PAIN (MED SURG) Flashcards by Angel Rhainne Custodio

involve
complex interactions between the
Peripheral Nervous System (PNS),
Autonomic Nervous System (ANS), and
Central Nervous System (CNS). These
systems work together to detect, transmit,
and process pain signals, ultimately
influencing the body’s response to painful
stimuli.

Pain perception and modulation

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responsible for transmitting pain impulses
between the body and the central nervous
system. It includes spinal and cranial
nerves, which carry signals to and from the
Central Nervous System (CNS) to regulate
pain perception and response.

Peripheral Nervous System (PNS)

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Carry Impulses to the
CNS)

Afferent Nerve Fibers (Sensory
Pathways

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Carry sensory
impulses from the skin,
skeletal muscles, joints, and
tendons to the CNS.

Somatic Afferent Fibers
(SAF)

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Carry sensory
impulses from the thoracic
and abdominal viscera,
including aortic receptors, to
the brain. Visceral pain is
often dull, diffuse, and
poorly localized

Visceral Afferent Fibers
(VAF)

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Carry Impulses from
the CNS)

Efferent Nerve Fibers (Motor
Pathways

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Responsible for
responding to CNS afferent
impulses that innervate
voluntary body activities,
such as reflex actions in
skeletal muscles, tendons,
and joints.

Somatic Efferent Fibers
(SEF)

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Responsible for
responding to CNS afferent
impulses that regulate
involuntary body activities,
such as smooth muscle
contractions, cardiac muscle
function, and glandular
secretions.

Visceral Efferent Fibers
(VEF)

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specialized nerve endings
found in nearly every tissue of the
body, except the brain.

Nociceptors (Pain Receptors)

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Myelinated,
fast-conducting fibers that
transmit sharp, acute pain
signals.

A-delta fibers

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Unmyelinated,
slow-conducting fibers that
transmit dull, burning, or
aching pain.

C fibers

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regulates involuntary vital functions and
plays a crucial role in how the body reacts
to pain and stress.

Autonomic Nervous System (ANS)

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Two major divisions of ANS

Parasympathetic and SYMPATHETIC nervous system

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“Fight, Flight, or Freeze” Response

Sympathetic Nervous System (SNS)

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Activated in response to acute pain
and stress.
Increases heart rate, blood
pressure, and respiratory rate to
prepare the body for action.

Sympathetic Nervous System (SNS)

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Controls adrenal medullae

Sympathetic Nervous System (SNS)

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releases epinephrine and
norepinephrine.

Adrenal medullae

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–
“Rest and Digest” Response
●
Activated during prolonged stress
or exhaustion from pain.
●
Reduces heart rate, blood pressure,
and respiration to promote recovery
and energy conservation.
●
Controls digestion, elimination, and
other organ functions.

Parasympathetic Nervous System (PNS)

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chemical
messengers that mediate pain signals
within the nervous system.

neurotransmitters

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Involved in
muscle activation and autonomic
functions

Acetylcholine (ACh)

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Adrenergic System

Epinephrine (Adrenaline)

Norepinephrine

Dopamine

Serotonin

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Heightens alertness and pain
perception

Epinephrine (Adrenaline)

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Modulates pain
sensitivity and vasoconstriction.

Norepinephrine

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Influences pain relief,
pleasure, and emotional responses.

Dopamine

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Regulates pain inhibition, mood, and sleep cycles.

Serotonin

Central Nervous System (CNS) two main divisions

Brain and spinal cord

plays a major role in pain processing and perception, integrating signals from the PNS and regulating appropriate responses

Central Nervous System (CNS)

The Pain Transmission Center

Spinal Cord

serves as a key site for pain signal modulation.

dorsal horn of the spinal cord

The Pain Processing and Interpretation Center

Brain

The Control Center for Pain Modulation

Midbrain

Regulates pain sensitivity, alertness, and fatigue

Reticular Formation

Controls heart rate, breathing, and blood pressure responses to pain

Medulla

Governs body temperature, mood, hunger, and autonomic pain responses.

Hypothalamus

The Sensory Relay Station

Thalamus

The Emotional Response Center

Limbic system

The Tactile Interpretation Center. Interprets location, intensity, and quality of pain stimuli

d. Sensory Cortex

The Response Center. Initiates motor responses to painful stimuli, such as withdrawing from danger.

