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2229 > WEEK 5 Pain Concepts > Flashcards

WEEK 5 Pain Concepts Flashcards

1
Q

Define Pain

A

Sensory and emotional experience associated with actual or potential tissue damage

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2
Q

What is nociceptive pain?

A

Associated with tissues

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3
Q

What are the two types of nociceptive pain?

A

Somatic: Connective tissue
Visceral: Organ tissue

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4
Q

What is neuropathic pain?

A

Means there is something wrong with the nervous system itself. Nerves do not generally heal very well

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5
Q

Identify the nervous systems x3 key areas related to the sensation and perception of pain

A
  1. Afferent pathway: Consist of nociceptors (pain receptors), afferent nerve fibres and the spinal cord network
  2. CNS: Portions involved in the interpretation of pain signals eg. limbic system, reticular formation
  3. Efferent pathways: Composed of the fibres connecting the reticular formation, midbrain and substantia gelatinosa
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6
Q

What are nociceptors?

A

Sensory receptors (nerve endings) activated by noxious stimuli, transmit impulses via C fibres and A delta fibres

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7
Q

Where are nociceptors distributed?

A

Somatic structures e.g. skin, muscles, bones
Visceral structures e.g. liver, GIT

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8
Q

What areas are located with the superficial somatic region?

A

Skin, mucus membranes, subcutaneous tissue

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9
Q

What areas are located with the deep somatic region?

A

Muscles, bones, tendons

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10
Q

Identify the 3 types of nerve fibres

A

A Delta fibres
C fibres
A Beta fibres

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11
Q

Describe A Delta fibres

A

Thinly myelinated, transmit well localised, sharp pain and sensitive to mechanical and thermal stimuli. ACUTE pain

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12
Q

Describe C fibres

A

Unmyelinated, transmit poorly localised, dull, aching pain and sensitive to mechanical, thermal and chemical stimuli. PERSISTENT pain

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13
Q

Describe A beta fibres

A

Highly myelinated, rapid conducting, respond to light touch, transmit non-noxious stimuli. GATE THEORY

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14
Q

Identify the 4 stages of the nocicpetive pain response

A
  1. Transduction
  2. Transmission
  3. Perception
  4. Modulation
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15
Q

Describe Transduction (Nociceptive pain response)

A

Response to tissue injury, release of chemical mediators e.g. Histamine, Prostaglandin, Generation of action potential

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16
Q

Describe Transmission (Nociceptive pain response)

A

Made up of three phases
1. Injury to spinal cord
2. Spinal cord to brainstem and thalamus
3. Thalamus to cortex

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17
Q

Describe Perception (Nociceptive pain response)

A

Conscious experience of pain, reticular activating system, somatosensory system

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18
Q

Describe Modulation (Nociceptive pain response)

A

Signals from brain travelling downwards, release of chemical substances, signals enhanced or inhibited, variability in pain response from gate control theory

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19
Q

Identify the 2 pain pathways

A

Ascending (sensory)
Descending (motor)

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20
Q

Describe the ascending (sensory) pain pathway

A

From nociceptors to brain, neurons with long axons ascend to brain

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21
Q

Describe the descending (motor) pain pathway

A

From the brain to spinal dorsal horn, can be modulated by gate thoeory, actions e.g. rubbing the site

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22
Q

What is the gate control theory?

A

Created by Melzack and Wall 1965, theorised the existence of a “gate” that could faciliate/inhibit transmission of pain signals

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23
Q

What is the pain experience dependent on? (Gate control theory)

A

The amount of info that gets through the gate into the brain and amount of downward signalling from brain

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24
Q

What faciliates opening and closing of the gate (Gate control theory)

A

T cells within the dorsal horn, gate can be closed by activities such as touch e.g. rubbing the injured site

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25
Q

What is an action potential?

