pain Flashcards
is pain objective or subjective?
subjective!
what’s the most reported chronic pain?
migraine and low back pain
factors affecting pain
sociocultural influences, past experiences, source, fatigue, anxiety, depression, coping skills
nociceptive system
system involved in the transmission and perception of pain
pain transduction
begins at peripheral site, noxious stimuli cause release of chemicals, activation of nociceptors, noxious stimuli converted into action potential carried to the spinal cord
pain transmission
dorsal horn receives and processes signal, neurotransmitters released, dorsal horn can experience central sensitization, dorsal horn relays signal to spinothalamic and spinoreticular tracts, signal ascends to thalamus and then relayed to multiple areas of cortex
pain perception
RAS alerted to pain, somatosensory cortex localizes and characterizes pain, limbic system drives emotion/behavior
pain modulation
activation of descending pathways that inhibit transmission of pain, caused by release of opioids or admin of opioids
nociceptive pain
damage to a variety of bodily structures both somatic and visceral
neuropathic pain
damage to peripheral nerves or structures in the CNS, often described as numbing, hot, burning, shooting, stabbing, or sharp
superficial somatic pain
nociceptive
includes skin, MM and SQ tissues; well localized, often sharp, burning, prickly
deep somatic pain
nociceptive
bone, joint, muscle, and connective tissue; deep ache or throb; may be localized or diffuse and radiating
visceral pain
nociceptive
response to inflammation, stretch, or ischemia; well or poorly localized; may be referred to skin at a distant point
deafferentation pain
neuropathic
peripheral nerve injury from loss of input
sympathetically maintained pain
neuropathic
dysregulation of the ANS
central pain
neuropathic
caused by a lesion in the CNS
peripheral neuropathy
neuropathic
damage to a peripheral nerve
acute/transient pain
self-limiting pain that improves; short duration, often from trauma or surgery
chronic/persistent pain
persists over 3mo duration, from wide variety of causes
referred pain
pain felt at the surface distant from the visceral location
breakthrough pain
pain occurring between doses of med/treatment
phantom pain
associated with amputation; a neuropathic pain
idiopathic pain
unknown cause
components of pain assessment
pattern, location, intensity, quality, management strategies, impact, pt beliefs/expectations/goals, documentation, reassessment
ladder of analgesia
1 - nonopioids
2 - opioids for mild/mod pain
3 - opioids for mod/severe pain
nonopioids
work at PNS, mild/mod pain, have dose limit (ceiling), no tolerance/dependence, available OTC
opioids
work at CNS by binding to cell wall of opiate receptors, for acute and chronic pain, often given w/ acetaminophen, pure agonists or mixed agonist/antagonists
side effects of opioids
constipation, NV, drowsiness, resp depression, pruritus (itching), urinary retention, pupil constriction
why is scheduling meds good?
the pt won’t peak and drop - it’s more consistent pain relief
what are some non-pharm pain management strategies?
positioning, pressure, acupuncture, massage, heat/cold, distraction, relaxation, hypnosis, exercise
tolerance
increased need for med to achieve same pain relief (common with opiates)
physical dependence
causes withdrawal when blood level drops too low
addiction
behavioral; aberrant behavior from a drive to obtain and take drugs for reasons other than their prescribed use
