PAIN LECTURE Flashcards
An unpleasant sensory and emotional
experience, which we primarily associate
with tissue damage or describe in terms of
such damage, or both (IASP, 1994;
Ranney, 2008).”
The fifth vital sign
pain
Melzack and Wall (1965) emphasized the
importance of the central nervous system
mechanisms of pain
gate control model
Peripheral nerve endings stimulated by
source of pain which transmit the sensations
to the central nervous system.
nociceptors
types of stimuli
mechanical
thermal
chemical
types of physiologic process in nociception
transduction
tranmission
modulation
perception
results in tissue injury or
damage stimulating the
nociceptors
transduction
initiate
painful stimulus resulting in inflammatory
process to release of cytokines and
neuropeptides
noxious stimuli
Initiated by this
inflammatory process,
resulting in the conduction
of an impulse in the
primary afferent neurons
to the dorsal horn of the spinal cord
transmission
Inhibits pain message and
involves the body’s own
endogenous
neurotransmitters in the
course of processing the pain stimuli
modulation
Inhibits pain message and
involves the body’s own
endogenous
neurotransmitters in the
course of processing the pain stimuli
perception
this controls body
temperature during stress
diaphoresis
this causes
elevation in blood pressure with shift of
blood supply from the periphery and
viscera to the skeletal muscles and brain
peripheral vasoconstriction
this causes blood supply to shift
away from the periphery
pallor
this results from fatigue
muscle tension
this causes the
body defenses to fail under prolonged
stress of pain
rapid, irregular breathing
Pain elicits a stress response in the human
body triggering the sympathetic nervous
system resulting in
physiologic responses
classification of pain
acute pain
chronic nonmalignant pain
cancer pain
this is usually associated with
a recent injury
acute pain
this is
usually associated with a specific cause or
injury and described as a constant pain
that persists for more than six months so
an example is back pain
chronic nonmalignant pain
This is often due to the
compression of peripheral nerves or
meninges or from the damage to these
structures following surgery,
chemotherapy, radiation therapy, or
tumor growth and infiltration
cancer pain
classfication pf pain location
cutaneous pain
visceral pain
deep somatic pain
is usually on the skin or
subcutaneous tissue
cutaneous pain
usually in the abdominal
cavity thorax and cranium
visceral pain
usually in the ligaments tendons bones
blood vessels and nerves
deep somatic pain
Can be perceived in
nerves left by a missing amputated or
paralyzed body part
phantom pain
causes an abnormal
processing of pain messages and results
from past damage to peripheral or
central nerves due to sustained
neurochemical levels. Exact mechanisms for
the perception of neuropathic pain are
still unclear
neuropathic pain
defined by its high resistance to pain
relief so in this case many patients may
have opioid addiction
intractable pain
7 dimensions of pain
physical
sensory
behavioral
sociocultural
cognitive
affective
spiritual
effect of anatomic structure and
physiological functioning on the experience
of pain
physical
This dimension concerns the quality of the
pain and how severe the pain is perceived
to be. This dimension includes the patient’s
perception of the pain’s location intensity
and quality
sensory
verbal and nonverbal
behaviors associated with pain
behavioral
effect of social and cultural
backgrounds on the experience of pain
→ influences of the patient’s social context
and cultural background on the patient’s
pain experience
sociocultural
thoughts, beliefs, attitudes,
intentions, and motivations related t
cognitive
feelings and emotions that result
from pain
affective
ultimate meaning and purpose
attributed to pain, self, others, and the
divine
spiritual
Was developed by Baker and Wong in
1987
→ Question the child
→ Use pain rating scales
questt principles for pain in children
pain is a special category of pain
because it may reflect all of the pain types
at the same time or at different times
during the course of the disease
may be caused by the cancer
its treatment or its metastasis
cancer pain
a subjective phenomenon and thus
the main assessment lies in the client’s
reporting
pain
this type of culture uses mind over body, have positive thinking, pain is honorable ; caused by past transgressions and helps to atone and achieve higher spirituality
asian and asian american
for this culture, pain is a challenge to be fought, inevitable, and is to be endured, stigmatized resulting in inhibition in expressing pain or seeking help, punishment from God
african-american cultures
for them pain must be endured as part of preparing for the next life in the cycle of reincarnation ; remain conscious when nearing death
hindu culture
for them pain is to be endured ; not ask for medication due to respect for caregivers who should know their neeeds
native american culture
their pain response if often very expressive though pain must be endured to perform gender role duties ; pain is natural but may be a result of sinful or immoral behavior
hispanic culture
for them pain is expressed openly with much complaining, pain must be shared, recognized, and validated by others
jewish culture
occurs because heat loss mechanisms are unable to keep pace with excessive heat production, resulting in an abnormal rise in body temperature
pyrexia
based on several temp readings at different times of the day
fever determination
act as antigen, triggering the immune system responses ; hypothalamus reacts to raise the set point and the body responds by producing and conserving heat several hours pass before the body temp reaches a new set point
pyrogens
resolves when new set point, a higher temperature is achieved
chills
chills subside ; person feels warm and dry
plateau phase
if the new set point is overshot or the pyrogens are removed ; skin becomes warm and flushed vasodilation
febrile phase
when the fever breaks diaphoresis assists in evaporative heat loss
afebrile phase
mild temp elevations as high as 39 enhance the immune system of the body ; white blood cell production is stimulated ; reduces concentration of iron ; stimulates interferon
fever
constant body temperature continuously above 38C
sustained
fever spikes interspersed with usual temp levels
intermittent
fever spikes and falls without a return to normal temp levels
remittent
periods of febrile episodes and periods with acceptable temp values
relapsing
elevated body temperature related to the inability of the body to promote heat loss or reduce heat production ; results from overload of thermoregulatory mechanisms of the body
hyperthermia
hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs
malignant hyperthermia
prolonged exposure to the sun or high environmental temp ; depresses hypothalamic function ; 40C or more
heatstroke
the most important sign of heatstroke
dry and hot skino
occurs when profuse diaphoresis results in excess water and electrolyte loss ; first aid involved transferring to cooler env and giving electrolytes
heat exhaustion
heat loss during prolonged exposure to cold overwhelms the ability of the body to produce heat
hypothermia
usually develops gradually and goes unnoticed for several hours
accidental hypothermia
ice crystals form inside the cell, permanent circulatory and tissue damage occurs ; earlobes, tips of nose ; injured area becomes waxy and firm to touch
frostbite
convert the temp scales by activating a switch
electronic thermometers
