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Pain management Flashcards

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1
Q

it is an unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

A

Pain

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2
Q

What are the Theories of Pain?

A

1) Pattern Theory
2) Specificity Theory
3) Gate Control Theory
4) Affect Theory
5) Parallel Processing Model

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3
Q

It states that there are
specific nerve receptors for
particular stimuli.

A

Specificity Theory

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4
Q

It states that pain is
perceived whenever the
stimulus is intense enough

A

Pattern Theory

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5
Q

It conceptualizes that there is a gate
in the spinal cord called substantia
gelatinosa cells in the dorsal horn

A

Gate Control Theory

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6
Q

In Gate Control Theory, what stimulate
impulses in large nerves which in
turn close the gate to back pain?

A

Back massage

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7
Q

It avers that the pain
is emotional

A

Affect Theory

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8
Q

it believes that the
physiologic or
neurologic deciphering
of the pain sensation
and the cognitive
emotional properties
occur along different
nerve fibers

A

Parallel Processing Model

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9
Q

What is the physiology of pain?

A

1) Transduction
2) Transmission
3) Perception
4) Modulation

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10
Q

What type of Nerve fiber that has the characteristics below:

  • Conduct impulses rapidly
  • Sharp, pricking pain
  • Superficial, somatic pain
A

A-Delta Fibers
(Large, Myelinated)

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11
Q

What type of Nerve fiber that has the characteristics below:

  • Conduct impulses slowly
  • Dull, aching, burning sensation
  • Deep somatic and visceral pain
A

C Fibers
(Small, Unmyelinated)

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12
Q

What is the gate in the spinal cord that is also in the dorsal horn?

A

substantia
gelatinosa cells

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13
Q

What are the Pain-producing stimuli?

A

Thermal,
Chemical or,
Mechanical stimuli

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14
Q

causes cellular damage
leading to a release of
neurotransmitters

A

Stimuli

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15
Q

determines the pain
intensity and location

A

Somatosensory cortex

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16
Q

determines how the person perceives pain

A

Association cortex (mainly the limbic system)

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17
Q

Are released the moment pain is perceived by the brain

A

Neuromodulators

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18
Q

deliver sensory impulses to the spinal cord, where they synapse with spinal
motor neurons

A

Delta A fibers

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19
Q

What are the types of Neurotransmitters (Excitatory)?

A
  1. PROSTAGLANDINS
  2. BRADYKININ
  3. SUBSTANCE P
  4. HISTAMINE
  5. SEROTONIN
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20
Q
  • Released from plasma that escapes from neighboring blood vessels at the location of tissue
    damage
  • Attaches to receptors on peripheral nerves, amplifying sensations of pain
  • Attaches to cells that initiate the cascade leading to the production of prostaglandins
A

BRADYKININ

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21
Q
  • Produced through the breakdown of phospholipids found in cellular membranes
  • Increase pain sensitivity
A

PROSTAGLANDINS

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22
Q
  • Discovered within the pain neurons of the dorsal horn (excitatory peptide)
  • Required for the transmission of pain signals from the periphery to higher centers in the
    brain
  • Induces vasodilation and edema
A

SUBSTANCE P

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23
Q
  • Released from both the brainstem and dorsal horn to suppress pain transmission
A

SEROTONIN

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24
Q
  • Generated by mast cells, leading to
    capillary dilation and increase in capillary permeability
A

HISTAMINE

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25
Q
  • Naturally occurring sources of
    morphine-like substances within the
    body
  • Triggered by stress and pain
  • Found in the brain, spinal cord, and
    gastrointestinal tract
  • Induce analgesia when they fasten to
    opiate receptors in the brain
  • Found in increased levels in people
    with less pain than others with the
    same injury
A

NEUROMODULATORS (Inhibitory)

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26
Q

Low to moderate intensity pain or
superficial pain

A
  • Trigger the fight or flight response
  • Stimulate the sympathetic nervous
    system
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27
Q

Severe , deep, or continuous pain

A
  • Activate the parasympathetic
    nervous system
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28
Q

What are the signs of pain?

A
  • Teeth clenching
  • Holding the affected area
  • Adopting a hunched posture
  • Grimace
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29
Q

What are the types of pain in terms of location?

