Pain Ch. 11 Flashcards
Briefly describe the physiology of pain
Transduction- injured tissue releases chemicals to travel along spinal cort
Transmission- pain impulse moves from spinal cord to the brain
Perception of Pain
Modulation- neurons in brainstem release impulses to block the pain impulse
What are the 3 sources of pain?
Visceral
Somatic
Referred
Explain visceral pain
Originated from larger interior organs, usually abdomen
Explain somatic pain
Originates from musculoskeletal tissues or body surface
Explain the two types of somatic pain
Deep Somatic Pain: injury to blood vessels, joints, tendons, muscles, bone
Cutaneous (superficial) Somatic Pain: injury to skin surface and subcutaneous tissues
Explain referred pain
What causes it?
Give a common example
Pain felt at one location but originating from another
Both sites innervated by the same spinal nerve and the brain cannot differentiate the source
MI= Myocardial Infarction= left arm/jaw pain
List the types of pain
Acute
Chronic
Breakthrough
Explain Acute pain
give an example
short-term
self-limiting
incident pain
burning finger on hot stove
Explain Chronic pain
longer than 6 months
doesn’t stop when injury heals
pain intensity doesn’t correlate with physical findings
Explain the 2 types of chronic pain
Malignant: parallels pathology of tumor (cancer-associated)
Nonmalignant: usually musculoskeletal conditions
Explain breakthrough pain
List possible causes
Transient spike in pain when pain was otherwise controlled.
End-of-dose medication failure
INcident/episodic pain
Who is the best indicator of a patient’s pain?
The patient
T/F: Older adults perceive pain to a lesser degree/have diminished sensitivity
False
How can dementia affect a patient’s pain expression?
It doesn’t affect ability to feel pain, but it does impact their ability to accurately report the pain
is pain always subjective?
YES
What is the gold standard of pain assessment?
Subjective report
How should a pain assessment tool be selected?
Based on its purpose, time required, and the patient’s ability to comprehend and complete the tool
What is an Initial Pain Assessment?
A chart given to a patient where they can circle the exact spot of pain on a picture and report the OPQRSTU characteristics
What is a Brief Pain Inventory?
A more detailed Initial Pain Assessment that asks the patient to rate each site of pain from 0-10 based on how the pain affects their ADLs
What is a McGill Pain Questionnaire?
Provides more descriptive qualities of the pain for the patient to select from.
Throbbing, shotting, heavy, tender, splitting, etc
What are some qualities of regular pain rating scales of 0-10?
One-dimensional, reflect pain intensity
Indicate a baseline intensity
Track changes
Help evaluate treatment’s effectiveness
When are pain rating scales with smiley/frowny faces useful?
Patients with aphasia, children
What kind of objective data can be collected to help understand the subjective nature of the pain?
Physical assessment
What does a physical assessment regarding a patient’s pain entail checking?
Joint size, contour, circumference, active/passive range of motion
Muscle and Skin color, swelling, masses, deformities
Abdomen palpation, color/symmetry, referred pain
Pain should be treated while ______
Establishing diagnosis
What is a nonverbal behavoir regarding acute pain?
guarding, grimacing, agitation, diaphoresis, vital changes
What is nonverbal behavior regarding chronic pain?
Bracing, rubbing, sleeping (self-distraction), diminished activity
In what population is Denial of Pain common?
Aging adults
How should pain be evaluated in aging adults?
When looking for behavoiral cues, look at changes in functional status and ADLs
What can sudden onset of acute confusion indicate in aging adults?
poorly controlled pain
What is the PAINAD Scale?
Pain Assessment in Advanced Dementia Scale
Explain the PAINAD Scale
Rates pain impact on the following categories:
Breathing independent of vocalization
Negative vocalization
Facial Expression
Body Language
Consolability
