Pain Management Flashcards
What is pain?
- whatever and wherever the pt says it is
- learned through life experiences
- influenced by biological, social, and psychological factors
- expressed in many ways
Gate Control Theory
- describes the transmission of painful stimuli and recognizes a relationship between pain and emotions
- small and large nerve fibers conduct and inhibit pain stimuli toward the brain
- gating mechanism determines the impulses that reach the brain
Small nerve fibers
conduct excitatory pain stimuli toward the brain, exaggerating the effect of arriving stimuli through a positive feedback mechanism
Large nerve fibers
inhibit the transmission of pain impulses from the spinal cord to the brain through a negative feedback system
The pain process
- Transduction
- Transmission
- Perception of pain
- Modulation
Transduction
-activation of pain receptors
- electrical impulse that travels from the periphery to the spinal cord at the dorsal horn from the conversion of painful stimuli into electrical pulses
Transmission
- conduction along pathways (A- delta and C- delta fibers)
- from the site of injury/inflammation conducted to the spinal cord
- the time when you pull back from whatever is causing pain
Perception of Pain
- awareness of the characteristics of pain
- perceived amount of pain differs for each individual
Modulation of pain
- inhibition or modifcation of pain
- neuromodulators are regulated or modified by the sensation of pain
- neuromodulators: endorphins, dynorphins, enkephalins
Acute
duration of pain
- rapid in onset, varies in intensity and duration
- protective in nature
- example: burst appendix
Chronic
duration of pain
- may be limited, intermittent, persistent
- lasts beyond normal healing period
- periods or remission or exacerbation
- example: rheumatoid arthritis
Nociceptive
etiology of pain
- occurs during normal pain process
- nociceptors are activated by actual or threatened damage to nonneural tissue
Neuropathic
etiology of pain
- caused by disease or lesion of the peripheral or central somatosensory nervous system
- burning, electric, tingling, stabbing
- example: diabetic neuropathy
Nociplastic
etiology of pain
- neither nociceptive or neuropathic but is chronic primary pain
- often misdiagnosed
Intractable
etiology of pain
- occurs when there is resistance to interventions or treatment
Phantom
etiology of pain
- occurs with an amputated leg where receptors and nerves are absent, but is a real experience for the pt
Somatic
location of pain
- diffuse or scattered
- occurs in bones, tendons, ligaments, blood vessels, nerves
-* example: damage to tissue that occurs with a sprain*
Visceral
location of pain
- poorly localized
- orginates in thorax, cranium, abdomen
- occurs as organs stretch abnormally and become distended , ischemic, or inflamed
Referred
location of pain
- originates in one part of the body but perceived in an area distant from origin
- example: myocardial infarction pain in the neck, shoulder, left arm
Cutaneous
location of pain
- involves skin or subq tissue
- example: paper cut
Quality
terms to describe pain
- dull
- sharp
- diffuse
- shifting
Severity
terms to describe pain
- severe or exruciating
- mild
- moderate or slight
Pain assessment tools
- 0-10 rating
- adult nonverbal pain scale (NVPS)
- Behavioral pain scale (BPS)
- checklist of nonverbal indicators
- COMFORT behavior scale
- CRIES instrument
Pain assessment tools cont.
- critical care pain observation tool (CPOT)
- faces pain scale (FPS)
- FLACC behavioral scale
- Iowa pain thermometer
- oucher pain scale
- Pain Assessment in Advanced Dementia Scale (PAINAD)
- Wong-Baker FACES
Nursing interventions for pain
- establish nurse-patient relationship
- understand placebo controversy
- ensure ethical and legal responsibility to relieve pain
- managing pharmacologic relief measures
Non Pharmacological pain interventions
- distraction
- humor
- music
- imagery
- acupuncture
- mindfulness
- hypnosis
- biofeedback
- animal assisted intervention
- therapeutic touch
Analgesics
- opiods
- adjuvant
- nonopiod
Numeric Sedation Scale
S
1
2
3
4
S
numeric sedation scale
sleep, easy to arouse, no action necessary
1
numeric sedation scale
awake and alert, no action necessary
2
numeric sedation scale
occasionally drowsy but easy to arouse
no action necessary
3
numeric sedation scale
frequently drowsy, drifts to sleep during conversation
reduce dosage
4
numeric sedation scale
somnolent with minimal or no response to stimuli
discontinue opiod, consider use of naloxone
Older adults
pain treatment
- communication difficulties
- denial of pain
- altered physiological response to analgesics
Teaching about pain
- should include family or caregivers
- explanation of pain scales
- keep diary of pain and meds
- diet: do not take meds on empty stomach
- safety: avoid driving, operating machinery, alcohol or other CNS depressants