A
  1. SUPERFICIAL OR CUTANEOUS
    PAIN
  2. DEEP OR VISCERAL
  3. REFERRED
  4. RADIATING
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30
Q
  • Results from stimulation of the
    skin
  • Short duration and localized
  • Sharp sensation
  • Examples: small cuts, insect bites
A

SUPERFICIAL OR CUTANEOUS
PAIN

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31
Q
  • Perception of pain in non-affected
    regions
  • Pain is experienced in a body part
    that is separate from the actual
    source of pain, and it can take on
    various characteristics
A

REFERRED

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32
Q
  • Results from stimulation of internal
    organs
  • Spreads out and radiates in multiple
    directions
  • Lasts longer than superficial pain
  • Sharp, dull, or distinct to the organ
    involved
A

DEEP or VISCERAL

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33
Q

crushing or
squeezing chest
pain

A

Myocardial
Infarction

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34
Q

severe and persistent
abdominal pain

A

Appendicitis

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35
Q

Intense pain
in the upper abdomen

A

Pancreatitis

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36
Q

chest pain or discomfort
that may radiate to
the left arm or jaw

A

Angina

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37
Q

pain radiating from the lower
back to the groin area

A

Kidney stones

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38
Q

originates in the
lower back or
buttock and
radiates down the
back of the leg,
often caused by
compression or
irritation of the
sciatic nerve

A

Sciatica

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39
Q

radiates from one side of the head and
may extend to the forehead, temples, or back of the head

A

Migraine Headache

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40
Q
  • The feeling of pain spreading from
    the original injury site to a different
    area of the body
  • The sensation of pain moving or
    coursing along a specific body part
  • Intermittent or constant
A

RADIATING

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41
Q

What are the types of pain in terms of duration?

A
  1. ACUTE / TRANSIENT PAIN
  2. CHRONIC / PERSISTENT NON-
    CANCER PAIN
  3. CHRONIC EPISODIC PAIN
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42
Q
  • Protective
  • Has a known cause
  • Short duration, less than 3 months
  • Reduced damage to tissues
  • Eventually resolves, whether or not
    medical intervention is provided, once the affected area is healed
A

ACUTE / TRANSIENT PAIN

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42
Q

What is the Primary Nursing Goal in relieving Acute/Transient Pain?

A

Provide pain relief

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43
Q
  • Not protective
  • No purpose
  • Lasts longer than 6 months
  • Constant or recurring with mild to severe
    intensity
  • No known cause
A

CHRONIC / PERSISTENT NON-
CANCER PAIN

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44
Q
  • Occurs sporadically over extended periods of time
  • May lasts for hours, days or weeks
  • Example: migraine headaches, pain
    associated with sickle cell disease
A

CHRONIC EPISODIC PAIN

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45
Q

How do you measure the intensity of pain?

A

By using pain assessment scales

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46
Q

What are the types of pain assessment scales?

A
  • Numerical Rating Scale
  • Verbal Rating Scale
  • Visual Analog Scale
  • Face Scale
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47
Q

What are the types of Pain in terms of Etiology/Pathology?

A
  1. CANCER PAIN
  2. PAIN BY INFERRED PATHOLOGICAL
    PROCESSES
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48
Q

is experienced when an
intact, properly functioning nervous system sends signals that tissues are damaged, requiring attention and proper care.

A

Nociceptive pain

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49
Q

pain arises from the bone, joint, muscle, skin or connective tissue; typically characterized by a dull or pulsating sensation and highly localized

A

Somatic (musculoskeletal)

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50
Q

pain that originates from internal organs like the gastrointestinal tract and pancreas.

A

Visceral (internal organ)

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51
Q

What are the types of Centrally Generated Pain?

