Pain I Flashcards
What is nociception?
the method of feeling pain
What is a neuromodulator?
a substance that alters nerve impulse transmission.
What is pain threshold?
the point beyond which a stimulus causes pain
what is an adjunct or adjuvant?
something that is added as a supplementary rather than an essential part
How long must you experience pain for it to be classified as chronic?
> 3 months
Describe what deep somatic pain or visceral pain is.
It is pain that is initiated in the ligaments, tendons, bones, blood vessels, and muscles.
described as dull, aching, poorly localized pain. Ex broken bone or sprain
What is neuropathic pain?
chronic pain resulting from injury to the nervous system.
Can be to the CNS or PNS
What are endogenous chemicals?
chemicals that originate within the body
What is pain tolerance?
it is the maximum level of pain that a person is able to tolerate
explain the difference between pain threshold and pain tolerance.
Pain threshold is the point where pain can be detected
pain tolerance is the maximum pain that one can endure
What is cutaneous/superficial pain?
pain that is detected just below the skin.
This area has a high amount of nociceptors resulting in a well defined, localized pain of short duration
What is referred pain?
It is pain that is felt in a part of the body other than its actual source.
Define pain.
Pain is whatever the experiencing person says it is, existing wherever the person says it is.
PAIN IS WHAT THE PATIENT SAYS IT IS
Who introduced the gate control theory and in what year?
Melzack and Wall in 1965
Explain the gate control theory. What does it emphasize?
Pain = physiological process + psychological variables
emphasized the holistic nature of pain.
What did the gate control theory develop into?
the neuromatrix theory that includes a genetic component
What are the five dimensions of pain? explain each.
1) PHYSIOLOGICAL and SENSORY: the physical sensation/experience
2) AFFECTIVE: emotional aspect
3) BEHAVIOURAL: wincing, crying, irritable, not wanting to move
4) COGNITIVE: perception and coping strategies
5) SOCIOCULTURAL: influence how pain is expressed
What are the four phases of nociception?
TRANSDUCTION
TRANSMISSION
PERCEPTION
MODULATION
Describe the phase of transduction
1) noxious stimuli cause tissue damage
2) sensitizing chemicals released by damaged cells (ex bradykinins and prostaglandins)
3) chemicals stimulate nociceptors
4) AP generated and travels from periphery to spinal cord
What do NSAIDs target to relieve pain?
NSAIDs target the sensitizing substances released by damaged cells such as bradykinins and prostaglandins
Describe the transmission phase of nociception.
Has three parts
1) injury site to spinal cord
2) spinal cord to dorsal horn for processing
3) to thalamus (basic pain sensation) and cortex (interprets pain)
Describe what perception of pain is
the conscious experience of pain
recognition and definition of pain
Describe what perception of pain is
the conscious experience of pain
when pain is recognized, defined and responded to by the individual
List 3 substances that are involved in the modulation of pain.
1) endogenous opioids such as enkephalins and endorphins
2) serotonin
3) norepinephrine
List 3 substances that are involved in the modulation of pain.
1) endogenous opioids such as enkephalins and endorphins
2) serotonin
3) norepinephrine
List the 8 types of pain
ACUTE
CHRONIC
CUTANEOUS / SUPERFICIAL
DEEP SOMATIC
VISCERAL
REFERRED
NEUROPATHIC
PHANTOM
Describe acute pain
Sudden onset with limited duration
has purpose
expect elevated HR and BP, will be able to observe signs
Describe chronic pain.
more gradual pain
becomes chronic after 3-6 months
can show no signs
Want to limit opioids within 90 days
Describe cutaneous / superficial pain
pain on your skin
Describe deep somatic pain
muscles, tendons and organs
Describe visceral pain
inside the body
ex gallstones, chest pain
Describe neuropathic pain.
due to damage to the nervous system
tingling, electrical
ex slipped disk, shingles, diabetic neuropathy
What is phantom pain?
feeling in a limb that is no longer there
What are some predisposing factors that contribute to acute pain progressing to chronic pain?
Hx of anxiety, depression
type A personality
Pre-existing chronic pain
hx of childhood abuse
hx of substance abuse
List some factors affecting response to pain.
Pain tolerance
Pain threshold
Fear and fatigue
Developmental factors
Sociocultural influences
Physchological and physiological factors
Nurse’s interpretations or biases
What are some developmental factors that might influence pain?
older adults do not want to admit pain
children can’t explain or verbalize pain
Describe the three ways that sleep disturbances are associated with pain.
Sleep deprivation inc pain perception and neg affects mood
90 percent of patients with chronic pain also experience sleep disturbances
Medications:
NSAIDs dec melatonin production
OPIOIDS dec REM cycles
What should you be sure you are assessing when someone has pain?
sleep disturbances
What are the principles to remember when assessing pain?
1) Sensation of pain is completely subjective
2) Pain can’t be proven or disproved
3) Pain is whatever the experiencing person says it is
4) The gold standard for assessing existence of pain is the pt’s self report of pain
5) People’s responses to pain will vary
What are some appropriate assessment tools for pain?
OPQRSTA (med-surg)
Descriptive scale (mild, mod, severe)
Numerical scale (initial assessment tool
age relevant factors such as faces
List things that can be affected by pain.
Sleep
Activity level
Concentration
Appetite
Social activities
List things that can be affected by pain.
Sleep
Activity level
Concentration
Appetite
Social activities
What is the mnemonic OPQRSTA stand for and what is it used for?
it outlines the questions to be asked when assessing pain.
Origin Provocation or palliation Quality Region and radiation Severity Time Associated symptoms
