Week 1: Comfort-Pain Flashcards
Explain acute pain.
It is pain that lasts through the recovery period of up to 6 months.
What 4 things are involved in the pain process?
- Transduction
- Transmission
- Perception
- Pain Modulation
Pain Process
Which 4 substances are involved in the transduction phase? Explain each of them.
- Bradykinins: powerful vasodilator that increases permeability, constricts smooth muscle, and triggers histamine release.
- Prostaglandins : send additional pain stimuli to the CNS.
- Substance P: neuropeptide that makes nerves feel pain and increases rate at which nerves fire.
- Serotonin: a hormone that can act to stimulate smooth muscles, stop gastric secretion, and produce vasconstriction.
Pain Process
Which two fibers are involved in the transmission phase?
- Afferent Fibers: carries impulses from the pain receptors toward the brain.
- Efferent Fibers: carries information away from the CNS to the body.
Pain Process
Describe the perception of pain and the pain threshold.
- Perception: sensory process that occurs when a stimulus for pain is present.
2.Pain Threshold: minimum intensity of a stimulus that is seen as painful.
Pain Process
Describe the 3 things involved in Pain Modulation.
- Endogenous Opioid Compounds: are neuromodulators, naturally present, morphine-like regulators in the spinal cord and brain.
- Endorphins: produced at neural synapses, powerful pain-blocking chemicals that produce euphoria.
- Enkephalins: neurotransmitter, produces even more powerful effect than endorphins.
Explain the Gate Control Theory in simple terms.
- Stimulation of small diameter fibers sense pain and cause the gates to open up.
- Stimulation of large diameter fibers such as heat, cold, mechanical, and pressure causes the gates to close.
- Amount of activation in the small fibers versus the large fibers controls the overall perception of pain.
Gate Control Theory is the basis for cold therapy, massage, distraction, and TENS therapies.
Which system is pain triggered by?
Parasympathetic Nervous System
What are nociceptors?
They send signals along sensory neurons to the spinal cord and then to the brain for translation.
The brain will send the signal back down motor neurons to the site of pain causing the body to respond to pain.
What are the 6 categories of pain stimuli? Give examples in each category.
- Biological: bacteria, viruses (flu, pneumonia)
- Chemical: smoke, cleaning solution (smoke inhalation from fires- fireman)
- Electrical: electrical burns (finger in the socket- children are at risk)
- Thermal: heat, cold (frostbite)
- Mechanical: fractures, shearing forces, bending (trauma, surgery)
- Cellular: hypoxia is the most common cause (MI, sickle-cell disease)
Describe Nociceptive Pain
Pain is from uninjured, fully functional nervous system, this is normal pain.
Describe Neuropathic Pain
Pain from nerve malfunction or injuries from trauma, disease, chemicals, and infections. This is abnormal.
Describe Acute Pain
- Sudden onset
- Results from an identifiable source
- Duration is short-lived only until injury is healed
Describe Chronic Pain
Pain that is maladaptive lasting more than 3 months.
Describe Intractable Pain
Pain that is resistant to therapy
Describe Phantom Pain
Results from pain after an amputation that feels as though the limb is still there and hurts.
Describe Cutaneous Pain
- Superficial
- Involves skin or subcutaneous tissues
Describe Somatic Pain
- Deeper
- Tendons, ligaments, joints, bones, blood vessels, nerves
Describe Visceral Pain
- Body organs and cavities in the chest, abdomen, and pelvic areas.
- Most often caused by disease, pain is diffuse.
Describe Referred Pain
Pain that is felt at a location other than the site of the painful stimulus or origin of pain.
Describe Breakthrough Pain
An exacerbation of pain that happens suddenly, or in relation to a predictable or unpredictable trigger, despite the pain being pretty stable and controlled.
What are the 3 types of breakthrough pain? Give an explanation for each.
- Incident Pain: short-term, predictable pain that happens with movement such as coughing or changing a dressing.
- Idiopathic Pain: unknown cause, lasts longer, difficult to treat.
- End-of-dose medication failure: pain at the end of 1 med dose before the next scheduled dose.
How can we prevent End-of-Dose Medication Failures?
Increase medication dose or shorten the time between doses.
What are 7 Pain Risk Factors?
