Pain Flashcards
What is acute pain?
- Caused by tissue damage– it is a protective response
- Peripheral nociceptive neuron is stimulated by intense noxious stimuli which sends a signal to the CNS
- CNS: brain and spinal cord process the afferent input and this results in sensation of pain
What is chronic pain?
- Neural dysfunction in the peripheral and/or CNS pain pathways
- extends beyond the expected 3-6 months healing period and often has no identifiable cause
- serves no purpose
What are the consequences of pain?
- Activation of stress response- SNS and adrenocortical stimulation
- elevated blood sugar
- immunosuppression
- urinary retention
- altered coagulation
- psychosocial- anxiety, depression, impact of relationships and productivity
What makes pain assessment difficult?
- It is difficult because it is subjective and each patient’s experience of pain is unique
- Pain can be influenced by:
- unique physiology (PNS and CNS circuitry)
- pathophysiology
- personality
- previous life experience
- cultural and religious background
- age
- Healthcare providers may undertreat pain if:
- they dont believe the pt
- they dont understand the science behind it
What should you assess regarding the history of pain?
- existence of pain
- assess each type of pain/pain problem separately
- previous injuries
- Adjunctive therapies
- acupuncture, TENS, injection therapy, SCS
- Coexisting psychological disease/physical disease
What are the elements of a pain assessment?
- P- precipitating events
- Q- quality
- R- Region/radiation
- S- severity
- T- Temporal relationship/Timing
-
A- associated symptoms
- functional impairment
- previous treatment
- inflammation
- Pain goals
What is the benefit of behavioral pain scales?
- provides a means for consistent evaluation of pain in non-verbal patients
- pediatric pts
- pts with cognitive impairment
- critically ill patients
What pain scale would be appropriate for a pediatric patient >3 yrs old?
- Wong-Baker FACES scale
What is the Payen Behavioral pain scale?
- It was developed for critically ill intubated ICU patients
- Is reliable and valid and correlates to NPI ratings, even in patients who are on sedation
- uses a 0-12 pain rating scale
For what patients would you use the FLACC score?
2 months to 7 years
For what patients would you use the CRIES pain scale?
0-6 month olds
What else should you assess in a patient with chronic pain?
- General medical history- comorbidities contributing to complex pain condition
- How does pain effect:
- sleep?
- physical functions?
- ability to work?
- your mood?
- family/social life?
- What treatments have you received? Effects? adverse effects?
- Are you depressed
What should you assess on the physical exam of pain?
- General physical examination
- affected area
- neurological exam
- musculoskeletal system
- ROM
- muscle wasting
- skin- redness, wounds, edema, changes
- assessment of psychological factors: un-kept personal hygiene
What are some specific diagnostic studies that can be done?
- Quantitative sensory testing for pain thresholds and pain tolerance
- diagnostic nerve blocks
- pharmacologic tests
- conventional radiography, tomography, MRI, ultrasound imaging
- Electromyography nerve test (EMG)- assess nerve impulses into muscle
- Nerve conduction velocity test (NCV)- to see how rapid an impulse comes through a nerve
- bone scans- cancer pain
- blood test- looking for comorbidites
How can you test for different types of allodyna?
- “poor man’s sensory testing”
- Cold allodynia- cold water in a glass tube
- heat allodynia- glass tube with warm water
- dynamic mechanical allodynia- cotton wool and artist’s brush
- hyperalgesia- blunt needle
What is the neuroendocrine response that is caused by acute pain?
An SNS response, release of cortisol and Renin
