Pain Flashcards
> 40 to 50% of patients in routine practice settings
fail to achieve adequate pain relief
___ is the leading cause of disability in those >45
back pain
50 million __ are lost per year due to pain
workdays
Pain assessment is NOT
relying on changes in vtal signs
deciding a patient does not look in pain
knowing how much a procedure or disease should hurt
assuming sleeping patietn does not have pain
does not assum a patient will tell you they are in pain
Physician-Related barriers to pain managente
` Limited knowledge of pain pathophysiology and assessment skills
` Biases against opioid therapy and overestimation of risks
` Fear of regulatory scrutiny/action
patient related barriers to pain managment
Exagge ate ea o a ct o , to e a ce, s e e ects rated fear of addiction, tolerance, side effects
` Reluctance to report pain: stoicism, desire to “please” physician
` Concerns about “mean
System related barriers to pain management
` Low priority given to pain and symptom control
` Limits on number of Rxs filled per month & number of refills
allowed
` Reimbursement policies
Ethnic and Racial Barriers to Pain
Management
y Language or cultural differences make pain assessment more difficult
y Physicians’ perceptions and misconceptions:
y minority-group patients have fewer financial resources to pay for
prescriptions
y higher drug-abuse potential among minority groups
y Patients’ lack of assertiveness in seeking treatment
y Lack of treatment expertise at many sites at which minority-group
patients are treated
y Relative unavailability of opioids in some communities
Neuronal Pathways in the Pain Process
y Transduction
y Transmission
y Modulation
y Perception
Nociception - Process Steps
• Contact with stimulus – Stimuli can be mechanical
(pressure, punctures and cuts) or chemical (burns).
• Reception – A nerve ending senses the stimulus.
• Transmission – A nerve sends the signal to the central nervous
system. The relay of information usually involves several neurons
within the central nervous system.
• Pain center reception –The brain receives the information
for further processing and action.
AFFERENT PATHWAY. BRINGS THINGS U TO THE BRAIN
Transduction
noxious stimulus and is converted into a electrical energy
Transmission
propagation through the peripheral nervous system via first order neurons.
Nociceptor
free afferent nerve ending
aDelta
fast fibers. Initial very sharp pain.
cSlow fibers
dull pain
Modulation
when first order neurons synapse with second order neurons in the dorsal horn cells of the spinal cord
Perception
cerebral cortex (cerebral cortical) response
Factors Affecting Pain Perception
• Age – Brain circuitry generally degenerates with age, so older
people have lower pain thresholds and have more problems
dealing with pain.
• Gender – Research shows that women have a higher sensitivity
to i h d pain than men do.
• Fatigue –We often experience more pain when our body is
stressed from lack of sleep.
• Memory – How we have experienced pain in the past can
influence neural responses (memory comes from the limbic
system).
• A δ (delta) mechanosensitive receptors -
lightly myelinated,
faster conducting neurons that respond to mechanical stimuli
(pressure, touch)
A δ (delta) mechanothermal receptors
- lightly myelinated, faster
cond i h d h i l i li ducting neurons that respond to mechanical stimuli
(pressure, touch) and to heat