- Age
- Gender
- Obesity
- Sedentary Lifestyle
- Level of stress/anxiety
- High-risk activities - smoking, sports
- Cultural beliefs of pain
What are 6 pain risk factors/barriers from the client’s perspective?
- Reluctance to report pain r/t: indication of the progression of the disease, fear of taking the focus off the disease, the belief that pain is inevitable so nothing can be done about it.
- cultural expectations that one should not report pain.
- fear of becoming an addict
- worries about medication side effects
- financial barriers
- a belief that minorities do not get treated for pain fairly when reported.
What are 6 pain risk factors/barriers from the HCP perspective?
- Regulatory issues r/t opioids
- Delay in administration until there is a diagnosis
- Not enough knowledge about pain management
- Poor pain assessment
- Fear of adverse effects
- Fear of tolerance/addiction
What are 5 ways pain may be prevented?
- Provide adequate pain relief through medications and nonpharmacologic therapies.
- Take pain meds as prescribed.
- Pain meds are more effective when taken regularly instead of when pain happens.
- Take safety precautions from risk factors.
- Change modifiable risk factors.
What are 7 somatic pain manifestations?
- sharp
- swelling
- cramping, aching, gnawing
- can see bleeding
- localized to specific area
What are 7 visceral pain manifestations?
- dull
- deep
- squeezing, pressure, aching
- can be vague and difficult to localize
Pain Manifestations
What will happen to vital signs if someone is in pain?
- Increased HR
- Increased BP
- Increased RR
- Diaphoresis
- Pallor and Dilated pupils
Pain Manifestations
What are some observable pain manifestations? Things that you can see.
- crying
- grimacing
- guarding site of injury
- compensatory posturing and slow movements
Uncontrolled pain will lead to these 4 things.
- changes in appetite and sleep
- decreased circulation and oxygen levels
- increased risk of thrombosis
- decreased quality of life
What is the 3 step approach in pharmacologic management of pain?
Client begins with a non-opioid drug. They climb the ladder if pain is still present. Step 2 involves a weak opioid and Step 3 involves a strong opioid.
What is the range from mild pain, to moderate pain, versus severe pain?
- Mild Pain: 1-3
- Moderate Pain: 4-6
- Severe Pain: 7-10
What are 6 opiate side effects?
- Constipation
- N/V
- Sedation
- Pruritus
- Sexual dysfunction
- Respiratory Dysfunction
What are the 6 side effects of the opioid antagonist, Narcan?
- HA
- Anxiety
- Joint Pain
- Vomiting
- Nervousness
- Possible hepatic damage
What are 7 complications of untreated pain?
- Chronic pain
- Depression
- Sleep disturbances
- Obesity
- Accelerated disease progression
- Changes in nervous system response to pain
- Decreased patient outcomes
- Anxiety
What is fibromyalgia?
It is chronic diffuse musculoskeletal pain. The exact pathophysiology is unknown.
What are the theories about fibromyalgia?
- Decreased blood flow
- Endocrine dysfunction
- Excess excitatory neurotransmitters
What are the risk factors and incidence of Fibromyalgia?
Risk Factors:
- Female
- Family history
- History of Rheumatic Disease
- Variable age of onset
Incidence: affects 2-3% of the population
What are 7 manifestations of fibromyalgia?
- Persistent diffuse pain
- Sleep disturbance
- Generalized fatigue
- Anxiety, Depression
- Cognitive difficulties
- Paresthesias
- HA
What will the physical findings/diagnostics be for Fibromyalgia?
- Tender points (11 out of 18 needed to confirm that it is fibromyalgia).
- Evaluation of Widespread Pain Index and Symptom Severity Score
- Presence of Symptoms greater than 3 months
- Ruling out other disorders
What are 4 nonpharmacologic treatments for Fibromyalgia?
- Massage
- Sleep Hygiene
- Heat
- Acupuncture
When educating someone with fibromyalgia, what should their diet look like?
- Avoid caffeine and alcohol
- High Fiber and Seafood Diet
What types of activity should a patient with fibromyalgia participate in?
- Low-impact
- Resistance training
What are 4 pharmacologic treatments for Fibromyalgia?
- Tricyclic Antidepressants
- Lidocaine
- Pregabalin or Gabapentin
- NSAIDs
