Pain Assessment Flashcards
With the recent opioid epidemic and advances in pain research, there is a renewed emphasis.
on early multimodal pain management, nonpharmacologic options and nonopioid alternatives
What 3 factors can influence the patients response to prescribed pain treatment unrelated to actual pharmacological treatments
Perceived effective communication with physicians and nurses by the patient
Perceived responsiveness by the treating team
Perceived empathy by the treating team
what can. affect patietns response to painful stimuli
age, gender, ethnicity, socioeconomic and psychological factors, catastrophizing, culture/religion, genetics, previous experiences, patient perceptions and expectations
how often is depression and pain co-existing
30-60% of pain patients report depression
what disorders have been linked to the development of chronic pain`
mood disorders and psychiatric disorders
what is pain catastrophizing
an exaggerated cognitive response to anticipated or actual painful stimulus
what are tendencies of people who catastrophize in relation to pain
magnification of pain
rumination about their pain
feeling helpless in managing their pain
examples of catastrophizing: magnification
“I’m afraid the pain will get worse”
examples of catastrophizing: rumination
“i cant stop thinking about how much this hurts”
examples of catastrophizing: helplessness
“there is nothing I can do to reduce the intensity of my pain”
underlying etiology refers to the
source of the experienced pain
nociecpetive
inflammatory
neuropathic
antatomic locatoin
somatic
visceral
temporal nature refers to
the duration of pain
acute <3 months
chronic > 3 months
acute on chronic
intensitiy refers to the
degree of level of pain
(mild, moderate, severe)
example of nociceptive pain
bone fractures, surgical incision, acute burn
examples of inflammatory pain
appendicitis, RA, inflammatory bowel disease, late stage burn
examples of neuropathic pain
diabetic peripheral neuropathy, postherpetic neuralgia, chemotherapy-induced pain and radiculopathy
difference between somatic and visceral pain
somatic - musculoskeletal pain (bone, joint, connective tissues and deep tissues)
visceral - internal pain frominternal organs and tissues
which pain is well localized, sharp and worse with movement
somatic pain
which pain is described as poorly localized and vague deep aches, colicky, and/or cramping
visceral pain
what is the mechanism of somatic pain
a-delta fiber activity located in peripheral tissues
what is the mechanism of visceral pain
c fiber activity located in deeper tissues
name the type of pain and treatment: femur fracture
nociceptive pain
opioids and nonopioids
name the type of pain and treatment: late stage burn healing
inflammatory pain
anti-inflammatory agents
name the type of pain and treatment: post-herpetic neuralgia
neuropathic pain
tricyclics, SNRTs, GABA analogs or antidepressants
name the type of pain and treatment: superficial burn
somatic pain
topical/and or local anesthetics, opiates, and non-opiates
pain history elements and questiosn
detailed hx of current pain, and for chronic pain - previous pain hx, comorbidities, psychosocial and pyschiatric
besides the basics of a pain assessment (OPQRST) what else should be assessed
functionality
*ADLs impaired
*does the patient work
*how does the patient cope
OPQRST
onset
pallative or provacatoin
quality
region radiation
severity
timing
pain assessment: physical findings
VS- elevated BP or HR
cues - positioning, crying, flushing, diaphoresis
what should always be conducted with neuropathic pain
a sensory exam
pedi tylenol dose
15mg/kg PO
PO Q4-6 Hr
max 90 mg/kg/day
ketamine MOA
Block NMDA receptors, peripheral Na+ channels, and mu-opioid receptors providing sedation, amnesia, and analgesia
when should pain level be reassesseed
after intervention
consider reassessing pain level 30 minutes after IV and 60 minutes after PO administration of a medication
consequences of unrelieved acute pain
psychological impacts
chronic pain syndromes
mortality and morbidity
Appropriate discharge planning should consider what interventions the patient has received during the visit and transportation home.
How will the patient safely arrive home? Consider patient transportation and driving precautions, especially after receiving a sedating medication
Are they ambulating at their baseline without assistance?
Could the treatment or medication still be exerting its effects (i.e. lethargy as a side effect of morphine)?
Genetic polymorphisms and pain
Caucasian and African American populations have approximately equal proportions of fast and slow metabolizers, whereas nearly 90% of certain Asian groups are fast acetylators.
Examples of somatic pain
lacerations, fractures, and pelvic pain.
examples of visceral pain
appendicitis, peptic ulcer disease, diverticulitis, endometriosis, and ureteral stones.
acute pain is defined as
lasting less than 3 months and is a neurophysiological response to noxious injury that should resolve with normal healing.
chronic pain is defined as
lasting more than 3 months or beyond the expected course of an acute disease or after complete tissue healing. Chronic pain extends beyond the time of normal wound healing with the development of multiple neurophysiological changes in the central nervous system.
examples of acute pain
post-operative pain, fractured bones, appendicitis, crush injury to finger, labor and delivery pain.
examples of chronic pain
low back pain, neck pain, and chronic pancreatitis.
what do pain scales not take into account
Pain scales DO NOT take into account patient genetics, past experiences, comorbidities, or other pain influencing factors.
examples of acute on chronic pain
sickle cell exacerbation in a patient with sickle cell disease or an abscess in a patient with sickle cell disease.
non-pharm interventions for pain
4 tire analogy
medications is only one tire when it comes to pain management
chronic pain vicious cycle
what is PDMPs
prescription drug monitoring programs
Pain catastrophizing shares similarities
Depression and anxiety
what is pain catastrophizing associated with
outcomes such as pain severity, activity interference and disability, depression, changes in social support networks, more frequent healthcare visits, and opioid usage.
