Pain Management Flashcards
Physiological effects of pain
Hyperglycemia
Increased cardiac workload
Immune dysfunction
Altered coagulation
Illeus
Urinary retention
Decreased lung volume
Fatigue
Debility — physical weakness
CHANGE IN VITALS AND CHARACTERISTICS
SNS
Psychological effects of pain
Social isolation
Disability/job loss
Poor QOL
Anxiety
**Depression
Demoralization
Suicide
How many Americans are effected by chronic pain
100 million experience chronic pain
25 million are limited ADLs
COSTS: 560-630 billion
What makes pain chronic
Lasts 3-6 months
What are the four processes of pain
Transduction, transmission, perception, modulation
What is transduction
Convert noxious stimuli to electrical impulse (brains response)
Mechanical/thermal/chemical response
Nociceptors —> dorsal horn (spinal cord)
What stimulates nociceptors
Histamine
Lactic acid
Bradykinin
Prostaglandins
Substance P
Serotonin
HELP CREATE NOCICEPTORS
What is the transmission of pain
A delta - transmitters of pain, FAST conducting, transmits acute localized pain
C fibers - defused or generalized pain
THE REFLEX ARC
What is the perception of pain, threshold and adaptation
Interpretation of stimuli
Threshold= lowest intensity of stimulus that causes recognition of pain
Adaptation- result of chronic pain
What can effect a persons perception of pain
PEDS= how their parent reacts
Culture= can appear more stoic
Experience= develop a new threshold
What is modulation of pain and the neuromodulators related to it
Regulation or inhibition of sensation
Effected by neuromodulators
-endorphins= pain blocking chemicals, prolongs analgesia
Enkephalins= reduces the sensation of pain, inhibits substance P
What are the two durations of pain
Acute
Chronic
- malignant/non malignant
What are the 3 sources of pain
Cutaneous
Somatic
Visceral
What is the mode of transmission of pain
Referred
What are the three etiology’s of pain
Nociceptive — most common physical damage
Neuropathic — nerve damage
Psychogenic — mental
How long does acute pain last
No longer than a week
Clear cause and normally corrected
What is cutaneous pain and give an example
Superficial — paper cut
What is somatic pain and example
Diffused or scattered pain, musculoskeletal, with generalized area pain
Sprained ankle
What is visceral pain and give an example
Caused by internal organs, stretching/spasm pain, generalized pain area, REFERRED PAIN
appendicitis
What is the danger with neuropathy
Risk for unknown injury or severity
What does neuropathic pain feel like
Burning, electric, tingling, stabbing
How is psychogenic pain treated
Least to most invasive
How is psychogenic pain treated
Least to most invasive
What is allodynia
Pain after non painful stimuli
What is intractable pain
Untreatable with interventions and therapy
-try distractive techniques or alternative therapy, communication with providers is KEY
Things to know about newborn/infant pain
Lack of pain perception, usually given sugar water for treatment
Things to know about toddler pain
Pain can not be identified
-is there but hard to assess
How to ask someone about their pain
Describe
Rate
What makes it worse/better
Location
Duration
Describe the verbal rating scale for pain
Used for adults and adolescents
-after ask for the pain to be described
Describe the Wong-Baker pain scale
Faces, used for toddlers and children
-note: some kids will pick the face they LIKE best
Describe the adult non verbal pain scale NVPS
Based on facial expressions, activity, guarding, vital signs, presentation (eyes, sweating, flushed)
Describe the CRIES observer pain scale
Used for peds
C: crying
R: requires oxygen
I: increased vitals
E: expression
S: sleeplessness
Describe the FLACC scale
Used in peds
F: face
L: legs
A: activity
C: cry
C: consilability
What are some drug seeking behaviors
Changing story, changed pain location, demanding specific med/dose/administration
SNS response to moderate pain
HTN
Tachycardia/pnea
Pallor
Increase blood sugar
Muscle tension
PNS response to severe pain
N/V
Fainting
Hypotension
Bradycardia
Rapid/irregular breathing
Behavioral signs of pain
Grimacing
Moaning
Restlessness
Guarding
Moving away
Crying
Behavioral signs of pain
Grimacing
Moaning
Restlessness
Guarding
Moving away
Crying
Affective signs of pain
Withdrawal
Stoicism
Anxiety/depression
Fear/anger
Anorexia
Fatigue
Hopelessness
What are adjuvant analgesics
Will buffer neuro response and causes synergy effect when used with pain reliever
Examples of adjuvant analgesics
Tricyclic antidepressants
Antihistamines
Caffeine
Muscle relaxant
Anticonvulsant
Antiemetic
Examples of adjuvant analgesics
Tricyclic antidepressants
Antihistamines
Caffeine
Muscle relaxant
Anticonvulsant
Antiemetic
Dosage of hydromorphone compared to morphine
7-10 times stronger, so smaller dose is needed
Types of administration for PCAs
IV
Nerve block
Epidural
Intrathecal
When are PCAs used and what are the stipulations
Post op, chronic pain, cancer pain
Pt can not have altered consciousness, be the only one to push the button, and still be using the prescribed dose
What meds are typically used in PCAs
Fentanyl, morphine, hydromorphine
What are the most serious opioid side effects
Respiratory depression
Apnea
Respiratory arrest
Circulatory depression
Hypotension
Shock
What are the most common side effects of opioids
Constipation —normally prescribed stool softeners
N/V
Sedation
Dizziness
Pruritus
HA
Dry mouth
When is a person considered in respiratory depression and what do you do
Respirations less than 8 — try to wake up and check other vitals
-give narcan — will last only 3-5 minutes
*if no response look for other causes
What is the numeric sedation scale and each category
represents effect of opioids
S: sleep, easy to arouse no intervention
1: awake and alert, no intervention
2: occasionally drowsy, but easy to arouse, non intervention
3: frequently drowsy, drifts into sleep during conversation REDUCE dose
4: somnolent with minimal or no response to stimulation DISCONTINUE and consider naloxone
What is physical dependence
Withdrawal if drug is discontinued or change in dose
What is physical dependence
Withdrawal if drug is discontinued or change in dose
What is tolerance
Greater amount needed to get therapeutic effect
What is Pseudoaddiction
Behavior is suggestive to addiction, caused by under treatment
What is Pseudoaddiction
Behavior is suggestive to addiction, caused by under treatment
What is Psychological dependence
Psychiatric disorder characterized by compulsive use of substance, despite harm
