Pain Assessment

Question 1

With the recent opioid epidemic and advances in pain research, there is a renewed emphasis.

Answer 1

on early multimodal pain management, nonpharmacologic options and nonopioid alternatives

Question 2

What 3 factors can influence the patients response to prescribed pain treatment unrelated to actual pharmacological treatments

Answer 2

Perceived effective communication with physicians and nurses by the patient

Perceived responsiveness by the treating team

Perceived empathy by the treating team

Question 3

what can. affect patietns response to painful stimuli

Answer 3

age, gender, ethnicity, socioeconomic and psychological factors, catastrophizing, culture/religion, genetics, previous experiences, patient perceptions and expectations

Question 4

how often is depression and pain co-existing

Answer 4

30-60% of pain patients report depression

Question 5

what disorders have been linked to the development of chronic pain`

Answer 5

mood disorders and psychiatric disorders

Question 6

what is pain catastrophizing

Answer 6

an exaggerated cognitive response to anticipated or actual painful stimulus

Question 7

what are tendencies of people who catastrophize in relation to pain

Answer 7

magnification of pain
rumination about their pain
feeling helpless in managing their pain

Question 8

examples of catastrophizing: magnification

Answer 8

“I’m afraid the pain will get worse”

Question 9

examples of catastrophizing: rumination

Answer 9

“i cant stop thinking about how much this hurts”

Question 10

examples of catastrophizing: helplessness

Answer 10

“there is nothing I can do to reduce the intensity of my pain”

Question 11

underlying etiology refers to the

Answer 11

source of the experienced pain
nociecpetive
inflammatory
neuropathic

Question 12

antatomic locatoin

Answer 12

somatic
visceral

Question 13

temporal nature refers to

Answer 13

the duration of pain
acute <3 months
chronic > 3 months
acute on chronic

Question 14

intensitiy refers to the

Answer 14

degree of level of pain
(mild, moderate, severe)

Question 15

example of nociceptive pain

Answer 15

bone fractures, surgical incision, acute burn

Question 16

examples of inflammatory pain

Answer 16

appendicitis, RA, inflammatory bowel disease, late stage burn

Question 17

examples of neuropathic pain

Answer 17

diabetic peripheral neuropathy, postherpetic neuralgia, chemotherapy-induced pain and radiculopathy

Question 18

difference between somatic and visceral pain

Answer 18

somatic - musculoskeletal pain (bone, joint, connective tissues and deep tissues)
visceral - internal pain frominternal organs and tissues

Question 19

which pain is well localized, sharp and worse with movement

Answer 19

somatic pain

Question 20

which pain is described as poorly localized and vague deep aches, colicky, and/or cramping

Answer 20

visceral pain

Question 21

what is the mechanism of somatic pain

Answer 21

a-delta fiber activity located in peripheral tissues

Question 22

what is the mechanism of visceral pain

Answer 22

c fiber activity located in deeper tissues

Question 23

name the type of pain and treatment: femur fracture

Answer 23

nociceptive pain
opioids and nonopioids

Question 24

name the type of pain and treatment: late stage burn healing

Answer 24

inflammatory pain
anti-inflammatory agents

Question 25

name the type of pain and treatment: post-herpetic neuralgia

Answer 25

neuropathic pain
tricyclics, SNRTs, GABA analogs or antidepressants

Question 26

name the type of pain and treatment: superficial burn

Answer 26

somatic pain
topical/and or local anesthetics, opiates, and non-opiates

Question 27

pain history elements and questiosn

Answer 27

detailed hx of current pain, and for chronic pain - previous pain hx, comorbidities, psychosocial and pyschiatric

Question 28

besides the basics of a pain assessment (OPQRST) what else should be assessed

Answer 28

functionality
*ADLs impaired
*does the patient work
*how does the patient cope

Question 29

OPQRST

Answer 29

onset
pallative or provacatoin
quality
region radiation
severity
timing

Question 30

pain assessment: physical findings

Answer 30

VS- elevated BP or HR
cues - positioning, crying, flushing, diaphoresis

Question 31

what should always be conducted with neuropathic pain

Answer 31

a sensory exam

Question 32

pedi tylenol dose

Answer 32

15mg/kg PO
PO Q4-6 Hr
max 90 mg/kg/day

Question 33

ketamine MOA

Answer 33

Block NMDA receptors, peripheral Na+ channels, and mu-opioid receptors providing sedation, amnesia, and analgesia

Question 34

when should pain level be reassesseed

Answer 34

after intervention
consider reassessing pain level 30 minutes after IV and 60 minutes after PO administration of a medication

Question 35

consequences of unrelieved acute pain

Answer 35

psychological impacts
chronic pain syndromes
mortality and morbidity

Question 36

Appropriate discharge planning should consider what interventions the patient has received during the visit and transportation home.

Answer 36

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)?

Question 37

Genetic polymorphisms and pain

Answer 37

Caucasian and African American populations have approximately equal proportions of fast and slow metabolizers, whereas nearly 90% of certain Asian groups are fast acetylators.

Question 38

Examples of somatic pain

Answer 38

lacerations, fractures, and pelvic pain.

Question 39

examples of visceral pain

Answer 39

appendicitis, peptic ulcer disease, diverticulitis, endometriosis, and ureteral stones.

Question 40

acute pain is defined as

Answer 40

lasting less than 3 months and is a neurophysiological response to noxious injury that should resolve with normal healing.

Question 41

chronic pain is defined as

Answer 41

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.

Question 42

examples of acute pain

Answer 42

post-operative pain, fractured bones, appendicitis, crush injury to finger, labor and delivery pain.

Question 43

examples of chronic pain

Answer 43

low back pain, neck pain, and chronic pancreatitis.

Question 44

what do pain scales not take into account

Answer 44

Pain scales DO NOT take into account patient genetics, past experiences, comorbidities, or other pain influencing factors.

Question 45

examples of acute on chronic pain

Answer 45

sickle cell exacerbation in a patient with sickle cell disease or an abscess in a patient with sickle cell disease.

Question 46

non-pharm interventions for pain

Answer 46

Question 47

4 tire analogy

Answer 47

medications is only one tire when it comes to pain management

Question 48

chronic pain vicious cycle

Answer 48

Question 49

what is PDMPs

Answer 49

prescription drug monitoring programs

Question 50

Pain catastrophizing shares similarities

Answer 50

Depression and anxiety

Question 51

what is pain catastrophizing associated with

Answer 51

outcomes such as pain severity, activity interference and disability, depression, changes in social support networks, more frequent healthcare visits, and opioid usage.