Pain Flashcards
**What is pain?
- subjective unpleasant sensory/emotional experience
- destructive physiological effects
- warns of potential injury
- McCaffrey- put your beliefs about pain aside and focus on the patients’ pain experience*
What does pain affect?
- job performance
- engagement in social activities
- sexual intimacy
- sleep and rest
- ability to exercise
- ADLs
***What is cutaneous/superficial pain?
arises from skin or subcutaneous tissue
example: burn or paper cut
***What is deep somatic pain?
arises from ligaments, tendons, nerves, blood vessels and bones (achy, tender)
example: fracture, sprain, arthritis, bone cancer
***What is visceral pain?
arises from deep internal pain receptors (tight, pressure, crampy)
example: menstrual cramps, labor pain, GI infection, bowel disorders, organ cancer
***What is radiating pain?
starts at the origin and extends to other location
example: heartburn felt all ove thorax, sore throat making ears and head hurt
***What is referred pain?
arises from an area that is distant to the original site
example: pain from a heart attack may be felt in jaw or left arm
***What is phantom pain?
pain that is perceived to originate from an area that has been surgically removed (burning, itching, pain)
***What is psychogenic pain?
arises from the mind, no other cause identified
***What is nociceptive pain?
nociceptors (pain receptors) respond to stimuli that are potentially damaging
***What is neuropathic pain?
injury to nerve results in repeated transmission of pain signals in the absence of stimuli
***What is pain quality?
- sharp or dull
- aching
- throbbing
- stabbing
- burning
- ripping
- searing
- tingling
***What is pain periodicity?
- episodic
- intermittent
- constant
***What is pain intensity?
- mild
- moderate
- distracting
- severe
- intolerable
What is transduction?
activation of nociceptors by stimuli (mechanical, thermal, chemical)
What is transmission?
conduction of pain message to the spinal cord (via A-delta fibers-fast, via c fibers-slow)
What is pain perception?
recognizing and defining pain in the cortex
What is pain threshold vs pain tolerance?
Threshold- point at which the brain defines stimulus as pain
Tolerance- duration and intensity of pain the person is willing to endure
What is pain modulation?
changing pain perception
What is the endogenous analgesia system?
neurons in the brainstem send impulses down to trigger endogenous opioids (naturally occurring)
What is the gate-control theory?
-interplay between two different kinds of fibers (produce pain, inhibit pain)
What factors influence pain?
- emotions
- past experience with pain
- developmental stage
- sociocultural factors
- communication skills
- cognitive impairments
How does pain affect the endocrine system? Result?
pain triggers excessive release of adrenocorticotrophic, cortisol, ADH, growth, catecholamines, and glucagon
Result: weight loss, tachycardia, fever, increased RR, death
How does pain affect the cardiovascular system? Result?
hypercoagulation, tachycardia, hypertension, cardiac workload, oxygen demand
Result: unstable angina, intracoronary thrombosis, heart attack
How does pain affect the respiratory system? Result?
splinting (shallow breathing) reduces tidal volume, increased i/e pressures
Result: pneumonia, atelectasis, hypercarbia, respiratory acidosis
How does pain affect the genitourinary system? Result?
release of excessive catecholamines, aldosterone, ADH, cortisol, angiotension II, prostaglandins
Result: decreased urine output, urinary retention, fluid overload, hypokalemia, hypertension, increased cardiac output
How does pain affect the gastrointestinal system? Result?
intestinal secretions and smooth muscle tone increase
Result: gastric emptying, motility decrease
**What are the characteristics we assess for of pain?
- pain location
- quality (sharp/dull, burning, stabbing, aching, throbbing, ripping, searing, tingling)
- intensity (pain scale, mild, distracting, moderate, severe, intolerable)
- aggravating/alleviating factors (what makes it better/worse)
- periodicity (episodic, intermittent, constant)
What are some nonverbal signs of pain?
- facial expression (lowered brow, wincing, clenching jaw, closed eyes)
- posture (guarding)
- vital signs (increased HR, BP)
- behavioral manifestations (depression, stoic, laughter, sleep)
What does a TENS or PENS unit do?
-stimulates a-delta sensory fibers through pads applied to skin or needles inserted
What is a spinal cord stimulator?
used for chronic neurological pain, implanted. Tingly sensation interferes with perception of pain
**What is acupuncture?
needles to specific sites to relieve pain by stimulating endogenous analgesia system
**What is acupressure?
pressure over pressure points releases endorphins
What is massage?
cutaneous stimulation reduces pain
Who would benefit from oral sucrose?
infants experiencing pain
***What are some non-medical pain relief interventions?
- distraction
- hot/cold therapy
- therapeutic touch (massage)
- sequential muscle relaxation
- guided imagery
- diaphragmatic breathing (relaxation)
- hypnosis
What do NSAIDS do?
- aspirin, ibuprofen
- act on peripheral tissues best
- interfere with production of prostaglandins
What does acetaminophen do?
- safer than NSAIDS bc no GI upset, platelet function
- analgesic and fever-reducing properties
What are adjuvant analgesics?
- reduce the amount of opioid needed
- anticonvulsants, antidepressants, local anesthetics, topical agents, psychostimulants, muscle relaxants, neuroleptics, corticosteroids
What do opioids do?
-find pain receptor sites (mu, delta, kappa, sigma) to bind with and block the pain impulse
What are some examples of chemical pain relief measures
- nerve block
- epidural injection
- local anesthesia
- topical anesthesia
What is radiofrequency ablation?
electromagnetic waves target the pain nerves. Longer relief than steroids and nerve blocks
What is a cordotomy?
interrupts pain and temp sensation below the tract that is severed
What is a rhizotomy?
interrupts the anterior or posterior nerve route
-often used for head and neck pain produced by cancer
What is a neurectomy?
peripheral and cranial pathways are interrupted
What is a sympathectomy?
severs the paths to the sympathetic division of the autonomic nervous system
**What types of pain scales are there?
- numerical rating scale (NRS)
- visual analog scale (VAS)
- Wong-Baker FACES
- simple descriptive scale (SDS)
- narrative descriptive scale (NDS)
***What are the physiological responses to pain?
- increased BP, HR, RR
- dilated pupils