A
  • Differentiated pain
  • Sympathetically Maintained Pain
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52
Q

damage to either the peripheral or central nervous system

A

Differentiated pain

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53
Q

injury to the central nervous system

A

Burning pain below the level of spinal cord

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54
Q

injury to the peripheral nervous system

A

Phantom pain

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55
Q

impaired regulation of the autonomic
nervous system (ANS)

A

Sympathetically Maintained Pain

56
Q

Types of Peripherally Generated Pain

A
  • Painful polyneuropathies
  • Painful mononeuropathies
57
Q

related with a known peripheral nerve injury

A

Painful mononeuropathies

58
Q

pain experienced throughout the course of multiple peripheral
nerves

A

Painful polyneuropathies

59
Q

A Type of Peripherally generated pain that has these examples:

  • Diabetic neuropathy
  • Alcohol-Nutritional neuropathy
  • Guillain-Barre Syndrome
A

Painful polyneuropathies

60
Q

What are the Factors Affecting the Pain Experience

A
  • Ethnic and Cultural Values
  • Developmental Stage
  • Environment and Support People
  • Previous Pain Experience
  • Meaning of pain
  • Emotional Responses to Pain
  • Anxiety
  • Attention
  • Spiritual factors
  • Neurological Function
  • Coping style
60
Q

A Type of Peripherally generated pain that has these examples:

  • Nerve root compression
  • Nerve entrapment
  • Trigeminal neuralgia
A

Painful mononeuropathies

61
Q

What are the concepts associated with pain?

A
  • Pain Threshold
  • Hyperalgesia
  • Pain Tolerance
  • Pain reaction
  • Pain perception
  • Bradykinin
62
Q
  • The amount of pain stimulation a person requires before
    feeling pain (also pain sensation)
  • Generally fairly uniform among people
A

Pain Threshold

63
Q
  • Excessive sensitivity to pain
A

Hyperalgesia

64
Q

The autonomic nervous system and
behavioral responses to pain

A

Pain reaction

65
Q

The maximum amount and duration of pain that an individual is willing to endure. Varies greatly among people

A

Pain Tolerance

66
Q

The actual feeling of pain

A

Pain perception

67
Q

Universal stimulus for pain

A

Bradykinin

68
Q

TYPES OF RESPONSES TO PAIN

A

1) Involuntary Response
2) Voluntary Response

69
Q

are mediated by the autonomic
nervous system.

A

Physiologic responses

70
Q

crying, moaning, grimacing, tossing
in bed, splinting the painful area, assuming fetal position

A

Behavioral responses

71
Q

What are the three stages of Pain?

A

1) Activation
2) Rebound
3) Adaptation

72
Q

where non-painful stimuli (contact with
linen, water or wind) produce pain

A

Allodynia

73
Q

an unpleasant abnormal sensation,
mimics/imitates the pathology of a
central neuropathic pain disorder (ex.
Pain that follows a spinal cord injury)

A

Dysesthesia

74
Q
  • Is actual pain felt in a body part that is no longer present
  • Painful sensation in a body part that is missing
A

Phantom pain

75
Q
  • The result of current or past damage to the peripheral or central nervous system and may not have a stimulus such as tissue or nerve damage
  • Long lasting, unpleasant and can be described as burning, dull, aching, sharp, shooting pain
A

Neuropathic pain

76
Q

It is primarily due to emotional factors with no physiologic basis

A

Psychogenic pain

77
Q

Pain that stops and starts again

A

Intermittent pain

78
Q

PQRST Mnemonic

A

Q – Quality / Quantity
R – Region / Radiation
S – Severity Scale
T – Timing

79
Q

highly individualized and the most reliable indicator of the existence and intensity of pain

A

Self Report of pain

80
Q

This pain assessment tool is intended to help patient care providers assess pain according to individual patient needs, explains and uses 0-10 Scale for patient self-assessment.

A

Universal Pain Assessment Tool

81
Q

What are the different type of pain intensity scales?

