Pain Assessment Flashcards
Pain is ……………
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage”
whatever the person says it is….. existing whenever the person says it does
Should pain be addressed immediately?
Yes, All persons deserve prompt recognition and treatment of pain even when they cannot express their pain verbally
Two classifications of pain ………….
Nociceptive and Neuropathic
What are nociceptors?
Specialized pain receptors that detect painful sensations from the periphery and transmit them to the CNS
What are the four phases of nociceptive pain?
Transduction
Transmission
Perception
Modulation
Nociceptive Pain can be ………..
somatic or visceral
Somatic when it arises from the skin, connective tissue, muscle, bones, or joints
Visceral when it arises from internal organs
Nociceptors are activated by
noxious stimuli that is either mechanical, thermal, or chemical in nature
Nerve fibers that carry pain impulses ….
A delta fibers
C fibers
A delta fibers
Large, myelinated fibers
Impulses travel quickly; “fast pain”
Release glutamate at the synapse with the spinal neurons
C fibers
small and unmyelinated; impulses travel more slowly
Release glutamate and substance P
What are endogenous opioids?
They are neurotransmitters produced by the body that block the transmission of the nerve pathway by binding with specific opioid receptors, reducing pain.
What are the three types of opioid receptors ?
Mu, Kappa, Delta
Examples of Endogenous Opioids
Enkephalins
Endorphins
Dynorphins
Endomorphins
What do exogenous opioids do ?
These are opiate drugs - they relieve pain by attaching to opiate receptors, thus enhancing the natural endogenous opioid response
Neuropathic pain is ………………….
an abnormal processing of the pain message from an injury to the nerve fibers.
Neuropathic pain does not follow the typical and rather predictable phases as in nociceptive pain.
True or false. Nociceptive pain can evolve into neuropathic pain.
True… this can happen when pain is poorly controlled. The constant irritation and inflammation caused by a pain stimulus can lead to an altered form of the nerve cells, making them more sensitive to any stimulus. This also decreased the number of opioid receptors.
How do First Order Neurons, Second Order Neurons and Third Order Neurons work together to transmit the pain signal to the brain?,
First order neurons are the nociceptors that are sensitive to certain substances and different types of noxious stimuli (mechanical, thermal, chemical) and generate the pain signal.
Second order neurons process the nociceptive information within the spinal cord and communicate with various pathways to transmit pain signal up spinal cord and to the thalamus
Third Order Neurons direct nociceptive pain signals to different areas of the brain such as the cerebral cortex where it is perceived
What kind of substances do cells release when they are damaged ? Why does this matter ?
Prostaglandins Histamine Bradykinin Serotonin Substance P
This matters because nociceptors are sensitive to these substances. When tissue is damaged and there is inflammation, these substances are released. Nociceptors detect this and generate a pain signal in the process of transduction.
Characteristics of Acute pain
Goal is to treat cause to eliminate pain
Sudden, short term and self limiting - example - pulled a hamstring
follows predictable trajectory and dissipates when injury is healed
What is incidence pain ?
Expected pain to result upon certain movements - such as shoulder pain when arms are raised
Characteristics of Chronic Pain -
Insidious Onset, or follows acute
lasts beyond expected healing period
Goal is to manage pain and maintain function and quality of life
Persistent/Chronic pain is diagnosed when the pain ……………..
continues for 6 months of longer
Chronic pain outlasts its ________________
protective purpose
Chronic pain originates from __________________ processing of pain fibers from ___________ or _____________ sites.
abnormal; peripheral; central
Chronic Pain Cycle
Increased Pain …….. Increased Anxiety ………………. Sleeping Problems ……………. Not Coping Well ………………. Increased Pain
Chronic pain affects many aspects of a person’s life
Pain Tolerance
The intensity or duration of painful stimulation one endured before pain responses are initiated
Pain Threshold
The point at which the stimulus is perceived as pain
Different types of sources of pain
Deep Somatic
Visceral
Cutaneous
Referred
What is referred pain ? What is it the result of ?
Pain perceived at a different location other than the site of the painful stimulus/origin. It is the result of interconnecting sensory nerves
Sympathetic response to low to moderate pain ………….
Bronchial dilation Increased HR Peripheral vasoconstriction Hypertension Diaphoresis Increased muscle tension Dilated pupils Decreased GI motility
Parasympathetic response to severe or deep nerve pain
Pallor Muscle Tension Decreased Heart Rate N/V Rapid, irregular breathing
Pain Related Assessment Questions
Location Quality Chronology Setting Associated manifestation Alleviating factors Aggravating factors Meaning
The major cause of chronic pain in the elderly has to do with ………….
musculoskeletal problems - bones, joints, muscles
When to assess and document pain ……..
admission Regular intervals New pain Exacerbations Uncontrolled pain New therapy (new meds, increased doses)
Pain assessment needs to occur regularly and frequently – at admission to a facility or service; every month, week or shift, depending on the resident situation; whenever there is a new pain reported or observed; every time pain gets worse or is uncontrolled; and re-assess needs to happen with a new medication or other therapy is tried or when the dosage is increased.
How to look for pain ?
Patient’s report of pain
Body movements and facial expressions -including withdrawal, fatigue, grimaces, moans, and irritability,
Sympathetic response
Interest in usual events
Ability to participate in usual activities
Interference in life
Pharmacologic Interventions for Pain
Non-opioid medications
Opioid medications
Adjuvant medications
Nonpharmacologic interventions for pain
Cognitive Behavioral Therapies (CBT)
Physical comfort measures
Complementary/Alternative therapies
Some people, especially older adults, may not use the word “pain.” They may talk about how sore they are but not say they are in pain. For this reason it is important to …………………
be creative with the questions you ask to explore the presence of pain.
…… any discomfort, achiness, soreness, heaviness, burning sensations
Once you know how a person refers to his pain, be sure to use that term consistently when assessing pain.
Examples of Non physical pain ………….
Existential distress Grief-anticipatory, complicated… Fear-uncertainty Dependency-helplessness Social Isolation-Loneliness Boredom
Points to Remember about pain in nonverbal patients and those with dementia
Tolerance to acute pain possibly increases but pain threshold does not appear to change
Dementia may blunt response to acute pain
Cognitive impairment may decrease the perceived analgesic effectiveness
Pain can negatively affect cognitive function
Behaviors Related to Pain
More Obvious Grimacing or wincing Bracing Guarding Rubbing
Less Obvious: Changes in activity level Sleeplessness, restlessness Resistance to movement Withdrawal/apathy Increased agitation, anger, etc. Decreased appetite Vocalizations
Causes of Physical Pain in Patients with Dementia
Constipation or diarrhea Lodged food particles Contractures Ill fitting dentures Pressure ulcers UTI
Things affecting perception of pain
Fatigue Anxiety Past experience Coping style Culture
Different Perceptions of Pain
Punishment
Threat
loss
Challenge
Use of Pain Scales - what is important to assess?
Ask the patients individual “acceptable” pain score
Using Faces rating scale, numeric scale, Oucher Scale
Hierarchy of Data Sources
Patient’s report (if possible) Prior pain history Painful diagnoses Behavioral indicators Observer assessment Response to empirical therapy
There is no pain __________________ when there is no pain _________________.
relief; assessment
Why is it important to distinguish between nociceptive and neuropathic pain in the pain assessment?
Because neuropathic pain requires different types of pain medications than nociceptive pain
characteristics of nociceptive pain
Dull, aching, pressure, tender
characteristics of neuropathic pain
shooting, burning, electric shock, tingling
Nociceptive pain responds to …………..
traditional pain medicines and therapies
