Pain Flashcards
pain
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”
International Association for the
Pain (IASP)
Margo McCaffrey idea of pain
the main researcher on pain, go-to person that we talk about in terms of the study of pain.
she describes it as whatever the experiencing person says it is existing whenever he or she says it does.
So basically, pain is whatever the patient says it is.
what is important on margo mccaffreys definition of pain?
it emphasizes the fact that pain is subjective, not objective, meaning it’s hard for the nurse to just look at the patient or use assessment data, physical assessment data or labs to figure out if they’re in pain.
also stresses the patient, not the clinician as the authority on his or her pain, whatever the patient says it is. And it also describes the patient self-report as the most reliable indicator of pain. These are really important concepts nurse really needs to keep in mind when analyzing the patient’s pain.
magnitude of pain
one of the most common reasons people seek medical care.
15 to 20% of all Americans annually have acute pain and 21% have chronic pain.
And we talked about this when we talked about cancer. And that is approximately 1 third of adults who are actively receiving treatment for cancer and two-thirds of those with advanced malignant disease experienced pain.
common problems with doc/nurses and pain management?
One of the issues that comes up that we’ll talk about is the fact that doctors tend to under prescribe management and nurses tend to under educate. And these are two of the things that we’re really trying to work against.
gate control theory of pain
So one way to describe the transmission of pain to the brain is to use this thing we call the gate control theory. And that’s what this is depicting, the fact that only one message, message gets to be sent to the brain. And so depending on what gets through, that’s the experience of the patient. So this, this picture is describing either the pain railroad gets through and the patient experiences pain or something else, opioids or some other message gets sent to the brain. If that other message, and we’ll talk about opioids as an example. The opioids get to the brain and that’s the experience. That’s experience of euphoria overrides the message of pain in the brain.
why does acupuncture work for pain?
lets say the person has an injury to their finger or they slam their finger in the car door And that experience of pain will go up to the brain.
if the acupuncturist applies the needle in the proper place as they’re trained, then it’s that message or that blocking action that the acupuncture needle does that gets to the brain. And what it does is it blocks the ability for that experience of pain to get to the brain. complementary/alternative therapy
acute vs chronic pain
oftentimes you’ll hear it described as you know, acute pain is anything less than six months and chronic pain more than six months. And I really want to discourage you from having that simplistic and understanding of the difference. So one of the things that’s different between the two is intensity. So acute pain tends to be very short duration. Six months is arbitrary, but it’s short duration. So for example, when whatever the cause of the pain is removed or the healing happens, the pain goes away.
whereas with chronic pain, it last longer and oftentimes those treatments aren’t enough to heal the pain. The other thing that’s significant about the experience of chronic pain is oftentimes the patient doesn’t know what the source is. with acute pain, you know, the source you treated goes away with chronic pain. Oftentimes the exact cause is not known and therefore that’s why it can’t be treated. So it might have originated as a back injury, but the pain continues despite all the treatments and despite being able to decrease the pressure on the spinal cord or whatever the original pain was that has a big impact.
Another difference is autonomic response. And so with acute pain, the patient will have a sympathetic nervous system response, increased heart rate, respirations, those sorts of things, that happens with acute pain as a immediate sensation.
Whereas with chronic pain, the body experiences this for a long enough period of time that it no longer triggers that sympathetic nervous system response.
The other issues, including psychosocial issues that I alluded to this before. With acute pain, the patient oftentimes knows it will stop when the bone heals or whatever the damages, the pain will stop.
Whereas with chronic pain, the patient doesn’t always know it will stop and that has an impact.