A

Generated by voltage gated ion channels embedded in a cells plasma membrane

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26
Q

Identify the 2 main classifications of pain

A

Acute Pain and Persistent Pain

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27
Q

Describe acute pain

A

Sudden onset, mild to severe, duration dependent upon “normal healing”, If pain persists acute pain cycle may occur, Pt exhibits behaviours indicative of pain e.g. crying, rubbing

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28
Q

Describe chronic pain

A

“Chronic”, extends beyond the normal healing time, mild to severe, gradual or sudden, usually resulting from pathological processes, usually no signs of sympathetic over activity e.g. increased HR, pt appears depressed and withdrawn

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29
Q

Identify 3 further classifications of pain

A
  1. Nociceptive pain: Response to nociceptors, normal processing
  2. Neuropathic/Neurogenic: Nerve damage and abnormal processing along nerve pathway
  3. Somatoform (Psychogenic): Physical cause cannot be found
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30
Q

Identify the 5 further classifications of pain

A

Referred pain
Phantom pain
Cancer pain
Intractable pain
Breakthrough pain

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31
Q

Identify the physiological structures where somatic pain may be found (nociceptive pain)

A

Skin, blood, muscle, connective tissue

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32
Q

Identify the mechanism of somatic (nociceptive pain)

A

Activation of nociceptors

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33
Q

Describe the characteristics of of somatic (nociceptive pain)

A

Well localised, constant, achy, may be initially acute

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34
Q

Idenitfy 2 examples of sources of acute somatic pain (nociceptive pain)

A

Incisional pain, insertion sites of tubes

35
Q

Idenitfy 2 examples of sources of chronic somatic pain (nociceptive pain)

A

Bony metastases, OA

36
Q

Idenitfy the physiological structures where visceral pain may be found (nociceptive pain)

A

Organs and linings of the body cavities

37
Q

Identify the mechanism of visceral (nociceptive pain)

A

Activation of nociceptors

38
Q

Describe the characteristics of visceral (nociceptive pain)

A

Poorly localised, diffuse, deep, cramping, splitting

39
Q

Identify 2 examples of sources of acute visceral pain (nociceptive pain)

A

Chest tubes, abdominal tube drains, bladder distention

40
Q

Idenitfy 2 examples of sources of chronic visceral pain (nociceptive pain)

A

Pancreatitis, liver metastses

41
Q

Idenitfy the physiological structures where neuropathic pain may be found (nociceptive pain)

A

Nerve fibres, spinal cord and CNS

42
Q

Identify the mechanism of neuropathic pain

A

Non nociceptive injury to nervous system structures

43
Q

Describe the chacrteristics of neuropathic pain

A

Poorly localised, shooting, burning, shock-like

44
Q

Identify a source of acute and chronic neuropathic pain

A

Nerve tissue injury due to diabetes, HIV, chemotherapy

45
Q

Describe somatoform pain disorder

A

Pain caused, increased, or prolonged by mental, emotional or behavioural factors, diagnosis of exclusion e.g. headache or abdo pain

46
Q

Describe cancer pain

A

Has its own category, usually persistent (long term)

47
Q

Describe breakthrough pain

A

Sudden onset, short duration, unresponsive to pain management

48
Q

Describe intractable pain

A

Pain not relieved by ordinary medical, surgical or nursing measures, excruciating pain e.g. firbomyalgia

49
Q

Describe phantom pain

A

Pain felt in a body part that is missing, sensation or pain

50
Q

Describe referred pain

A

Pain felt at another site other than the injured body part

51
Q

Identify one harmful effect of unrelieved pain for endocrine system

A

When a person is under stress the endocrine system releases excessive amounts of hormones e.g. increased cortisol

52
Q

Identify one harmful effect of unrelieved pain for metabolic system

A

Sympathetic stimulation results in release of glucose into bloodstream for energy in other areas e.g. hyperglycaemia

53
Q

Identify one harmful effect of unrelieved pain for CVS system

A

CVS responds by activating the sympathetic nervous system resulting in fight or flight response e.g. incrased HR

54
Q

Identify one harmful effect of unrelieved pain for respiratory system

A

Increased RR, decreased coughing

55
Q

Identify one harmful effect of unrelieved pain for genitourinary system

A

Excessive release of hormones resulting in decreased urinary output and urinary retention

56
Q

Identify one harmful effect of unrelieved pain for GIT system

A

Reduction in gastric emptying = decreased bowel motility

57
Q

Identify one harmful effect of unrelieved pain for cognitive system

A

Pain may produce crisis reactions = reduction in cognitive function and mental confusion

