Pain Assessment: Ch. 11

Question 1

what is Nociceptive pain?
what are examples of nociception?
What are the 4 Phases?

Answer 1

Functioning nerve fibers are stimulated from actual or potential tissue damage
-eg: skinned knee, kidney stones, menstrual cramps, muscle strain, venipuncture, or arthritic joint pain

1-transduction: injured tissues release neurotransmitters (histamine, prostaglandins, serotonin, and bradykinin). They transmit a pain message (action potential) along sensory afferent nerve fibers to the spinal cord. These nerve fibers terminate in the dorsal horn of the spinal cord. Because the initial afferent fibers stop in the dorsal horn, a second set of neurotransmitters (ATP) carries the pain impulse across the synaptic cleft to the dorsal horn neurons.

2-transmission: the pain impulse moves from the level of the spinal cord to the brain.

3-perception: conscious awareness of a painful sensation.

4-modulation: the pain message is inhibited.
To inhibit and block the pain impulse, descending pathways from the brainstem to the spinal cord release neurotransmitters (serotonin, norepinephrine) that produce an analgesic effect.

Question 2

what is Neuropathic pain

Answer 2

Occurs b/c of abnormal processing of sensory input

• difficult to assess/ treat
• persists long after healing
• eg: pins and needles

Question 3

Acute Pain

Answer 3

short term and self limiting

Question 4

Chronic (persistent) pain

Answer 4

pain that continues for >6mo

-can result in depression

Question 5

Referred Pain

Answer 5

Pain that is felt in a location other than where the injury is

Question 6

Effects of Pain

Answer 6

• increased catabolic demands
• decreased mobility
• tachypnea
• tachycardia
• impaired sleep
• loss of appetite
• depression w/ chronic pain

Question 7

What is used to help a patient describe the details of their pain?

Answer 7

OPQRSTU

Onset: when did it start?
Provoking: what makes better/ worse/ start?
Quality: what does it feel like? (stabbing, throbbing, aching)
Radiating: where does it hurt the most, does the pain go anywhere from there?
Severity: 1 to 10 pain scale
Treatment: are you doing anything to treat it?
Understanding: what do you think is causing it?

Question 8

Diaphoresis

Answer 8

Excessive sweating

Question 9

Analgesic

Answer 9

Painkiller

Question 10

Visceral pain

Answer 10

Occurs in larger internal organs (stomach, intestine, gallbladder, pancreas).
Often is described as dull, deep, squeezing, or cramping

Question 11

Somatic pain

Answer 11

Originates from musculoskeletal tissues or body surface

Question 12

Deep somatic pain

Answer 12

pain from the blood vessels, joints, tendons, muscles, and bone.
Pain may result from pressure, trauma, or ischemia.

Question 13

Breakthrough pain

Answer 13

A spike in pain level, moderate to severe in intensity, in an otherwise controlled pain syndrome.

It can result from end-of-dose medication failure. This occurs when a patient taking a long-acting opioid has a recurrence of pain before the next scheduled dose.

Treatment of end-of-dose failure includes shortening the interval between doses or increasing the dose of medication.

Question 14

what is FPS-R?

when/ who is it used for?

Answer 14

The Faces Pain Scale–Revised

• Used for children 4 to 5y
• has six drawings of faces that show pain intensity
• The FPS-R has realistic facial expressions, with a furrowed brow and horizontal mouth. It avoids smiles or tears so that children will not confuse pain intensity with happiness or sadness

Question 15

Physical findings that could indicate pain:

Answer 15

• Joints: swelling, inflammation, injury, deformity, decreased ROM, increased pain w/ palpitation, crepitation
• Skin and Muscle: inspect for bruising, swelling, any masses or deformity, lesions, open wounds, tissue damage, atrophy, bulging, change in hair distribution
• Abdomen: Swelling, bulging, herniation, inflammation, organ enlargement

Question 16

Crepitation

Answer 16

Audible and palpable crunching that accompanies movement

Question 17

Analgesia

Answer 17

Absent pain sensation when there should be one. Inability to feel pain.

Question 18

Hyperalgesia

Answer 18

Increased sensitivity to pain. Experience pain when exposed to normal stimuli

Question 19

Allodynia

Answer 19

Severe pain sensation evoked with a stimulus that does not normally induce pain
-e.g: the blunt end of the tongue blade, cotton ball, clothing

Question 20

C- Fibers

Answer 20

Nociceptors carry the pain signal to the CNS using A and C sensory fibers.

• unmyelinated, thus transmit the signal more slowly.
• smaller fibers (than A)
• The “secondary” sensations are dull and aching
• pain lasts longer after the initial injury.

Question 21

A- Fibers

Answer 21

Nociceptors carry the pain signal to the CNS using A and C sensory fibers.

• myelinated thus transmit the signal rapidly to the CNS
• larger in diameter (than C)
• The sensation is localized, short term, and sharp in nature

Question 22

How does opioid analgesia work?

Answer 22

They activate the opioid receptors in the spinal cord and block the transmission of the pain impulse from the spinal cord to the thalamus.
-this occurs during transmission (pain pathway phase 2)

Question 23

FLACC scale, and who is it used for?

Answer 23

A nonverbal assessment tool for infants and young children < 3 y

• Face:
• Leg:
• Activity:
• Cry:
• Consolability:

Question 24

Nonmalignant

Answer 24

Pain often associated with musculoskeletal conditions such as arthritis, low back pain, or fibromyalgia.

Question 25

CRIES scale, who is it used for?

Answer 25

Pain scale used for infants and neonate

Question 26

PAINAD scale, who is it used for, what does it evaluate?

Answer 26

Pain scale used for patients with dementia

• evaluates: breathing, vocalization, facial expression, body language, and consolability
• a score of 4 or more indicates a need for pain management