Pain Management

Question 1

What is pain?

Answer 1

• whatever and wherever the pt says it is
• learned through life experiences
• influenced by biological, social, and psychological factors
• expressed in many ways

Question 2

Gate Control Theory

Answer 2

• 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

Question 3

Small nerve fibers

Answer 3

conduct excitatory pain stimuli toward the brain, exaggerating the effect of arriving stimuli through a positive feedback mechanism

Question 4

Large nerve fibers

Answer 4

inhibit the transmission of pain impulses from the spinal cord to the brain through a negative feedback system

Question 5

The pain process

Answer 5

1. Transduction
2. Transmission
3. Perception of pain
4. Modulation

Question 6

Transduction

Answer 6

-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

Question 7

Transmission

Answer 7

• 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

Question 8

Perception of Pain

Answer 8

• awareness of the characteristics of pain
• perceived amount of pain differs for each individual

Question 9

Modulation of pain

Answer 9

• inhibition or modifcation of pain
• neuromodulators are regulated or modified by the sensation of pain
• neuromodulators: endorphins, dynorphins, enkephalins

Question 10

Acute

duration of pain

Answer 10

• rapid in onset, varies in intensity and duration
• protective in nature
• example: burst appendix

Question 11

Chronic

duration of pain

Answer 11

• may be limited, intermittent, persistent
• lasts beyond normal healing period
• periods or remission or exacerbation
• example: rheumatoid arthritis

Question 12

Nociceptive

etiology of pain

Answer 12

• occurs during normal pain process
• nociceptors are activated by actual or threatened damage to nonneural tissue

Question 13

Neuropathic

etiology of pain

Answer 13

• caused by disease or lesion of the peripheral or central somatosensory nervous system
• burning, electric, tingling, stabbing
  - example: diabetic neuropathy

Question 14

Nociplastic

etiology of pain

Answer 14

• neither nociceptive or neuropathic but is chronic primary pain
• often misdiagnosed

Question 15

Intractable

etiology of pain

Answer 15

• occurs when there is resistance to interventions or treatment

Question 16

Phantom

etiology of pain

Answer 16

• occurs with an amputated leg where receptors and nerves are absent, but is a real experience for the pt

Question 17

Somatic

location of pain

Answer 17

• diffuse or scattered
• occurs in bones, tendons, ligaments, blood vessels, nerves
  -* example: damage to tissue that occurs with a sprain*

Question 18

Visceral

location of pain

Answer 18

• poorly localized
• orginates in thorax, cranium, abdomen
• occurs as organs stretch abnormally and become distended , ischemic, or inflamed

Question 19

Referred

location of pain

Answer 19

• 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

Question 20

Cutaneous

location of pain

Answer 20

• involves skin or subq tissue
• example: paper cut

Question 21

Quality

terms to describe pain

Answer 21

• dull
• sharp
• diffuse
• shifting

Question 22

Severity

terms to describe pain

Answer 22

• severe or exruciating
• mild
• moderate or slight

Question 23

Pain assessment tools

Answer 23

• 0-10 rating
• adult nonverbal pain scale (NVPS)
• Behavioral pain scale (BPS)
• checklist of nonverbal indicators
• COMFORT behavior scale
• CRIES instrument

Question 24

Pain assessment tools cont.

Answer 24

• 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

Question 25

Nursing interventions for pain

Answer 25

• establish nurse-patient relationship
• understand placebo controversy
• ensure ethical and legal responsibility to relieve pain
• managing pharmacologic relief measures

Question 26

Non Pharmacological pain interventions

Answer 26

• distraction
• humor
• music
• imagery
• acupuncture
• mindfulness
• hypnosis
• biofeedback
• animal assisted intervention
• therapeutic touch

Question 27

Analgesics

Answer 27

• opiods
• adjuvant
• nonopiod

Question 28

Numeric Sedation Scale

Answer 28

S
1
2
3
4

Question 29

S

numeric sedation scale

Answer 29

sleep, easy to arouse, no action necessary

Question 30

1

numeric sedation scale

Answer 30

awake and alert, no action necessary

Question 31

2

numeric sedation scale

Answer 31

occasionally drowsy but easy to arouse
no action necessary

Question 32

3

numeric sedation scale

Answer 32

frequently drowsy, drifts to sleep during conversation
reduce dosage

Question 33

4

numeric sedation scale

Answer 33

somnolent with minimal or no response to stimuli
discontinue opiod, consider use of naloxone

Question 34

Older adults

pain treatment

Answer 34

• communication difficulties
• denial of pain
• altered physiological response to analgesics

Question 35

Teaching about pain

Answer 35

• 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