Pain Management

Question 1

What are common barriers to pain management? Why?

Answer 1

• Lack of pain training in medical/ nursing school
• Insufficent knowledge
• Lack of pain assessment skills
• Rigidity of timidity in prescribing practices
  -Fear of regulatory oversight

Patient barriers:
- reluctance to report pain
- reluctance to take opiod drugs
-poor adherence
- inapproate storage of unused medications
-lack of patient education about the use and missue of pain medications

Question 1

What is pain?

Answer 1

An unpleasant sensory or emotional experience, associated with, or resembling that associated with, actual or potential tissue damage

informal:
whatever the person says it is

Question 2

What are the manifestations of pain? Why are they important? How would you describe them? How might you incorporate these in your nursing assessment?

Answer 2

Change in vital signs (increased RR —> low Sp02 , these are important because sometimes a change in vital signs is a response to the body being in pain.

when the pain is put under control, compare the vital signs again

Question 3

Describe the physiological process of pain.

Answer 3

Tissue Damage

leading to an inflammatory response (sensitizers active neurons, activates dormant neurons)

amplification of noxious (harmful) process

peripheral sensization - a reduction in the threshold and/or an increase in magnitude of responsiveness at the peripheral ends of sensory nerve fibers.

Question 4

Differentiate the classifications of pain (nociceptive, neuropathic, mixed). What are common signs and symptoms of each? With which medical diagnoses would you find each? How do you assess, manage, and evaluate each?

Answer 4

nociceptive (pain you can point to) leg pain, sickle cell crisis, pancreatitis

Neuropathic - firing is out of wack (burning, pins and needles, sporadic and unpredictable)

Mixed/Syndromes - mixed neuropathic pain (cancer pain, fibromyalgia, phantom limb pain)

Question 5

How would you differentiate between acute and chronic pain? How do you assess, manage, and evaluate each?

Answer 5

Acute Pain -
*sudden
*less than 3 months duration

Physical and behavioral Manifestations:
- inc HR, RR, BP
- Diaphresis
- URINE RETENTION

Chronic Pain -
*gradual or sudden
* > 3 months, can start as an acute pain

Physical and behavior manifestations: Fatigue, flat effect, decrease physical activity, withdrawal from social interactions

Question 6

How would you individualize your assessment, management, and evaluation plan for different patients?

Answer 6

Identify the patients goals for therapy and resources for self management (referring them to PT)

• Direct dialogue or observation

Elements of pain assessment:
OLDCART or
P allotting or precipitating factors (what makes it better or worse?)
Q quality of pain (neuropathic, nociceptor, etc)
R region or radiating pain
S objective descriptions of pain
T emporal nature of pain (time is accuses)
U you , how is this affecting you as a person , how are the side effects of patients affecting you?

Question 7

What are common pharmacological measures to treat pain? What is the mechanism of action and common side effects of each medication? What are nursing considerations of each pharmacologic measure?

Answer 7

Opiods - respiratory depression , vasodilation, GI effects (nausea, vomiting, constipation)

Nonopiod (Tylenol, saids, topicals)

• Adjuvant (enhance bodys immune response)
• Antidepressants
• GABA-receptor agnostic
  interferes with transmission of. nociceptive impulses

-Corticosteroids
dec edema and inflammation

-Local
-Regional
-Canabiniods

IV route

Question 8

What are common non-pharmacological measures to treat pain? How would you assess, manage, and evaluate the effectiveness of each?

Answer 8

Re-positioning
Aromatherapy
Hot or Cold Therapy
Exercise/ Stretching
Meditation
Music Therapy

Question 9

What are common short- and long-term outcomes associated with pain management?

Answer 9

Temp relief

Question 10

What are common challenges to effective pain management?

Answer 10

Physiologic
- critical pain obs. tool

Behavioral
- behavioral pain scale

Social
- pain was sig. in veterans with PTSD , had more depressive symptoms, decreased material satisfaction , BUT not really more pain

Spiritual
- why is this pain happening to me?

Culture

Question 11

What are important pain management considerations for an individual with opioid tolerance?

Answer 11

They may not be as helped by a normal dose of those opiod medications , may require higher dosing

individuals who have chronic pain may require pain analgesia at baseline

Unrelieved pain can lead to complications

Question 12

What are important pain management considerations for an individual with Opioid Use Disorder (OUD)?

Answer 12

Psychosocial and/or behavioral therapy

Medications for OUD:
Methadone - opiod agonist
Naltrexone - office-based opiod antagonist
Buprenorphine , blocks other opioids while reducing withdrawal risk