Motor Cortex

The Cognitive Processing Center. Plays a role in attention, memory, cognition, emotion, and decision-making related to pain perception.

Frontal Lobes

complex, multidimensional experience that involves sensory, emotional, cognitive, and physiological components. It serves as a protective mechanism, alerting the body to potential or actual tissue damage.

Pain

6 TYPES OF PAIN

ACNNRP

Short-term pain that signals immediate injury or damage

Acute Pain

Persistent pain lasting beyond normal healing time, often associated with underlying conditions

Chronic Pain

Pain caused by nerve damage or dysfunction, characterized by burning, tingling, or electric shock-like sensations.

Neuropathic Pain

Pain resulting from direct tissue injury or inflammation

Nociceptive Pain

Pain Arises from skin, muscles, bones, or joints; typically localized and sharp.

Somatic Pain

Pain that Originates from internal organs; often diffuse, dull, and accompanied by autonomic responses (e.g., nausea, sweating)

Visceral Pain

Pain felt in a location different from the source due to shared neural pathways.

Referred Pain

Sensations perceived in an amputated limb due to neural pathway reorganization.

Phantom pain

refers to the body's ability to regulate and modify pain perception through different pathways

PAIN MODULATION MECHANISMS

Pain signals can be inhibited at the spinal cord level by non-painful stimuli (e.g., rubbing an injured area reduces pain perception).

Gate Control Theory

The brain and spinal cord release endogenous opioids (endorphins, enkephalins, dynorphins) that bind to opioid receptors, reducing pain perception.

Endogenous Opioid System

The brainstem sends inhibitory signals to the spinal cord to suppress pain signals

Descending Pain Inhibition Pathway

NEUROTRANSMITTERS IN PAIN MODULATION

Inhibitory Neurotransmitters Excitatory Neurotransmitters

Inhibitory Neurotransmitters (4)

Endorphins and Enkephalins Serotonin (5-HT) Gamma-Aminobutyric Acid (GABA) Norepinephrine (NE)

Excitatory Neurotransmitters (2)

Substance P Glutamate

as natural pain relievers by binding to opioid receptors.

Endo and enke

Modulates pain perception and mood.

Serotonin (5-HT)

Inhibits pain transmission in the spinal cord.

Gamma-Aminobutyric Acid (GABA

Enhances pain inhibition in descending pathways

Norepinephrine (NE

Facilitates pain transmission in the spinal cord

Substance P

Increases pain sensitivity by enhancing nociceptor activation.

Glutamate

PAIN MANAGEMENT STRATEGIES

1. Pharmacologic Interventions ○ Analgesics (NSAIDs, opioids, adjuvant medications). ○ Local anesthetics and nerve blocks. 2. Non-Pharmacologic Interventions ○ Physical therapy (heat/cold therapy, TENS, massage). ○ Cognitive-behavioral therapy (relaxation techniques, guided imagery). ○ Patient education on pain management techniques.

NATURE OF PAIN

Subjective and highly individualized. Its stimulus is physical and/or mental in nature. It interferes with personal relationships and influences the meaning of life. Only the patient knows whether pain is present and how the experience feels. May not be directly proportional to the amount of tissue injury.

SIGNS AND SYMPTOMS OF PAIN

Increased respiratory rate Increased heart rate Peripheral vasoconstriction Palor Elevated blood pressure Increased blood glucose levels Diaphoresis Dilated pupils Moaning Guarding the area Restlessness Irritability

TYPES OF PAIN (BASED ON DURATION)

Acute Pain Chronic Pain

pain lasts only through the expected recovery period

Acute Pain

protective, has an identifiable cause, is of short duration, and has limited tissue damage and emotional response.

Acute pain

eventually resolves, with or without treatment, after an injured area heals. Complete pain relief is not always achievable but reducing pain to a tolerable level is realistic.

Acute Pain

the pain that lasts longer than 6 months and is constant or recurring with a mild-to-severe intensity.

Chronic pain

It does not always have an identifiable cause and leads to great personal suffering. Examples: arthritic pain, headache, peripheral neuropathy

Chronic pain

Types of chronic pain (3)

Hronic noncancer Chronic cancer Chronic episodic

the chronic pain that resulted due to non cancer disease conditions.

