Pain Flashcards
___ is the 5th vital sign
Pain
Pain is objective or subjective
subjective
4 steps of pain
Transduction
Transmission
Perception
Modulation
Two major types of pain
Nociceptive and neuropathic pain
Nociceptive pain
Caused by injury or inflammation
Generally reversible (responding to analgesics and opioids)
Usually localized, constant and often associated with ache/throb
Example of nociceptive pain
Burn fracture, tomor, obstuctions
Neuroptathic pain
Caused by injury or malfunction within the CNS or PNS
Can occur without immediate tissue damage or inflamattion
Associated with diapetic neuropathy, inflammation around nerves, viruses)
Does not respond well to analgesics or opiods
Acute pain
Sudden onset
Subsides once treated (usuallyP
Often affecting BP,HR, RR
Behaviour changes may be apparent with cultural influences
Chronic pain
Ongoing/recurring
More difficult to treat
Can be complex, not afecting BP, HR, RR
Acute behaviour change less apparent
Onset of chronic pain
Days to months
Description of chronic pain
Dull, aching, always there
Example of chronic pain
Arthritis, cancer, lower back pain, peripheral neuropathy
Why is cancer pain often complicated
can be caused by tumor
pressure and inflammation on a
nerve near or within an organ or
bone.
What are the contributers to complicated pain
Sorrow and suffering, anxiety and
depression, an unknown outcome,
family pressures, loneliness and
isolation, etc., can contribute to
complicated pain.
Classification of Pain by Manifestation
Somatic (generalized body aches)
* Visceral (organ pain)
* Superficial (surface, skin-deep)
* Vascular (pulsating, or vessel
related)
* Referred (pain that is felt away
from the source)
* Chest (angina or potential
myocardial infarction MI)
* Phantom (limb loss)
* Neuropathic (nerve related pain:
pins & needles, burning, numbing,
freezing sensations)
* Cancer (severe, complex)
* Psychogenic (suffering caused by,
or triggered by, non-physical
causes)
* Radiating (traveling, usually along a
nerve path)
* Cramping (Gastro-intestinal pain
that is triggered by peristaltic
waves)
Pain scales for rating pain systematically:
- O-10 scale
- Verbal Descriptor Pain scale
Comprehensive pain assessment tools:
Body mapping of pain
* Pain diary (patient keeps this and brings it to the
provider)
* Interview with patient and family
LOTTAARRPP
- Location
- Onset
- Type
- Timing
- Alleviating factors
- Aggravating factors
- Related symptoms
- Radiating?
- Personal Perception (0-10 scale)
- Precipitating event
Assessment for
Non-verbal or dementia patients
Basic Needs Assessment
* ADD protocol
* Universal Pain Assessment (‘Faces’ scale)
* PAINAD
Basic Needs Assessment
- Does the resident need his or her eyeglasses or hearing aid?
- Is the hearing aid working?
- Is the patient’s discomfort due to toileting or incontinence
needs? Hunger? Thirst? - Is the resident too hot or too cold?
- Does the patient need a position change to relieve pressure?
- Does the resident need more light? Shadows can be
disturbing. Lots of natural or indirect bright light may reduce
anxiety. - Does the resident need more stimulation? Less stimulation? `
Possible disturbing environmental stressors for elderly patients
Noise from a television
* Echoes in bathrooms or other heavily tiled areas
* Noise from background conversations
* Pounding from pill crushers
* Ringing telephones or pagers
* Public address systems
* Glare from lighting
* Hard, unpadded chairs or uncomfortable vinyl furniture
* Wrinkled bed sheets or clothing
* Garments made of rough or itchy materials
* Poorly fitting shoes or clothing
Potential barreirs to the treatment of pain
Health care provider’s bias
* Patients’ misconception of what pain is
* Cultural beliefs
* Cost of medication
* Lack of knowledge
Pain Threshold
The point at which
pain begins to be felt
Pain Tolerance
Maximum level of pain a patient can endute
Medication tolerance
Body is accustomed to the medication and has a decreased responses to its therapeutic effect (a person requires more of the medication to achive the same effect)
Dependence
Development of withrdrawl symptoms when an opiod is suddenly discontinued
Addication
craving, compulsive use,
inability to control
Non-Opiod Analgesics
- Many are OTC (for mild to moderate pain):
- Tylenol
- Ibuprofen
- Naproxen
- Advil
- Aspirin (contraindicated for chronic pain)
- These medications are typically better than
opioids for bone and inflammation-related
pain.
How to use non-opiod analgesics
Wigh reisk.versus benefits
Start with low dose to determine
resident’s/patient’s reaction.
* Increase gradually to dose that relieves
pain, not to exceed maximum daily dose
If maximum anti-inflammatory effect is desired
in addition to analgesia, allow adequate trial
before discontinuing or switching
Some non-opiods take how long to work
Some non-opioids (especially those for
neuropathic pain) may take several weeks
to begin to work well (ex. Gabapentin).
What are Adjuvant Analgesics
- Medication that have a primary indication
other than treatment of pain but relieve pain in
some conditions.
Ex of adjuvant analgesics
Antidepressants
* Tricyclic antidepressants (TCAs)
* Selective Serotonin Reuptake Inhibitors (SSRIs)
* Anticonvulsants (neuropathic pain)
* Carbamazepine, Clonazepam, Lyrica
* Corticosteroids (inflammatory pain)
* Prednisone, Dexamethasone
* Caffeine (acts as a synergist, or ‘booster’ to
other analgesics) and is a ‘true’ adjuvant
medication.
* Ex. Midol is very common example
Opioid Analgesics
Pain relievers that contain opium, derived
from the opium poppy (morphine, a ‘true’
opiate) or are chemically related to opium but
synthetically manufactured (codeine sulfate):
* Methadone HCl
* Hydromorphone
* Morphine sulfate
* Oxycodone
* Fentanyl
* Tramadol/ Tramacet
* Meperidine HCl (Demerol) (not indicated
for older adults)
Start LOW and GO SLOW with the elderly
Side effects of opiods
Constipation
* Nausea and Vomiting (N & V)
* Orthostatic hypotension
* Dizziness
* Potential CNS (respiratory) depression
* Confusion, drowsiness
Opiote antagonists
Bind to opiate receptors and prevent a
response.
* Used to attempt complete or partial
reversal of opioid-induced respiratory
depression.
* Naloxone (Narcan)
* Naltrexone (Revia)
Always evaluate what after opiod administration
Evaluate Sedation and Vital Signs
POSS
Pasero Opioid-induced Sedation Scale
4 point scale assessing level of arousal
Pain clinics
- Provide specialized, comprehensive, and
multidisciplinary approach to pain
management. - Important advocacy for residents/patients
with complex, unresponsive pain. - Religious leaders may become part of the
team if complicated pain (suffering) is
causing physiological treatments to be
ineffective.
Non pharm interventions for pain
- Music therapy
- Pet therapy
- Biofeedback
- TENS (transcutaneous nerve
stimulation, usually by PT) - Body movement therapy
- Reposition
- Games and visits
- Gardening
- Favorite foods
- Therapeutic touch
- Counseling
- Art therapy
- Prayer and meditation
- Swimming or hydrotherapy
- Movement & stretches
- Heat and/or icing
- Herbal formulations
- Acupuncture/acupressure
Therapeutic outcomes of pain management
Decreased complaints of pain
* Decreased severity of pain
* Increased periods of comfort
* Improved activities of daily living, appetite,
and sense of well-being
* Improved ability to relate with family and
friends
* Improved QOL
