WEEK 3 - assessment and management of post-procedural pain Flashcards
What is nociceptive pain?
What is neuropathic pain?
nociceptive: from a stimulus in body
neuropathic: not from a stimulus in body
What is the pathophysiology of pain? (nociceptive)
- Transduction: stimulation of peripheral tissue pain receptors (heat, chemical, pressure stimulate)
- Transmission: nociceptive message from PNS to CNS
- Modulation: the process in which the body alters a pain signal as it is transmitted along the pain pathway.
The up or down regulation of pain signals throughout the spinal cord.
- Perception: pain awareness associated with a specific area of the body, depends on the transmission - influenced by social
What is the difference between acute and chronic pain?
ACUTE
- Up to 3 months
- Short term vitals altered
- Usually a response to infection/illness
- Peripheral receptors are triggered - causes unpleasant sensation
CHRONIC
- 3-6 months +
- Intermittent or consistant
- Gradual onset becomes continuous, progressively severe
- Vitals may preset differently long term
- Continues even after injuries heal
- Can get progressively worse with age
Explain the concept of acute on chronic pain.
- Acute pain from an injury/infection/illness etc. on top of chronic pain
- More analgesia required on top of existing to combat acute pain as existing only works on chronic pain.
What tools are used for acute pain assessment?
- Everyone has own perception of pain (influenced by past experiences)
- Pain scales (Faces, 10 point, Abbey)
Non-pharmacological pain management strategies.
- Mobilisation/rest
- Heat/cold packs
- Elevation
- Massage
- Acupuncture
- Transcutaneous electrical stimulation
- Physio/exercise
- TENS machine
- Cognitive therapy
+ Meditation
+ Music
+ Guided imagery
+ Distraction/deep breathing
+ Hypnosis
Pharmacological pain management strategies + examples of drug classes/drugs.
- Moving away from opioids - addiction, unwanted side effects
- Multimodal approach:
Different classes targeting different pain pathways to control pain = need for fewer/no opioids - Non-steroidal anti-inflammatory drugs
- Local or regional anaesthetic
- Mild and strong opioids
- Gabapentinoids and antidepressants
\+ Morphine \+ Paracetamol \+ Ibuprofen \+ Methadone \+ Tapentadol \+ Tremadol \+ Codeine (combined with paracetamol)
Regular vs PRN, when and why?
REGULAR
- charted
- consistent management
- readily available
- doctor prescribed
PRN
- prior to an physio/mobilisation/after or before a procedure
- charted or nurse initiated
- when pain escalates
- pain level v overdose
- multimodal approach to analgesia
- importance of prophylactic anti-emetics and aperients?
What is pain?
an unpleasant sensory and emotional experience associated with actual or potential tissue damage
subjective
individualised
Sympathetic symptoms of pain.
- tachycardia
- hypertension
- sweating
- pupil dilation
- pallor
What are the 4 stages of the analgesic ladder?
- non-steroidal & anti-inflammatory drugs
(paracetamol, ibuprofen) - weak opioids
(codeine, tramadol) - strong opioids
(morphine, oxycodone) - interventional therapy such as nerve blocks
What angle does each injection type need to be administered from:
- intramuscular
- subcutaneous
- intravenous
- intradermal
- intramuscular - 90
- subcutaneous - 45
- intravenous - 25
- intradermal - 10-15
What are the 3 layers of the skin?
Epidermis
(cells produce pigment + protect immune system)
Dermis
(nerve endings, oil, sweat glands, hair follicles)
Subcutaneous tissue
(fat, connective tissue, larger blood vessels)
Muscle
What is nociception?
nociception - neural process of nociceptors/pain receptors sending possible threat signals to the brain
3 main types of pain and what they are caused by:
NOCICEPTIVE
in response to a specific stimulus in the body
NEURPATHIC
damage to the nerves or NS
- a burning type of pain/numbness and tingling (diabetes, infection), nerve damage
(Radicular
radiates from your back and hip to your legs through the spine - a TYPE of neuropathic)
NOCIPLASTIC
ongoing inflammation and tissue damage
