Pain in Clinical Practice Flashcards
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Why is pain subjective?
Our CNS modulates the way we feel pain, from minute to minute and from person to person.
What can you glean from what a person in pain tells you?
If you listen carefully enough, a person in pain will tell you their diagnosis.
Steve is in acute pain. What information should you obtain in your assessment?
Mnemonic:
O - onset (sudden or gradual, what were you doing when the pain started?)
P - provokes or palliates (what makes your pain better or worse?)
Q - quality (sharp or dull? What words would you use to describe your pain? What does your pain feel like?)
R - radiates/region (point to where it hurts the most. Where does your pain go from there?)
S - severity (subjective, 0 to 10)
T - time (how long ago did the pain start?)
What are 3 tools or methods that can be used to assess the intensity of acute pain.
Numbers (0-10)
Colours (Green to Red)
Faces (Smiley vs Sad)
Words (mild, moderate, severe)
Not objective - can’t compare between people.
BUT they are CONSISTENT for the person; you know if it has gotten worse or better.
Joe is asking you to recite the IASP (International Association for the Study of Pain) definition of pain. You say:
A sensory AND emotional experience associated with actual tissue damage or described in terms of such damage.
Still subjective for the person, and severity can change throughout the day.
Describe the 4 terms that describe how pain is experienced and expressed:
1) Nociception: physiological process, pain receptors activated.
2) Pain: Unpleasant sensory experience (physical and/or emotional).
3) Suffering: How the experience is subjectively perceived, drives pain behaviour. (lack of acceptance)
4) Pain Behaviour: What you see, how they act. What they say and do/don’t do.
No linear link between any of these concepts.
Chloe and Zoe have identical physical trauma, but report significantly different levels of pain. How can this be?
Afferent pain fibers bring stimulus to the CNS.
CNS descending pathways modulate pain (can inhibit or enhance pain nociception) based on expectations, past experiences, etc.
You bang your elbow, and you immediately start rubbing it. Why and what theory does this relate to?
The “Gate Theory” of pain suggests pain signals are not free to reach the brain, and encounter neurological gates at spinal cord level.
If pain is less intense than other non-noxious stimuli, the gate is closed (inhibitory neuron is stimulated). If pain is more intense, it will get through.
Pain travels on smaller fibers (faster). It inhibits the inhibitory neuron and stimulates transmission.
Distraction stimulus (non-noxious) on larger, slower nerve fibers. Activates inhibitor neuron, and activates transmission cell (so distraction signal gets to CNS). Attenuates pain and sends distracting stimulus.