And then physiologic differences. And these don’t get talked about enough. And I think this is actually one of the most interesting differences between acute and chronic pain. Chronic pain causes physiologic changes in the brain. So you have that pain sensation that goes up to the brain and it takes a particular route. The more times that sensation passes that same route, the, the more embedded that becomes. And I heard this described once as think about, you know, you have a little trickle of water and that trickle of water passes through and it sort of creates a rut and it allows more water to pass through and that trickle becomes a river. And the longer it goes, the deeper the red is. And sometimes things that wouldn’t normally be experienced as pain get experienced as pain because they travel that route. So the wind blowing over the patient’s hand. If it’s a hand injury, that sensation of the wind, It’s felt, tests pain because it just takes that path of least resistance up to the brain. So that the physiologic changes in the brain have an impact on the patient’s experience of chronic pain, as well as differences in the quality of pain. And this is important to your physical assessment.
acute vs chronic pain
autonomic response
intensity
psychosocial issues
physiologic differences
quality of pain: nociceptive + examples
somatic or visceral.
somatic: experiences in the bone. Experience is in cutaneous tissue, subcutaneous tissue or as visceral pain is pain in the organs themselves. So somatic pain can be described as dull pain, sharp pain, aching pain, visceral pain can be described in those same ways. Dull, sharp, aching, but sometimes it has a little bit of a different description or feeling like the cramping pain depending on for example, at cramping pain that happens in the gallbladder when the gall bladder squeezes. Sometimes we describe certain visceral pains as colicky pain. And colicky pain is related to peristalsis, so it sort of comes in waves. So if the patient describes the pain coming in waves, you know, in their abdominal area, you can kind of make an assessment that, oh, that’s related to peristalsis, there’s probably something wrong with the GI tract. So those sorts of things will give you a sense of where.
quality of pain: neuropathic
Another type of pain is neuropathic pain, and that comes from damage to the nerve. So postherpetic neuropathy, also known as shingles. So that’s what the picture’s right there. Diabetic neuropathy, HIV associated neuropathy, chemotherapy related neuropathy. This pain is described by the patient as sharp pain or pins and needles. Diabetic Neuropathy in the feet. Sometimes the person will say, you know, it feels like I’m stepping on pins or feels like I’m stepping on an electrical cord. So it has a very different quality. And again, that’ll help you understand where the pain is and possibly what is the cause so that can be addressed.
cancer pain
There are different types of cancer pain.
Pain, acute pain, chronic pain. The cause of it can be the cancer itself, the treatment of it, such as surgery or medication or radiation later. It’s oftentimes associated with nerve pain, so the quality can be different. But the main thing that’s different about cancer pain is the significance and the meaning that the person gives to that pain. The meaning of the pain can actually make that patient’s experience of pain worse. And we’ll talk about all those sorts of things that contribute in addition to physiologic effects, the Emotion, Psychology, the meaning, all of these things make the experience of pain worse. And that’s very common in patients with cancer.
physiologic/pathologic consequences of pain
So physiologically, with acute pain, you’d get that stress response, which leads to catabolism, effects on the cells themselves. You see that increase heart rate, blood pressure, decrease GI motility, impaired immune response. So untreated pain can not only be difficult for the patient to bear, but it also can have effects on the functioning of the body. One of the reasons why after surgery we’re so aggressive about treating people’s pain is because it can get in the way of healing or it can cause new problems that didn’t exist before.
sensory dimension of pain
And then there’s the sensory and effective dimensions of pain. And sensory is just the location and intensity quality. Intensity is the kind of thing that usually gets measured with our uni-dimensional scales, which we’ll talk about in a minute. The quality is as sharp as dull. temporal patterns are onset duration, is it constant, is an intermittent, is episodic. So those are oftentimes physical things. How the patient feels the pain.
affective dimension of pain
Affective dimensions has to do with the emotions around the pain. The emotions the person assigned to pain. Why am I having this pain? What is this pain mean? This pain causes depression. Support has a lot to do with this. Many studies have shown that the lack of support for a person in pain actually makes the experience of pain worse and can bring on a lot of those sort of secondary problems. Also things like fear, frustration, anger, stress, anxiety. All of these increase the patient’s experience of pain and makes the pain worse. What would be a six becomes an 8.
