Pain Management Flashcards
Acute Pain
pain that results form an acute injury, has a rapid onset and short duration, and subsides when the injury is healed.
o ELEVATED HR/BP
o Pain that lasts less than 3-6 months
o Sources of pain:
Trauma, surgery,
labor,
acute disease
Chronic Pain
persistent pain that lasts longer than 3 months post op, or lasts longer than 6 months not following surgery. Chronic pain may be episodic or continuous and may lead to disability
o DECREASED HR/BP
o Post op pain that persists more than 3 months and pain (not following surgery) lasting longer than 6 months.
o Examples:
Arthritis
Fibromyalgia
Neuropathy
Cancer (malignant)
pain that stems from cancer or cancer treatment
o Examples:
Tumor pressing on a bone or nerve
Organ obstruction
Toxicity from chemotherapy
Noncancer pain
acute pain that becomes chronic pain and may be prolonged and potentially life-threatening
o Examples:
Whiplash injury
Low back pain
Osteoarthritis
Sickle cell diseases
Neuralgia
Neuropathic pain
episodic or continuous pain that results from a nerve injury and persists even without painful stimuli
o Examples
Tumor
Infection
Toxicity from chemo
Neuropathy
Visceral pain
Nociceptive or physiologic pain that results from nociceptor stimulation in response to an injury or tissue damage
o Arise from the organs of the body
Appendicitis
Pancreatitis
Inflammatory bowel disease
Bladder distention
Cancer
o Examples:
Heart
Kidney
Lungs
Gallbladder
Labor pain
pain during the birthing of a baby
o Examples
Uterine contractions
Cervical dilation
Pelvic pressure
Nociceptive pain
physiologic pain that results from nociceptor stimulation in response to an injury or tissue damage
o MOST COMMON TYPE OF PAIN, originates from the visceral and somatic locations of the body.
Sharp
Burning
Aching
Cramping
Stabbing
o Examples:
Surgery
Inflammation
Trauma
Radiating pain
pain that extends to other areas
o Extends from the source to an adjacent area of the body
Examples:
* GI reflux pain radiates from the stomach up the esophagus
Referred pain
: pain in an area other than the area causing the pain
o Originates in one area but hurts in another
o Examples:
Heart attack can be felt in arm or jaw
Jaw and left arm pain with a myocardial infarction
Somatic pain
nociceptive or physiological pain
o Results from injury to skin, muscles, bones, and joints
Examples:
* Sunburn
* Lacerations
* Fractures
* Sprains
* Arthritis
* Bone cancer
Psychogenic pain
perceived pain without a physical cause
o Example:
Headache
Backache
Stomach ache
Phantom pain
neuropathic or pathological pain from the loss of a body part
occurs when the brain continues to receive messages from the area of an amputation
o Example:
Amputated extremity
Breakthrough pain
spike in pain when chronic pain already exists
o Example:
Surgery
Injury
Fluctuation in pain associated with existing condition such as cancer.
0-10 Numeric Rating Scale (NRS):
most common; allows patients to verbally report and quantify their pain level. ; okay for cognitive persons
o 1-3=mild
o 4-7=moderate
o 8-10=severe
- SOCRATES
o site (where the pain is located
o onset (where did the pain start? Was it gradual?
o Character (what is the quality of pain? Stabbing, burning, or aching?
o Radiation (does the pain radiate anywhere?
o Associations (s/s/ are associated with the pain?
o Time course (is there a pattern to when the pain occurs
o Exacerbating/relieving factors (does anything make pain better or worse?
- Wong-Baker FACES pain rating scale
for those with difficulty communicating verbal pain levels.
o 0=no hurt (big smile)
o 2=hurts little bit (less smile)
o 4=hurt little more (straight mouth)
o 6=hurts even more (small frown)
o 8=hurts whole lot (bigger frown)
o 10=hurts worst (biggest frown and tears)
When is appropriate to use what pain assessment
- Non verbal pt= noncognitive pain scale (wong-baker faces or behavioral interpretations)
Different vitals between pains.
- Elevated pulse and blood pressure values may indicate acute pain and a need for pain medication.
- A decrease in blood pressure and pulse rate may indicate chronic pain
- Respiratory clinical manifestations of pain (4)
o Increased respiratory rate
o Increased bronchospasms
o Pneumonia
o Atelectasis
- Cardiovascular clinical manifestations of pain (8)
o Increased heart rate and force of contraction in acute pain
o Increased systolic BP in acute pain
o Decreased BP in prolonged pain or chronic pain
o Decreased pulse in prolonged pain or chronic pain
o Increased myocardial oxygen demand
o Increased vascular resistance
o Hypercoagulation
o Chest pain
- Gastrointestinal clinical manifestations of pain (5)
o Decreased gastric emptying
o Decreased intestinal motility
o Constipation
o Anorexia
o Weight loss
- Musculoskeletal clinical manifestations of pain (5)
o Muscle spasms
o Increased muscle tension
o Impaired mobility
o Weakness
o Fatigue
- Endocrine clinical manifestations of pain (2)
o Fever
o Shock
- Genitourinary clinical manifestations of pain (4)
o Decreased urine output
o Urinary retention
o Fluid overload
o Hypokalemia
- Sensory clinical manifestations of pain (6)
o Pallor
o Diaphoresis
o Dilated pupils in acute pain
o Constricted pupils in deep or prolonged pain
o Rapid speech in acute pain
o Slow speech in deep or prolonged pain
- Immune clinical manifestations of pain (2)
o Impaired immune function
o infection
- Cues or behaviors in response to pain
o grimaces
o clenched teeth
o rubbing or guarding of the painful area
o agitation
o restlessness
o withdrawal from painful stimuli
- Vocalizations of pain
o Crying
o Moaning
o Screaming
- Behaviors of a patient in labor in response to pain
o Effleurage (rhythmic massaging of the abdomen with her hands
o Immobilization to help deal with uterine contraction pain.
