Pain Chapter 44

Question 1

Define Nociception

Answer 1

The stimulus/response process of pain. Four processes involved: transduction, transmission, perception, modulation.

Question 2

Define transduction (first process of nociception)

Answer 2

Thermal, mechanical or chemical stimulus that activates the pain event. It converts this stimulus into an electrical impulse. Starts in the sensory peripheral pain nerve fibers (called nociceptors)

Question 3

Define transmission (the second process of nociception).

Answer 3

Movement of impulse from periphery to spinal cord through afferent nerve fibers.

Question 4

What are the two different types of afferent nerve fibers that transmit pain impulses?

Answer 4

Myelinated (A-delta fibers)-produce sharp, localized pain
Non-myelinated (C-fibers)-produce dull, achy, poorly localized pain

Question 5

Define perception (3rd process of nociception)

Answer 5

The point that transmission reaches brain and is interpreted as pain. Person becomes aware of pain.

Question 6

Define modulation (4th process of nociception)

Answer 6

Activation of body’s defense against pain-called endogenous descending mediators-that hinder pain transmission. These cause a physiological reaction to pain-sympathetic and parasympathetic reactions.

Question 7

What are some substances that lower the pain threshold and cause peripheral sensitization?

Answer 7

Prostaglandins
Bradykinin
Substance P
Histamine
Serotonin

Question 8

What are two classes of nociceptive pain?

Answer 8

Somatic: Bone, joint, muscle
Visceral: organs

Question 9

What are some types of neuropathic pain?

Answer 9

Centrally generated: Deafferentation pain-injury to peripheral or central nervous system. Sympathetically maintained pain-disfunction to ANS
Peripherally generated: Poly or mono neuropathies along one or several peripheral nerves

Question 10

What is idiopathic pain?

Answer 10

Unknown cause of pain that is chronic

Question 11

What physiological changes to older adults affect pain medication administration?

Answer 11

Reduced muscle, Reduced body water, low serum albumin levels, reduced liver and renal function all mean that slower absorption, metabolism, excretion and increased risk for toxicity.

Question 12

What is PQRST in pain assessment?

Answer 12

P:Palliative/Provocative factors-What makes it better or worse?
Q: Quality-Describe your pain.
R: Region-Where?
S: Severity-Scale of 1-10
T: Timing-Constant? Comes and goes?

Question 13

What does it mean to be opioid naive?

Answer 13

Pts most at risk for respiratory depression which include:
Around the clock administration for less than a week
Hx of obstructive sleep disorder
High dose opioid
Taking with other CNS depressants