A

1) Word scales
2) Numeric Scales
3) Linear (visual analog) scale/VAS
4) Rating scale

82
Q
  • Therapeutic touch. Energy is transmitted from one person to
    another
  • Contralateral stimulation.
    Stimulating the skin in an area
    opposite to the painful area
  • Vibration
  • Heat and cold application
A

enhance secretion of serotonin, a neurotransmitter that blocks transmission of pain impulses

83
Q

Energy is transmitted from one person to another

A

Therapeutic touch

84
Q

a method of treating chronic pain by applying electrodes to the skin and passing small electric currents through
sensory nerves and the spinal cord,
thus suppressing the transmission of
pain signals

A

TENS (Transcutaneous Electrical
Nerve Stimulation)

84
Q
  • Staring
  • Slow, rhythmic breathing
  • Recite, sing
  • Describe something in detail
  • Conversation
  • Read, play games
  • Busy oneself (chores, hobbies)
  • Favorite toy
A

Techniques that Distract
Attention – to close the gate by
acting on the hypothalamus

85
Q
  • relax muscles
  • Listen to music
  • Guided imagery. Use of images or fantasy to achieve specific health-
    related goals
  • Meditation, Yoga,
A

Conventional Methods

86
Q

the use of monitoring devices that display information about the operation of a bodily function that is not normally consciously controlled, e.g. heart rate or blood pressure; conscious control of the physiologic response under the
control of ANS

A

physiological control technique

87
Q

Non-Pharmacologic Pain Relief
Interventions

A
  • Relaxation and Guided
    Imagery
  • Distraction
  • Cutaneous Stimulation
  • Herbals
  • Reducing Pain Perception
88
Q

Involves stimulating the skin with the
use of mild electrical current that goes
through external electrodes

A

Transcutaneous Electrical
Nerve Stimulation (TENS)

89
Q
A
90
Q

Techniques that Promote Relaxation

A
  1. Conventional Methods
  2. Analgesic
  3. Placebo
91
Q

A non-organic substance that satisfies the patient’s request for analgesic. It requires physician’s order

A

Placebo

92
Q

Administer analgesic at the start of pain. It is no longer effective when pain reaches its peak

A

Analgesic

93
Q

Factors in Pain Management

A
  • Acknowledging & accepting client’s
    pain
  • Assisting support persons – massaging
    the clients back
  • Reducing misconceptions about pain
  • Reducing fear and anxiety
  • Preventing pain
94
Q

Administration of analgesics prior
to an invasive or operative
procedure in order to treat pain
before it occurs

A

Preemptive analgesia

95
Q

Types of Pharmacologic Pain Management

A
  • Opioid Analgesics
  • Nonopioids /NSAIDs
  • Adjuvant analgesics
96
Q
A
97
Q
A
98
Q
  • Includes morphine and codeine
  • Relieves pain and provides a sense of
    euphoria
A

Opioid Analgesics

98
Q

3 types of opioids:

A
  • Full agonists
  • Mixed agonists-antagonists
  • Partial agonists
99
Q
  • Include acetaminophen and non-steroidal anti-inflammatory drugs such as ibuprofen
A

Nonopioids /NSAIDs

100
Q
  • Medications that was developed for a use other than analgesia but has been found to reduced chronic pain and sometimes acute pain in addition to its primary action
  • Examples are mild sedatives or tranquilizers, antidepressants, anticonvulsants
A

Adjuvant analgesics

101
Q

Any medication or procedure, including surgery that produces an effect in a client because of its implicit or explicit intent and not because of its specific physical or chemical properties

A

ADMINISTRATION OF PLACEBOS

102
Q

Continuous subcutaneous administration of long-acting
local anesthetics into or near the surgical site in cases like mastectomy, hernia repair, abdominal hysterectomy

A

CONTINUOUS LOCAL ANESTHESIA

103
Q
  • An interactive pain management that permits clients to treat their pain by self-administering doses of analgesics
  • Oral route: most common
  • Other methods: subcutaneous, IV, epidural
A

PATIENT-CONTROLLED ANALGESIA

104
Q
  • The most prevalent
    and efficient approach to alleviate
    pain
  • Reduce or block the
    perception of pain
    signals in the body
A

ANALGESICS

105
Q
  • A drug delivery system that
    enables patients to self-
    administer opioids while
    significantly reducing the
    chances of an overdose
    occurring
A

PATIENT-CONTROLLED
ANALGESIA (PCA)

106
Q
  • Pain-relieving drugs that are
    applied externally to the skin
    rather than being ingested
    or injected
A

TOPICAL ANALGESICS

107
Q
  • Locally injecting an
    anesthetic medication to
    numb a specific area of the
    body and induce a loss of
    sensation in that particular
    region
  • Induce a transient absence
    of sensation by impending
    nerve conduction
A