Chronic Noncancer Pain

Pain that is caused by tumor progression and related pathological processes, invasive procedures, toxicities of treatment, infection, and physical limitations. Approximately 70 % to 90 % of patients with advanced cancer experience pain.

Chronic Cancer Pain

Pain that occurs sporadically over an extended period of time is episodic pain, Pain episodes last for hours, days, or weeks. Examples are migraine headaches.

Chronic Episodic Pain

BASED ON LOCATION

based on the site at which the pain is located. ● Headache ● Back pain ● Joint pain ● Stomach pain ● Cardiac pain

pain due to problems in other areas manifest in different body part. For example, cardiac pain may be felt in the shoulder or left arm, with or without chest pain.

Referred Pain -

BASED ON INTENSITY

Mild Pain Moderate Pain Severe Pain -

pain scale reading from 1-3

Mild

pain scale reading from 4-6

Mod pain

pain scale reading from 7-10

Severe Pain

BASED ON ETIOLOGY

Nociceptive Pain Neuropathic Pain

experienced when an intact, properly functioning nervous system sends signals that tissues are damaged, requiring attention and proper care

Nociceptive Pain

this is the pain that is originating from the skin, muscles, bone, or connective tissue.

Somatic Pain

pain that results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera (organs). Characterized by cramping, throbbing, pressing, or aching qualities.

Visceral Pain

associated with damaged or malfunctioning nerves due to illness, injury, or undetermined reasons. Examples include, Diabetic peripheral neuropathy, phantom limb pain, spinal cord injury pain. It is usually chronic. Described as burning, “electric-shock, and/or tingling, dull, and aching. Tends to be difficult to treat.

Neuropathic Pain

FACTORS INFLUENCING PAIN

Developmental factors Physiological factors Social factors Psychological factors Cultural factors

NURSING MANAGEMENT OF PAIN

PQRST

PAIN ASSESSMENT

Facial expressions Vocalizations Body movements

PAIN ASSESSMENT TOOLS (3)

Verbal Rating Scale 2Numeric Rating Scale 3. Wong Baker’s Faces Pain Scale

drugs originally developed to treat conditions other the pain but also have analgesic properties.

Adjuvants

medications that relieve pain. Derived from opium

Opioids

NSAIDS

non steroidal anti inflammatory drugs

WORLD HEALTH ORGANIZATION PAIN LADDER

Step 1 - NSAIDS + Adjuvants Step 2 - NSAIDS + Mild opioids + Adjuvants Step 3 - Strong opioids + NSAIDS + Adjuvants

Weak opioid

Codeine Tramadol

Strong opioid (1st line)

Morphine Hydromorphone Oxycodone

Strong opioid (2nd)

Fentanyl

Strong opioids (3rd)

Methadone

used for analgesic reasons and for sedation and reducing anxiety. Tricyclic antidepressants - Amitriptyline Anti epileptics - Phenytoin Corticosteroids - Prednisone

Adjuvants

safe method for pain management that many patients prefer.

patient-controlled analgesia (PCA

a drug delivery system that allows patients to self-administer opioids (morphine and fentanyl) with minimal risk of overdose.

patient-controlled analgesia (PCA

portable and computerized and contain a chamber for a syringe or bag that delivers a small preset dose of opioid

PCA infusion pumps

applied over the patient's skin either in the form of topical ointments or transdermal patches. The patches will be sticking to the skin and deliver a small amount of dosage continuously.

TOPICAL ANALGESICS

local infiltration of an anesthetic medication to induce loss of sensation to a body part. Use during brief surgical procedures such as removal of a skin lesion or suturing a wound The drugs produce temporary loss of sensation by inhibiting nerve conduction.

LOCAL ANESTHESIA

Regional anesthesia is the injection of local anesthetic to block a group of sensory nerve fibers. epidural anesthesia and spinal anesthesia.

REGIONAL ANESTHESIA

NON-PHARMACOLOGICAL INTERVENTIONS

Heat and cold applications 2. Meditation 3. Distraction 4. Imagery 5. Music therapy 6. Massage 7. Yoga 8. Acupuncture 9. Herbal therapy - garlic, echinacea, ginseng.