pain 2 Flashcards
types of acute pain
Somatic pain Visceral pain Referred pain Breakthrough / incident pain
types of chronic pain
Neuropathic pain (can be acute or chronic) Phantom pain Central pain Cancer pain
Factors that affect the pain experience and
response
brain – based phenomenon.
• Two individuals who are given a ‘standardized pain’ (for example, heat applied to the palm of the
hand at exactly the same temperature) may experience fairly big differences in the amount of ‘heat
pain’ each individual feels. One may rate the pain score at 3/10 while another at 6/10.
• Pain can not be thought of as purely a reflection of the severity of the injury.
• While there is some relationship between injury severity and pain intensity score this is not always
true and there can be a weak relationship or sometimes no relationship between anatomical
pathology and pain.
• Pain tolerance varies between individuals and the response to pain is
influenced by multiple factors
- Sociocultural influences
- Psychological factors
- Physiological factors
- Past experiences with pain
- Sources of pain
- Persons knowledge / age
Chronic pain
• Pain that lasts longer than 3 months or past the standard time for tissue to heal.
• Mechanism underlying the transition from acute to chronic pains include a
complex interaction of physiological, emotional, cognitive, social and
environmental factors.
• Acute, untreated pain can lead to chronic pain through the process of central
sensitisation.
• Even brief intervals of acute pain
can induce long-term neuronal remodelling and
sensitisation (plasticity), chronic pain and lasting psychological distress.
• Neuroplasticity allows neurons
in the brain to compensate for injury and adjust
their responses to new situations or changes in their environment.
• Neuroplasticity contributes to adaptive mechanisms for reducing pain but also
can result in maladaptive mechanisms that enhance pain.
Clinically, central sensitisation of the dorsal horn results in
- Hyperalgesia
- Painful responses to normally innocuous stimuli
- Prolonged pain after the original noxious stimulus ends
- The extension of tenderness or increased pain sensitivity outside of
an area of injury to include uninjured tissues
Chronic Pain
• 1 in 5 Australians live with chronic pain including children. • 1 in 3 over the age of 65 lives with chronic pain • Greatest prevalence occurs in the 65-69 y/o men and 80-84 y/o women • Currently 3.2 million adults live with chronic pain. • Projected to reach 5 million people by 2050.
Factors associated with increased likelihood
for chronic pain
- History of psychological trauma
- History of abuse
- Lower socioeconomic status
- Female gender
- Age
- Race
- Pain related anxiety, fear of pain, pain catastrophizing
- Substance use disorder
- Medical comorbidities
- Sleep disorders
- Nutritional status
- Sedentary or low activity levels
- Smoking
- Psychological disorders
Assessment of pain
Ask Ask patient about their pain Accept Accept and respect what they say Intervene Intervene to relieve the pain according to their pain management goals Ask Ask them again about their pain to evaluate the intervention
Assessment of pain 2
• Consider that some patients may use other words to describe pain
(soreness or aching)
• Use a framework for assessment (PQRSTU or OLD CHARTS – if you can’t
remember what these are then look them up) that will allow you to
capture a broad range of factors associated with pain and help you
understand what the patient understands about pain and pain
management
• Pain assessment tools are effective methods of identifying the presence
and intensity of pain in people
• Pain management is essential in healthcare and it is considered inhumane
(and unethical) to not provide such relief
• Pain in kids is often under -treated due to
- Lack of assessment and reassessment of pain
- Misunderstanding of how to quantify pain
- Lack of knowledge on pain treatment
- Fear of adverse effects of analgesic medication, respiratory depression and addiction
Infants pain assessment
Pain threshold
Physiological symptoms
Behavioural responses
Pain threshold Painful neonatal experiences increase pain sensitivity
Physiological symptoms
Increased heart rate, blood pressure and ventilator rate; flushed or pallor, sweating and decreased oxygen saturation
Behavioural responses
Change in facial expression, crying and body movements, with lowered brows drawn together; vertical bulge and furrows in the forehead; broadened nasal root; tightly closed eyes; angular, square-shaped mouth, chin quiver; withdrawal of affected limbs, rigidity, flailing.
Key points pain assessment children
• In order to provide adequate pain relief, the nurse must assess the patient
accurately and work with other key health professionals and family and
carers to make the patient as comfortable as possible.
• There are many tools to assess pain in the Infant and Child. It is important
the right tool is chosen for the developmental age and used consistently.
• Be mindful of the child with disabilities or communication deficits. There is
evidence to suggest this group may go through life with un-treated pain
either because they cannot communicate it or because health professionals
are focused on other medical issues they may be experiencing.
