Week 4 pain Flashcards
What are the 4 aspects of total pain?
- Emotional pain
- Physical Pain
- Social Pain
- Spiritual Pain
How these all interact with each other. Very individual and sometimes one can be way higher than another domain
What is suffering?
When someone experiences pain in all the domains of “total pain”
How do we provide “culturally comfortable” care ?
-Recognize the client as a unique individual
-Explore the client’s lived experience of pain
-Promote shared decision making
What are options If the patient cannot self-report?
- Observe behavior
- Talk with proxy, family member
- Think about: underlying diagnosis, impact of the illness
- Vitals- not really reliable for pain
- Trial treatment - does it seem to help?
What are the 4 common side effects of Opioids?
Constipation!
Nausea
Sedation
Xerostomia
What are the 2 less common side effects of Opioids?
Pruritus
Urinary retention
What are the 2 rare side effects Opioids?
Respiratory depression
Opioid- induced neurotoxicity
What can cause respiratory depression with Opioids?
- giving too much to someone opioid naive
- Someone chews their long acting meds accidentally
- too many opioids at once
Metabolites are the result of the breakdown of opioids. When too many build up, what happens?
Opioid - induced neurotoxicity (OIN)
What intervention makes OIN worse?
Adding more opioids cuz we’re just adding more metabolites in the body
What is the management of OIN?
Hydration - careful about fluid overload conditions - go slower
Decrease opioid dose
Opioid rotation more common
Calm reassurance - b/c person is confused
Educate the family
What are 6 risk factors for OIN?
Frail/elderly
Impaired renal function
Impaired Kidney function
Rapid dose increase of opioids
Using the same opioid for a long time
Dehydration
What are the clinical manefestations of OIN?
- Delirium/confusion - tends to be subtle
- myoclonus - can lead to seizure
- Hyperalgesia - heightened response to pain
- Allodynia - not typically painful but is for the person (like a blanket on their legs is painful)
- hallucinations
What differentiates total pain with OIN?
The clinical manifestations . If not there, it’s likely Total pain so assess the domains of total pain.
What main thing makes us stop and wonder if someone has OIN even before main clinical manifestations?
If we give opioids and the pain isn’t getting better
What is Tolerance when on opioids ?
Normal and expected
We need more drug to get the same effect
What is physical dependance?
The way our body responds physiologically to the opioids in our system. If they are suddenly withdrawn we get withdrawal symptoms : chills, N&V, insomnia
What is Addiction?
Pscyhological dependends
people want to feel eurphoric
results in negative social and personal consequences. People will do anything to get the opioid and compromise other aspects of their life - that is where the problem is.
when used properly, addiction is rarely an issue for people
How do we help with Emotional Pain?
Active listening
Being present
Relaxation interventions
Pharmacological management when appropriate
Mindfulness meditation/breathing
Use of humor (where appropriate)
Art therapy
Music therapy
Journaling
How do we help with social pain?
Encourage meaningful social connection
Include families in discussions
Reduce social isolation with the use of technology
Therapeutic touch
Pet therapy
Support for family caregiver
Encourage communication to heal damaged relationships
How do we help with spiritual pain?
A caring presence – from us and others
Facilitate connection to outdoors/nature
Give space for personal, spiritual and religious beliefs/rituals
Spiritual/pastoral care
What is a quick definition of emotional pain?
a subjective experience with negative thoughts and feelings because there are negative changes in the person’s self and their function
What is a quick definition of Physical pain?
it’s a sensory response to actual or potential tissue damage that is unpleasant
what is a quick definition of social pain?
a subjective experience where person feels lack of social connection whether that be real or perceived.
What is a quick definition of spiritual pain?
A threat of some kind - usually existential (purpose, meaning in life, relationships, higher power etc) . Closely tied to social pain
What is the preferred route for physical pain management?
always PO (by mouth)
What medication drug class is amitriptyline and what is one common side effect?
Antidepressant
Urinary retention
What is the main side effect of morphine?
constipation
What drug class is gabapentin and what is one main side effect?
Anticonvulsant
Dizziness
What drug class is Ketamine and what is one common side effect?
NMDA antagonist
confusion
What type of pain is Ketamine indicated in?
breakthrough pain
What meds are used for Somatic pain?
NSAIDS
Opioids
Steroids
What meds are used for Visceral pain?
NSAIDS
Opiods
steroids
What meds are used for neuropathic pain?
Antidepressants
Anticonvulsants
Steroids
Local anethetics
Ketamine
Do opioids work for neuropathic pain?
Only partially
What is Acute pain ?
- well defined pattern and onset
- can be indentified usually
- activation of ANS (vitals)
- precipitating cause
- time limited
analgesics and treat the cause
What is subacute pain?
- comes on over several days
- increases intensity
we can titrate appropriately
What is episodic pain?
- occurs during defined periods of time & regular basis (called intermittent pain also)
usually movement/dressing changes
use analgesics prior to pain-provoking event
What is chronic pain?
- persists more than 3 months
- ANS adapts - no signs in vitals
fatigue, depression, withdrawl, insomnia - all bad. want to die
What is breakthrough pain?
Transient increase in pain to more than moderate intensity - based on their baseline
usually happens near end of dosing interval for reg. sched. meds
What is incident pain?
Pain due to nurse or patient actions
changing/dressings
What diseases are Acetaminophen (non-opioid) good for?
Renal disease
Stroke
CHF
Liver disease (low dose)
What diseases are NSAIDS good for?
Stroke
ALS
Renal disease (time-limited use)
What diseases is codeine good for (weak opioid) ?
HIV/AIDS (co-analgesics)
ALS
Moderate to severe pain W/Tylenol & Caffeine (T3)
Somatic pain
What diseases is morphine good for?
Liver disease
HIV/AIDS
Somatic pain
Neuropathic (some)
What diseases is hydromorphone good for?
CHF
HIV/AIDS
Liver disease
ESRD
Somatic pain
Neuropathic (some)
What diseases does fentanyl help with?
HIV/AIDS
CHF
Liver disease
ESRD
Somatic pain
Neuropathic (some)
What are the 4 adjuvant analgesics ?
- Tri-cyclic antidepressants
- anticonvulsants
- NMDA (excitatory receptor) antagonists
- Corticosteroids
What is an example of a non-pharmacological intervention related to rehabilitative?
Physiotherapy
What is an example of a non-pharmacological intervention related to Psychological?
Psychoeducational and CBT
What is an example of a non-pharmacological intervention related to Integrative?
Massage
For opioid side effects what is the managment of constipation?
- laxative
- disimpaction
For opioid side effects what is the managment of sedation?
Keep patient safe from falls
For opioid side effects what is the managment of confusion/delirium?
Keep patient safe
ensure delirium isn’t from another cause
For opioid side effects what is the managment of N & V?
antiemetics
For opioid side effects what is the managment of multifocal myoclonus?
seizure meds
For opioid side effects what is the managment of Opioid-induced hyperalgesia?
Rest
For opioid side effects what is the management of urinary retention?
Monitor I &O
encourage fluids
For opioid side effects what is the management of pruritus?
benadryl
cold compress
slapping method
treat scabs
For opioid side effects what is the management of Respiratory depression?
Watch RR and O2 sats
give naloxone if serious to reverse opioid effect
