Pain Flashcards
Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Different types of pain
- Acute v. chronic
- Adaptive v. maladdaptive
- Nociceptive v. neuropathic
Acute pain
- Primarily symptom of pathological process or injury
- Treating the illness or injury typically will reduce or eliminate acute pain symptoms
- Duration usually less than 3 months
Adaptive pain
Contributes to survival because it protects from injury and promotes healing when the injury has occurred
Biomedical model of pain
- Patient presents with pain
- Formulate possible diagnoses
- Pain management
- Evaluation
Pain severity
5th vital sign using the pain assessment tool (the visual analog scale)
Chronic pain
- Pain which lasts beyond the ordinary duration of time that an injury to the body needs to heal
- Typically lasts 3-6 months
- Can be episodic or constant
- Acute pain evolves into chronic pain in about 20% of patients
Maladaptive pain
- A disease
- Represents pathological functioning of the nervous system
Epidemiology of chronic pain
- Adults: about 50% self reported chronic pain
- Children/adolescent: about 15-30%
Common causes of chronic pain:
Back pain, headaches, arthritis, fibromyalgia, neuropathy
Chronic pain is variable…
Involves individual variables, prior experiences, and social context to better understand the pain/treatment
Biopsychosocial model of pain…
looks at how the pain effects the person; includes environmental/social contributions, beliefs/attitudes, affective vulnerability, comorbid symptoms, and the pain
Consequences of chronic pain
- Quality of Life: physical & psychosocial
- Economic
- General Health: immune system suppression
- Effect on family/friends/relationships
Coping
Pattern of behavioral or cognitive efforts to manage external or internal stress
Coping strategies
- Active coping strategies: despite pain efforts to function or distract oneself
- Passive coping strategies: depending on others for help in pain control, restriction of activities
Behavioral aspects of chronic pain
- Anxiety
- Depression
- Anger
- Feelings of helplessness
- Pain catastrophizing
PEG 3-scale
To understand patients with chronic pain, a longitudinal perspective must be taken. This includes three questions that ask about the pain within the last week and how it has interfered with quality of life and daily activities
Physician perscpective on pain
- Patient’s goals/expectations must be explicitly addressed
- Chronic pain is poorly manages by medications alone
- Multiple management modalities must be employed
Opiods
Class of synthetic or semi-synthetic prescription drugs derived from opium poppy
Perscription opiods
should have no role in chronic non-cancer pain management
Therapeutic approaches to chronic pain
- Nonopiod medications
- Exercise
- Physical therapy, occupational therapy
- Complementary and alternative therapies
- Interventional pharmacotherapies
- Behavioral medicine approaches (biofeedback, hypnosis)
Older patients deny “pain”
Instead, ask them about their ache, soreness, or discomfort
Pain vocabulary: 6-18 months
Use words like owie, ouchie, booboo to describe pain
Pain vocabulary: 18-24 months
Use the word hurt to describe pain
Pain vocabulary: 2-3 years
Can describe pain and explain what caused it
Pain vocabulary: 3-5 years
Can describe the level of pain
Pain vocabulary: 5-7 years
Can more clearly describe the pain
Pain vocabulary: 7-10 years
Can explain why something hurts
Pain vocabulary: 11+ years
Can explain that pain is the body’s way of telling them something is wrong
Pain assessment in cognitively impaired adults
- Facial expressions
- Verbalizations, vocalizations
- Body movements
- Changes in interpersonal interactions
- Changes in activity patterns/routine
- Mental status change
Pain assessment in neurologically impaired children
- Vocalizations, crying, moaning
- Facial expressions, grimacing
- Inability to be consoled
- Increased movement, tone, and posture (arching, stiffening), and physiological responses