Local Anesthesia

108
Q
  • The local anesthetic is used
    to obstruct a cluster of
    sensory nerve fibers
A

Regional Anesthesia

109
Q
  • Used for the treatment of
    acute post-operative pain,
    labor and delivery pain, and
    chronic cancer pain
A

Epidural Analgesia

110
Q

Acetaminophen and Non-
steroidal Anti-inflammatory
Drugs

A

NON-OPIOIDS

111
Q
  • Most tolerated and safest
    pain-reliever
  • Hepatotoxicity – major
    adverse effect
  • no anti-inflammatory effects
    and its action is unknown
A

Acetaminophen

112
Q
  • Aspirin, Ibuprofen, and COX-
    2 Inhibitors
  • Provide mild to moderate
    pain relief
  • Highly likely to inhibit
    prostaglandins
  • Safe for short-term pain
    relief
A

Non-steroidal Anti-
inflammatory Drugs (NSAIDs)

113
Q

Prescribed for moderate to
severe pain

A

OPIOIDS

114
Q

commonly prescribed for cancer pain
and other forms of severe
pain

A

Morphine

115
Q

medication prescribed for
palliative care or opioid-
tolerant patients

A

Hydromorphone

116
Q

used for its analgesic action for a short
duration during anesthesia or immediate postoperative period; pain-relieving adjunct for either general or regional anesthesia

A

Fentanyl

117
Q

Not categorized as pain
relievers but has qualities
that may reduce pain alone
or combined with other
analgesics

A

ADJUVANTS

118
Q

enhance pain relief, improve mood,
and decrease agitation

A

Anti-depressants

119
Q

interrupt the transmission of pain
signals and are employed for
pain localized in specific
regions of nerve distribution

A

Local anesthetics

120
Q

reduces anxiety and improves sleep

A

Anxiolytics

121
Q

improves sleep
for patients with chronic
pain

A

Sedatives

122
Q

interrupts cranial or peripheral nerves by an incision such as pain in the lower leg or foot arising from vascular occlusion

A

Neurectomy

123
Q
  • interruption of the anterior or posterior nerve root area close to the spinal cord, between the ganglion & cord.
  • Performed on cervical nerve roots to alleviate pain of the head and neck from cancer or neuralgia
A

Rhizotomy

124
Q
  • The surgical interruption of pain-conducting pathways within the spinal cord.
  • The incision is made in the anterolateral pathway opposite to the side on which
    the pain is located
  • Usually done for pain in the legs and trunk to obliterate pain and temperature
    sensation
A

Cordotomy or Spinothalamic Tractotomy

125
Q

Surgical resection of the anterolateral pathway in the brainstem

A

Tractomy

126
Q

Removal of the postcentral gyrus (part of the sensory cortex of the
brain)

A

Gyrectomy

127
Q

Destroying the pituitary gland by injection with absolute alcohol

A

Hypophysectomy

128
Q

Chemical interruption of a nerve pathway by injecting a local
anesthesia into the nerve

A

Nerve block

129
Q
  • Pathways of the sympathetic division of the autonomic nervous system are
    severed
  • This process eliminates vasospasm, improves peripheral blood supply thus
    effective in treating painful vascular disorders like angina and Raynaud’s
    disease
A

Sympathectomy

130
Q
  • Used in nonmalignant pain that has not been controlled with less invasive
    therapies
  • Involves insertion of a cable that allows the placement of an electrode directly
    into the spinal cord
  • The cord is attached to a device that sends electrical impulses to the spinal cord
    to control pain.
A

Spinal Cord Stimulation

131
Q

chemical regulators that may modify
pain

A

Endogenous Opioids

132
Q

Types of Endogenous Opioids used in Pain modulation

A
  • Enkephalins
  • Endorphins
  • Dynorphins
133
Q

They inhibit the release of substance P, a neurotransmitter which enhances transmission of pain impulses

A

Enkephalins

134
Q

More potent that enkephalins

A

Endorphins

135
Q

They have an analgesic effect which is 50 times more potent than endorphins

A

Fundamental of Nursing (6 decks)

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