Pain- 32 Flashcards
Pain
is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Pain is
“whatever the person says it is, and existing whenever the person says it does”
Cutaneous or superficial pain
arises in the skin or the subcutaneous tissue (e.g., a burn or an abrasion). Although the injury is superficial, it may cause significant short-term pain.
Deep somatic pain
originates in the ligaments, tendons, nerves, blood vessels, and bones. Deep somatic pain is more diffuse than cutaneous pain and tends to last longer.
Visceral pain
is caused by the stimulation of deep internal pain receptors, most often in the abdominal cavity, cranium, or thorax.
Radiating pain
starts at the origin but extends to other locations. For instance, the pain of a severe sore throat may extend to the ears and head.
Referred pain
occurs in an area that is distant from the original site.
Phantom pain
is pain that is perceived to originate from an area that has been surgically removed.
Psychogenic pain
refers to pain that is believed to arise from the mind. The patient perceives the pain despite the fact that no physical cause can be identified.
Nociceptive Pain
is the most common type of pain. It occurs when pain receptors, which are called nociceptors, respond to stimuli that are potentially damaging
Neuropathic Pain
is complex and often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli.
Acute pain
has a short duration with rapid onset. It varies in intensity and may last up to 6 months
Chronic (or persistent) pain
lasts 3 to 6 months or longer and often interferes with daily activities.
intractable pain
is both chronic and highly resistant to relief. This type of pain is especially frustrating for the patient and care provider.
Pain quality
may be described as sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling.
Pain periodicity
may be referred to as episodic, intermittent, or constant.
Pain intensity
is described with a variety of terms, such as mild, distracting, moderate, severe, or intolerable.
transduction
nociceptors become activated by the perception of mechanical, thermal, and chemical stimuli.
Mechanical stimuli
are external forces that result in pressure or friction against the body. They involve stretching of body tissues
Thermal stimuli
result from exposure to extreme heat or cold.
Chemical stimuli
stimuli can be internal or external.
transmission
Peripheral nerves carry the pain message to the dorsal horn of the spinal cord
A-delta fibers
These fibers transmit fast pain impulses from acute, focused mechanical and thermal stimuli.
C fibers
smaller unmyelinated fibers that transmit slow pain impulses, that is, dull, diffuse pain impulses that travel at a slow rate.
neurotransmitters
Pain transmission involves endogenous chemicals
Perception
involves the recognition and interpretation of pain in the frontal cortex
Pain threshold
is the duration or intensity of pain that a person can endure.
hyperalgesia
Extreme sensitivity to pain
modulation
changes the perception of pain by either facilitating or inhibiting pain signals through the endogenous analgesia system and the gate-control mechanism.
endogenous analgesia system
neurons in the brainstem activate descending nerve fibers that conduct impulses back to the spinal column
Endogenous opioids
naturally occurring analgesic neurotransmitters that inhibit the transmission of pain impulses.
Key point
Pain is universal, yet each person experiences and responds to pain differently.
Emotions
multitude of feelings may overwhelm them and escalate their pain.
fear
confusion/helplessness
anxiety/depression
pain: infants/children
Newborns have the same sensitivity to pain as older infants and children, and preterm infants may have a greater sensitivity
usually cry- sometimes don’t cry but are still in pain alters pain scales pain goes untreated
pain:older adults
Pain occurs in more than half of the geriatric population.
- cognitive impairment
- nonverbal cues
- atypical response
- diminished quality of life
nonverbal cues
Facial expressions vocalizations change in physical activity change in routine mental status change physiological cues *lack of cues does not mean no pain
onset of acute pain
activates the sympathetic nervous system.
If the pain continues
the body adapts, and the parasympathetic nervous system takes over
Sympathetic Responses (Acute Pain)
Dilated blood vessels to the brain, increased alertness
Dilated pupils
Increased heart rate and force of contraction
Increased respiratory rate
Increased systolic blood pressure
Rapid speech
Pallor
Parasympathetic Responses (Deep or Prolonged Pain)
Changeable breathing patterns
Constricted pupils
Decreased pulse rate
Decreased systolic blood pressure, feeling faint, possible syncope
Slow, monotonous speech
Withdrawal
Behavioral Responses (Voluntary)
Agitation
Crying
Facial grimacing
Guarding the painful area
Moaning
Withdrawing from painful stimuli
Psychological (Affective) Responses
Anger
Anxiety
Depression
Exhaustion
Fear
Hopelessness
Irritability
Pain assessment
Pain location and quality
Pain intensity
Aggravating and alleviating factors
Timing and duration
Pain relief and expectations for how much pain is realistic
Questions that reveal the patient’s ability to perform activities of daily living
Mobility
Psychological/social factors
The Visual Analog Scale
“No pain” is written on the left side and “Worst pain imaginable” is written on the right. Patients point to a location on the line that reflects their current pain.
The Numerical Rating Scale
Zero indicates no pain at all, whereas a 10 indicates the worst possible pain.
The Simple Descriptor Scale
is a list of adjectives that describe different levels of pain intensity. The simplest version of this scale uses the words mild, moderate, and severe.
The Wong-Baker FACES Pain Rating Scale
FACES scale uses simple illustrations of faces to depict various levels of pain. It requires no numerical or reading skill.
Assessing Pain in Infants and Children
self-report, behavioral observation, or physiological measures
- ask parents usual signals
- use play to assess coping
- age appropriate toys to act out feelings
- simple pain rating scales
Nonverbal Signs of Pain
- Facial expression, posture, and body position
- change in vital signs- only last a short time
- pt can be in pain and not act like it
- ask pt and believe them
- use interpreter
- some think they are being weak
- assess for depression
Cutaneous Stimulation
This process diminishes the patient’s perception of pain. Cutaneous stimulation works best on pain that is localized and not diffuse.
TENS Units
consists of electrode pads, connecting wire, and the stimulator. The pads are applied directly to the painful area, which is most often muscle and soft tissue.
PENS Units
combines a TENS unit with needle probes percutaneously placed (through the skin) to stimulate peripheral sensory nerves. PENS is effective in short-term management of acute and chronic pain.
Spinal Cord Stimulator
The SCS produces a tingly sensation that interferes with the perception of pain.
Acupuncture
Application of extremely fine needles to specific sites in the body to relieve pain
Acupressure
stimulates specific sites in the body.
Massage
Massage has been shown to be effective in reducing pain. By providing cutaneous stimulation and relaxing the muscles
Myofascial release
manual pressure applied between overused or injured muscles and nerves to loosen adhesions that develop from overuse.
Application of Heat and Cold
The application of cold causes vasoconstriction and can help prevent swelling and bleeding
Heat promotes vasodilation and circulation, which speeds healing.
Contralateral Stimulation
stimulating the skin in an area opposite to the painful site.