58
Q

Identify one harmful effect of unrelieved pain for immune system

A

Immune cell supression = immunocompromised

59
Q

Describe the 5 aspects of the pain assessment plan

A
  1. Initial assessment
  2. Assessment tools
  3. Goals of pain management
  4. Ongoing assessment
  5. Documentation
60
Q

Idenitfy 3 factors relevant to effective treatment

A
  1. Ability to use appropriate pain measurement tools
  2. Coping mechanisms
  3. Family expectations and beliefs about pain and patinets illness
61
Q

Identify the two types of pain assessment tools

A
  1. Uni dimensional tools
  2. Multi dimensional tools
62
Q

Describe uni dimensional pain tools and provide an example

A

Accurate, simple, easy to use e.g. Numerical or visual analogue scale

63
Q

Describe multi dimensional pain tools and provide an example

A

Provide information about qualitative and quantitiative aspects of pain, requires pt to have good verbal skills e.g. PQRSTU

64
Q

Describe an acute pain assessment

A

Definable injury, definite onset, duration limited and predictable and asscociated with clincial signs of sympathetic overactivity

65
Q

Describe the initial pain assessment tool

A

Location, quality, manner expressing pain, what relieves it/makes it worse and effects of pain e.g. decreased sleep

66
Q

Describe the behavioural pain assessment scale

A

Face expressions, restlessness, muscle tone, vocalisation and consolability (out of 10)

67
Q

Describe the functional activity score pain assessment

A

Asks the patient to perform an activity related to their painful area
A: No limitation by pain
B: Mild limitation by pain
C: Severe limitation by pain

68
Q

Describe a persistent pain assessment

A

Individual may not have a definable injury or illness, may not have a definite onset, no clinical signs of sympathetic overactivity

69
Q

Identify 3 additonal questions for a peristsent pain assessment

A
  1. Does pain increase as the day goes on?
  2. Is there numbess or loss of muscle strength associated?
  3. Is there any weather that makes it worse?
70
Q

Describe the brief pain inventory (BPI) for persistent pain assessment

A

Assesses pain severity and degree of interference with function using 0-10 scale

71
Q

Describe the McGill pain questionarre for persistent pain assessment

A

Evaluates sensory, affective emotional, evaluative and temporal aspects of the pain. Three pain scores are collected (Sensory, affective and total pain index)

72
Q

Describe the leeds neuropathic assessment (LANSS) for persistent pain assessment

A

Varying questions e.g. sensitivity of skin, skin temp

73
Q

Idenitfy 4 other pain assessment tools

A

Pain catastrophising scale
PASS: Pain anxiety symptom scale
DN4: Neuropathic/nociceptive discrimination
Chronic pain grade (pain activity questionarre)

74
Q

Describe QUESTT as a paediatric pain assessment

A

Q: Question the child
U: Use pain rating scale
E: Evaluate behaviour/phsyiological changes
S: Secure parents involvement (Experts)
T: Take cause of pain into account
T: Take action and evaluate results

75
Q

Identify 4 ways of assessing pain in paediatrics

A
  1. Faces (Wong Baker)
  2. Numerical scale
  3. Behvaioural: FLACC, consolability
  4. Physiological e.g. increased HR, RR
76
Q

Idenitfy 3 acute pain effects in children

A

Altered temperament
Infant stress behaviours
Increased behaviour/physiological change

77
Q

Identify 3 variables which may effect pain

A

Genetic
Developmental
Psychological

78
Q

Identify a psychological factor which may influence ones perception of pain

A

Poor insight, cognitive defecit

79
Q

Identify a enviornmental factor which may influence ones perception of pain

A

Lack of secure housing, unhealthy environment

80
Q

Identify a social factor which may influence ones perception of pain

A

Lack of family support, unemployed

81
Q

Identify 5 psychosocial effects of persistent pain

A

Loss of employement/income
Isolation
Lowered self esteem/confience
Marital and family dysfunction
Sleep disorders

82
Q

Identify 3 things which pain can be impacted by

A

Attention the person pays to it
Emotions and mood
Coping strategies

83
Q

Identify 3 aspects of the persistent pain cycle

A

Persistent pain leads to:
- Being less active
- Sleep probs, tiredness, fatigue
- Negative thinking, fear of the future

2229 (6 decks)

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