Pain Management (Intro) Flashcards
Definition of pain
An unpleasant, sensory, & emotional experience associated with actual or potential tissue damage
Pain experience is influenced by what 4 factors?
- cultural factors
- physical factors
- psychosocial factors
- environmental factors
Is pain the same in every person?
No - pain is unique & individual for each person
Pain is often the first sign of the _____ _____
disease process
What kind of pain is time limited?
Acute pain
Is the cause of pain usually known or unknown in acute pain?
cause is usually known
Does acute pain diminish over time or persist?
diminishes over time
What are 3 observable signs of acute pain?
- increased BP and/or HR
- agitation
- guarding
How long does chronic (non-malignant) pain persist for?
persistent (> 6 months)
What kind of pain is purposeless?
Chronic (non-malignant) pain
Chronic (non-malignant) pain may lead to ______
depression
What type of pain can increase with stress response?
Chronic (non-malignant) pain
Chronic (non-malignant) pain often interferes with _____
sleep
What type of adaptation is chronic (non-malignant) pain?
Autonomic adaptation
Neuropathic pain is _____
non-nociceptive path; pathologic pain
neuropathic pain results from injury to or dysfunction of the _____ ______ ______ or _______
peripheral nervous system; CNS
Neuropathic pain has _______ neuronal receptor & ______ activity
abnormal neuronal receptor & metabolic activity
How is neuropathic pain usually described?
burning
shooting
shock-like
numb
List some causes of neuropathic pain
diabetes
alcoholism
shingles
HIV
Psychogenic pain is caused by what 3 stimuli?
emotional
psychological
behavioral
What is nociception (pain process)?
the normal function of the physiologic systems that lead to the perception of noxious stimuli as being painful (4 step process)
List the four steps in nociception (pain process)
- transduction
- transmission
- perception
- modulation
Nociception (pain process) is ongoing activation of nociceptors capable of _______ ______ in response to _____ ______
sensing pain; noxious stimuli
What are nociceptors?
free nerve endings in the afferent peripheral nervous system
What are some mechanical noxious stimuli?
Incisions
Tumor mass
What are some thermal noxious stimuli?
Burn
Frostbite
What are chemical noxious stimuli?
Toxin
Chemotherapy
Transduction definition
the conversion of a mechanical, thermal, or chemical stimulus to a neuronal action potential
Where/ why does transduction start and what is activated?
starts in periphery in response to noxious stimuli; where primary nociceptive fibers (afferent) are activated
Transduction causes the release of what 5 things?
serotonin
bradykinin
histamine
substance P
prostaglandins
What three places can opioid receptors be found in?
CNS
peripheral nerves
GI tract
What are the 2 naturally occurring morphine-like substances?
endorphins
enkephalins
Endorphins & Enkephalins act like…
neurotransmitters that block pain
Enkephalin affects what two receptors?
Mu & delta
What type of receptor do endorphins affect?
only mu receptors
What is the second step of nociception?
Transmission
What happens in transmission?
stimuli move from peripheral nervous system, to spinal cord through the dorsal root ganglion, into the ascending tract to the brain
What are the two types on nociceptive fibers?
A - delta (δ) fibers
C-fibers
What fibers are thinly myelinated, large in diameter, & fast-conducting fibers?
A - delta (δ) fibers
What kind of pain do A - delta (δ) fibers transmit?
sharp, localized (somatosensory) pain that is sensitive to mechanical & thermal stimuli
What fibers are unmyelinated, small in diameter, & slow-conducting fibers?
C-fibers
What kind of pain do C-fibers transmit?
dull, aching (visceral) pain that is diffuse
What is the third step of nociception?
Perception
Define perception
point at which person is aware of pain; threshold is reached (end result)
Perception includes activation of higher brain structures such as…
thalamus
limbic system
Is pain perception the same in every person?
No - it varies from person to person
What is the 4th step/ phase of pain impulse?
modulation
What occurs during modulation?
the brain interacts with the spinal nerves to alter the pain experience;
involves increasing (excitatory) or decreasing (inhibition) transmission of pain impulses in the spinal cord
What are the pain-inhibiting neurochemicals released during modulation?
substance P
Glutamate
GABA
Norepinephrine & serotonin
What are the two types of nociceptive pain?
somatic
visceral
Somatic pain is _____ localized while visceral pain is _____ localized
somatic = well localized
visceral = poorly localized
What nociceptive pain is sharp, aching, throbbing, gnawing?
somatic
What nociceptive pain is deep, aching, cramping, pressure, referred?
Visceral
Somatic pain is the activation of nociceptors resulting from ______, ______, & ______ _____
cutaneous, musculoskeletal, & deep tissue
Visceral pain is the activation of nociceptors resulting from _______, _______, or _______
stretching, distention, or inflammation
List some examples of somatic pain
bone pain
soft tissue injury
incisional
List some examples of visceral pain
bowel obstruction
biliary colic
What kind of pain is among the most common chronic conditions
Chronic pain
What types of pain/ why are older adults more prevalent to pain?
joint pain
activity limitations
poorer health
List the common causes of pain in older adults (11)
- osteoarthritis/ degenerative joint disease
- rheumatoid arthritis
- fractures
- osteoporosis
- post herpetic neuralgia
- spinal stenosis
- cervical & lumbar spondylosis
- diabetic neuropathy
- PVD
- temporal arteritis
- trigeminal neuralgia
What is some barriers to pain control in older adults?
- fear of addiction
- impaired cognition/ dementia
- financial
- thinking pain is a normal part of the aging process
- not all adults complain of pain
- younger nurses being afraid to ask in fear of being disrespectful
What are 8 consequences of unrelieved pain?
- impaired mobility
- post-op complications due to immobility
- impaired immune function & healing
- sleep disturbance
- mental health issues
- functional loss
- financial concerns
- increased HC costs
What are examples of post-op complications due to immobility?
DVT
emboli
pneumonia
deconditioning
What are examples of mental health issues related to unrelieved pain?
depression
withdrawal/ social isolation