- Complementary and alternative pain therapies
- recommended for patients with mild pain who do not want to use medications to control pain
o Herbal remedies
o Yoga
o Biofeedback
o Mediation
o Aromatherapy
o Hypnosis
o Reiki and therapeutic touch
o Traditional Chinese medicine
Acupuncture
Acupressure
Cupping
NSAID and non opioid analgesics
- Non-opioid: include acetaminophen NSAIDS (Motrin and aspirin). Used to treat mild pain. Non addictive and safer.
o Acetaminophen: long term use may result in hepatotoxicity or renal disease. Daily dose of 3000mg should not be exceeded. An OD can be fatal
o NSAIDS: have significant side effects (GI upset and bleeding, cardiac and renal complications). Can avoid symptoms by taking meds with food.
- Patient-controlled analgesia (PCA)
system in which an infusion pump immediately delivers medication to the patient when they push a button without the need for the nurse.
o Used more frequently but in smaller doses.
o Delivered:
IV
SubQ
Epidurally
o LEGALLY only the patient can push the button to give themselves the pain injection
- On-Q pump
continuous infusion of local anesthesia through an antimicrobial catheter
o Used for post op pain after abdominal surgery
- Transdermal patch:
consists of a medicated adhesive patch that is placed on the skin to deliver a specific dose of medication through the skin allowing for absorption into the blood stream
- Intrathecal injection
: into the subarachnoid spaice through a needle or a catheter to provide relief of pain to a large area of the body
o Spinal anesthesia for surgery
- Epidural anesthesia
continuous infusion of a narcotic or local anesthetic into the epidural space by a needle (used for labor pain, surgery, cancer pain)
- Nerve block
injection of local anesthetic into or near spinal nerves for temporary pain control
o Used for migraines
o Headaches
o Dental work
o Back pain
o Herniated disks
o Cancer pain
- Physical dependence
builds as the body becomes unable to function normally without the medication, reaching the point of withdrawal symptoms on abrupt cessation of the medication.
- Drug tolerance
an adaptation to medication which eventually leads to be less effective
o Better to change to a new medication instead of increasing dose.
- Addiction
psychological or emotional dependence on a prescribed medication or illicit drug. You crave the drug and engage in compulsive use or abuse regardless of consequences
- Opioid analgesics
the most effective agents for relief of moderate to severe pain.
Agonist analgesics
Agonist antagonist analgesics
Antagonist analgesics
o Agonist analgesics:
: they change the patients perception of pain while relieving the pain; most effective agents for relief of severe pain rated 7-10 on a NRS;
Drugs:
* Morphine
* Hydromorphone
* Oxycodone
* Fentanyl
* Meperidine
Routes:
* Oral
* Transdermal
* IM may be given q1-3
* IV may be given q1-3
Adverse effects:
* Respiratory depression
* Seizures
* Nausea
* Vomiting
* Constipation
* Itching
* Urinary retention
* Dizziness
* Blurred vision
* Confusion
* Orthostatic hypotension
o Agonist-antagonist analgesics
they depress the pain-impulse transmission at the spinal cord by acting with opioid receptors; used for moderate to severe pain
Drugs
* Pentazocine
* Butorphanol
* Dezocine
* Nalbuphine
Routes:
* IM; q1-4 depending on drug
* IV; q1-4 depending on drug
Adverse effects:
* Drowsiness
* Dizziness
* Nausea
* Vomiting
* Itching
* Respiratory depression
- Adjuvant or Co-analgesic medications:
: work synergistically with standard pain medications to enhance pain relief and treat side effects of the medication.
o Examples:
Antidepressants and anticonvulsants may be used together to treat neuropathic pain
Antiemetics given with opioids to counteract N/V
Laxatives given with opioids to help reduce constipation
* senna or docusate
antihistamines to decrease the itching side effect of opioids
Ketorolac (Toradol) and NSAID) given with opioids to enhance pain relief
Caffeine used with analgesics to treat migraines.
o Antagonist analgesics
used for treatment of opioid analgesic overdose; competes with the opioid receptor sites, decreasing the side effects of opioids.
Drugs:
* Naloxone
Routes: give q2-3min until symptoms of opioid overdose subside
* IV
* IM
* Sub Q
* Endotracheal tube
Withdrawal symptoms
* May occur up to 2 hours after administration
o Vomiting
o Hypertension
o anxiety
- Multimodal:
: provides holistic pain management by including nonpharmacological interventions, nonopioid analgesics, opioid analgesics and coanalgesics (meds that were not primarily for pain relief but work in conjunction with opioids to optimize outocme
