Assessment

A

each initial stands for a series of questions to be asked to the patient regarding self report and symptoms

68
Q

P=

A

= Provocation/palliation: What caused it? what makes better? What relieves it? What aggravates it?

69
Q

Q=

A

Quality/quantity: sharp,dull, stabbing,burning,crushing,throbbing,etc

70
Q

R=

A

Region/radiation: where is the pain located? Does it radiate?

71
Q

S=

A

Severity scale : how severe is the pain on a scale of 0 to 10

72
Q

T=

A

Timing: when did the pain start? How long did it last? How often does it occur? When do you usually experience (before meals,or after meals)

73
Q

pain assessment with infants will be based on ?

A

on behavioral and physiologic cues.

74
Q

Children 2 years of age can report pain and point to its location but cannot

A

rate pain intensity

75
Q

when can rating scales be given to a child ?

A

at age 4-5 years

76
Q

what rating scales can kids use?

A

Faces Pain Scale-Revised (FPS-R)

77
Q

pain assessment with patients that cannot verbally communicate

A

identify pain using behavioral cues.

78
Q

what are acute pain behaviors ?

A

Involve autonomic responses
Has a protective purpose

79
Q

Individuals experiencing moderate to intense levels of pain may exhibit the following behaviors

A

Guarding, grimacing
Vocalizations such as moaning, agitation, restlessness, stillness
Diaphoresis,
Change in vital signs
Remember, the vital signs can also be altered by medications, fluid volume

80
Q

Persistent (Chronic) pain behaviors
Often live with experience for months and years

A

Shows more variability than acute pain behaviors, adaption occurs over time
Higher risk for under detection

Bracing, rubbing
Diminished activity
Sighing
Change in appetite

81
Q

assessing chronic pain in infants ?

A

There is no one assessment tool that adequately identifies pain in infants, clinicians should: Use a multidimensional approach
- Changes in facial activity and body movements may help assess pain.

82
Q

tools used to assess pain in infants ?

A

CRIES
and FLACC

83
Q

CRIES assessment ?

A

Measures postoperative pain in preterm and term neonates
Examines physiologic and behavioral indicators on 3 point scale, a

84
Q

Flacc assessment ?

A

Nonverbal tool used for infants and young children up to age 3

Assesses 5 behaviors of pain (facial expression, leg movement, activity level, cry, and consolability)

85
Q

older adults will often ??

A

Deny having any pain - for fear of dependency, further testing or invasive procedures, cost, and fear of taking painkillers or becoming a drug addict.

86
Q

When do we use the PAINAD scale ?

A

pain assessment for advanced dementia patients , will evaluate Breathing, vocalization, facial expression, body language, and consolability
Quantified behaviors in category 0 to 2
Total score metric 0 to 10
Score of 4 or more requires treatment

87
Q

Older adults with history of comorbidities

A

should anticipate pain

88
Q

What should we observe in older adults in relation to pain

A

Observe for changes in functional behavior and/or behavioral cues

89
Q

What is CRPS?

A

aka reflexive sympathetic dystrophy which is a chronic progressve nerve condition - caused from a short circuiting effect of the interaction between the sensory, motor, autonomic nervous system, and immune system
happens in men and women (40-60 yrs )

90
Q

CRPS key feature ?

A

innocuous stimulus.
- light cotton brush causes severe pain

91
Q

treatment of CRPS

A

High doses of medications (e.g., prednisone, amitriptyline, pregabalin, clonidine) to decrease symptoms
physical therapy to regain limb function

Health Assessment (11 decks)

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