Pain Flashcards
what are the different types of pain?
acute
chronic
neuropathic
define pain per McCaffery
pain is whatever the person says it is, and existing whenever the person says it does
pain is ____________
subjective
what are three characteristics of acute pain?
- sudden in onset, localized last less than 6 mo
- result of tissue injury or inflammation
- resolves with healing of disorder
define pain per 1979 study of pain
an unpleasant sensory and emotional experience associated with actual or potential tissue damage
which kind of pain, results in a fight-or-flight response?
acute pain (tachycardia, tachypnea, ↑ BP, fear, anxiety)
how is acute pain treated?
therapy is aimed at treating underlying cause and interrupting nociceptive signals
how is chronic pain treated?
difficult to treat pharmacologically. complementary or alternative medicine approaches can provide relief.
what is are some side effects of chronic pain?
-increased mortality from heart or respiratory disease
-decreased physical activity = reduced flexibility, strength, stamina or weight gain
what are three characteristics of chronic pain?
- pain lasting more than 6 months
- may originate with injury, illness or no clear cause
- accompanied by fatigue, sleep disturbances, ↓appetite, mood changes, depression, anxiety
(normal vital signs)
what are three characteristics of neuropathic pain?
- abnormal pain from damage to nerve cells (shingles0
- burning, numb, pins and needles, tingling, or shooting sensation
- normal stimuli can produce significant discomfort
how is neuropathic pain treated?
adjuvant therapies (antidepressants, anticonvulsants, capsaicin)
(opioids and NSAIDs ineffective)
what are the 4 types of neuropathic pain?
- central pain (damage to CNS multiple sclerosis)
- peripheral neuropathies (diabetes)
- differentiation pain (phantom limb)
- sympathetically maintained pain (after injury or surgery, pain is out of proportion)
how is pain classified?
cause
duration
origin
what is intractable pain?
chronic or resistant to relief
what are the ways pain is classified by origin?
-cutaneous
-deep somatic
-visceral
-radiating/referred
-phantom
-psychogenic
what are the ways pain is classified by cause?
nociceptive (trauma)
neuropathic (nerve problem)
what are the ways pain is classified by duration?
acute
chronic
intractable
give an example of a cutaneous/ superficial pain cause:
cat scratches
give an example of deep somatic pain cause:
cancer, artritis, fracture
give an example of visceral pain cause:
organs, internal pain receptors (tight, pressure cramping)
give an example of psychogenic pain cause:
believed to come from the mind, no medical reason can be found
give an example of phantom pain cause:
amputation pain
what is an example of referred pain?
felt in one place but may originate elsewhere (gallbladder pain felt in rt. shoulder)
when describing pain what are the three categories we ask about?
quality
periodicity
intensity
what are some examples of descriptors for quality of pain?
sharp, dull, aching, throbbing, stabbing, burning
what are some examples of descriptors for periodicity of pain?
-episodic (related to something= period, migraines)
-intermittent (comes and goes)
-constant
what are some examples of descriptors for intensity of pain?
mild (1-3), moderate (4-6), severe (7-10), intolerable
what are the four mechanisms of pain perception?
- transduction
- transmission
- perception
- modulation
what is perception?
recognizing and defining pain in the cortex
what is transduction?
activation of nociceptors by stimuli
what is transmission?
conduction of pain message to dorsal part of spinal cord
what is modulation?
changing pain perception (non-pharmacological interventions can promote the release of endogenous opioids during this stage- perception of pain changes)
what are endogenous opioids?
pain relief from your own body not ingested
what is a nociceptor?
a nerve receptor that transmits pain located at the ends of small afferent neurons
what are nociceptors stimulated by?
direct cell damage
how is nociceptive pain described?
as aching or throbbing
what type of pain responds to non opioid and opioid analgesics
nociceptive pain
what are the two types of nociceptor fiber types?
C fiber non-myelinated (slow)
A-delta myelinated (fast)
what type of pain do C fibers transmit? What is an example?
dull, aching, burning pain
slow onset, longer duration
ex: bump knee
what is the “gate theory” of pain?
gate is opened by nociceptor input, anxiety, worry, concentrating on pain
gate is closed by non-nociceptor input, positive mood, concentrating on other than pain
what type of pain to A-delta fibers transmit? what is an example?
sharp localized pain
short duration
ex: paper cut
what are six factors that influence pain?
- emotions
- experience with pain
- developmental stage
- sociocultural factors
- communication skills
- cognitive impairments
when asessing pain it is important to obtain a __________ pain history including ___________, ____________, and_____________.
complete
onset
location
aggravating/alleviating factors
what are some nonverbal signs of pain?
elevated pulse/ BP
crying,
moaning
sweating
shaking
grimacing
guarding
silence
what are the 6 pain scales?
- numeric rating scale (NRS)
- vusual analogue scale (VAS)
- wong-baker faces pain scale
- PAINAD
- FLACC behavioral (kids)
- neonatal infant pain scale
what scale is used for normal adults?
numeric rating scale
what pain scale is used for children?
wong-baker faces scale
FLACC (behavioral pain scale) kids <7
what scale is used for people with dementia?
PAINAD
what scale is used for infants?
neonatal infant pain scale
what is a visual analog pain scale?
a tool that help pt. mark their pain on a continuum (line) from no pain to worst pain shown above faces scale usually
FACES is a _______________ pain scale
self-report. the pt. is telling YOU. used on 3+ kids able to say “i am here”
what are the 4 types of non-pharmacological pain management methods?
- cutaneous stimulation
- immobilization
- cognitive-behavioral interventions
- oral sucrose
what is oral sucrose used for?
babies in pain
what are some cognitive-behavioral interventions?
distraction (music)
sequential muscle relaxation
guided imagery
hypnosis
animal therapy
therapeutic touch
what are some example of cutaneous stimulation for pain management?
-transcutaneous electrical nerve stimulation (TENS)
-spinal cord stimulator (SCS)
- acupuncture
-acupressure
-massage
-use of hot and cold
-contralateral stimulation
what types of cutaneous stimulation is the nurse able to do?
massage
use of heat and cold
contralateral stimulation
who uses transcutaneous electrical nerve stimulation (TENS)?
chiropractors
physical therapist
people in labor
what do CAM promote the release of?
endogenous opioids (endorphins and enkephalins)
what are some pharmacological measures for pain management?
non-opioid analgesics
adjuvant analgesics
opioid analgesics
give an example of non opioid analgesics?
NSAIDs
acetaminophen
give an example of opioid analgesics?
(IV, transdermal and epidural forms)
nerve block
local or topical anesthesia
epidural injection
