Pain and Management Flashcards
Describe the basic concepts of assessment and management that should be considered when assessing a patient and demonstrate the correct use of entonox for providing pain relief therapy.
Pain - definition
“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
“Whatever the experiencing person says it is, existing whenever she/he says it does”
The Complexity of Pain
Pain is unpleasant and is uniquely experienced by each individual.
It cannot be defined, identified or measured by the observer.
Is the most common reason to seek medical attention.
Pain Pathway
Pain producing stimuli - mechanical thermal-chemical.
Activation - of primary afferent nociceptors.
Generation - of a barrage of electro chemical impulses.
Propagation - through the nerves to activate spinal cord nerve cells.
Spinal Cord Nerve Cells - in turn give rise to pathways that conduct the pain message to higher centres in the thalamus and cerebral cortex that are required for the conscious perception of pain.
Nociceptors
A nociceptor is a sensory neuron (nerve cell) that responds to potentially damaging stimuli by sending nerve signals to the spinal cord and brain.
(Nociceptor - Peripheral Nerve - Spinal Cord - Thalamus - Cerebral Cortex)
Somatogenic and Psychogenic pain
Somatogenic = such as a crushed finger or heart attack is a pain of cause.
Psychogenic = no known physical cause.
Acute pain
Protective mechanism.
Mobilises an individual to act.
Pain is relieved after the chemical mediators that stimulate the nociceptors are removed.
Split into three categories:
Somatic = superficial.
Visceral = Internal organs. Can radiate.
Referred Origin = removed or distant from the origin.
Referred pain sites
Liver and Gall Bladder = Right shoulder & Upper right quadrant.
Lung & Diaphragm = Left shoulder.
Heart = Left arm & upper back.
Chronic Pain
Two distinct definitions:
1. Prolonged and lasts longer than 6 months.
2. Pain that extends beyond the expected period of healing.
Can be persistent or intermittent.
Gate Control Theory
Proposed by Ronald Melzack and Patrick Wall during the early 1960s, gate control theory suggests that the spinal cord contains a neurological “gate” that either blocks pain signals or allows them to continue on to the brain. Unlike an actual gate, which opens and closes to allow things to pass through, the “gate” in the spinal cord operates by differentiating between the types of fibres carrying pain signals. Pain signals travelling via small nerve fibres are allowed to pass through, while signals sent by large nerve fibres are blocked. Gate control theory is often used to explain phantom or chronic pain.
Cancer Pain
Some clinicians define the pain caused by tumours as distinctly different from acute or chronic.
Chronic Pain: the persistent pain cycle
Persistent pain.
Being less active.
Loss of fitness, weak muscles and joint stiffness.
Create ‘no go’ lists of things you cannot do.
Sleep problems/tiredness/fatigue.
Stress/fear/anxiety/anger/frustration.
Weight gain/loss.
Negative thinking, fear of the future, depression/mood swings.
Time off work, money worries, relationship concerns.
(sometimes the arrows can also go anti-clockwise)
Physiological effects.
Increased heart & respiration rate. Elevated BP. Pallor or Flushing. Dilated Pupils. Diaphoresis (sweating).
Threshold and Tolerance.
Threshold is the point which a stimulus is perceived as pain.
Tolerance is the duration of time or the intensity of pain that an individual will endure before initiating a response.
Pain assessment barriers
Fear of unpleasant procedures. Medication. Prolonged hospitalisation. Distress to relatives. Subjectivity.
Assessing pain - SOCRATES
Site. Onset. Character. Radiates. Associated symptoms. Time/duration. Exacerbating or relieving factors. Severity.
