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Chronic Health Challenges > Week 7 > Flashcards

Week 7 Flashcards

1
Q

____of Canadians (>12yers) live with persistent pain which affects ADLs on a consistent basis

A

20%

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2
Q

___ children have chronic pain

A

15-30%

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3
Q

____ institutionalized seniors experience pain regularly

A

38%

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4
Q

How many Canadians live with neuropathic pain?

A

1 million

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5
Q

Canada is the 3rd largest opioid consumer globally. What implications are their?

A
  • Are we using them responsibly
  • Significant mortality due to resp depression
  • Are there alternatives
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6
Q

____ live with chronic non cancer pain

A

25%

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7
Q

Gate control theory.

A

Transmission of nerve impulses modulated by a gating mechanism from afferent fibers to the spinal cord; when the gate is CLOSED there are no pain impulses and when OPEN small fibres facilitated pain transmission (ascend from spinal cord)
SUBSTANTIA GELATINOSA NEURONS in the dorsal hornin in the SC act as the GATE
Chemicals release in response to stimuli can influence opening and closing of the gate

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8
Q

In gate theory what is the gate?

A

SUBSTANTIA GELATINOSA NEURONS in the dorsal hornin in the SC act as the GATE

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9
Q

What type of fibres is the gate gating

A

afferent fibres that go to the spinal cord

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10
Q

What influences the opening and closing of the gate?

A

chemicals released in response to stimuli

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11
Q

How can rubbing help close the gate?

A

activates large diameter fibres and that closes the gate of neutrons in the dorsal horn

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12
Q

Chronic pain.

A

Pain that persists for more than 3 months or beyond the usual course.

  • Persists beyond expected tissue healing time or d/t an underlying disease
  • Persistent pain or pain that recurs at intervals for months or years
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13
Q

Chronic pain leads to…

A

suppression of immune function and disability

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14
Q

Elderly man comes into the clinic with persistent pain. VS are WNL, and he states 8/10 on pain scale. Drug seeking?

A

chronic pain causes the body to adapt thus VS are not an indicator of pain level (only in acute)

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15
Q

What are the consequenses of chronic pain?

A

FATIGUE(d/t pain, depression, decreased sleep), DEPRESSION (lack of control and social isolation), ANXIETY (can increase pain), SLEEP DISTURBANCES

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16
Q

Nociceptive pain.

A

due to tissue damage; free nerve endings in the skin respond to intense damaging stimuli

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17
Q

Somatic.

A

skeletal muscle fascia and tendons

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18
Q

Visceral.

A

deep bodily organs, GI, pancrease

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19
Q

Neuropathic pain.

A

d/t nerve damage or abnormal processing of sensory input

  • peripheral or CNS injury (phantom limb pain)
  • peripheral nerve endings (diabetic neuropothy)
  • described as burning; can be short lived or lingering
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20
Q

What assessment should be done for ppl with chronic pain?

A

depression and chronic pain go hand in hand

- MSE to assess for depression

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21
Q

What are the multidimensional factors of chronic pain?

A 
PHYSIOLOGICAL
SENSORY
BEHAVIOURAL
AFFECTIVE
SOCIOCULTURAL
FAMILY/GENDER ROLES
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22
Q

Physiological aspect of pain.

A

PHYSIOLOGICAL- involve transduction, transmission, perception and modulation of pain

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23
Q

Sensory aspect of pain.

A

PQRSTU

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24
Q

Behavioural aspect of pain.

A

action to decrease intensity/indicate presence of pain (rubbing, grimacing, bending over)

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25
Q

Affective aspect of pain.

A

emotional component

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26
Q

Sociocultural aspect of pain.

A

SOCIOCULTURAL- pain response, perception, how much is tolerable; ways to express pain; pain relief methods

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27
Q

Family and gender roles aspect of pain.

A

FAMILY/GENDER ROLES- women tend to report higher levels of pain and highest intensity during th day

28
Q

Addiction.

A

PSYCHOLOGICAL dependence

An overwhelming and compulsive need to obtain and use drugs for their psychic effects

29
Q

Tolerance.

A

with prolonged use the body becomes “used to” the effect of a drug
- Drug no longer responds to the same extent

30
Q

Physical dependence.

A

a state of tolerance; abrupt cessation results in body needs to readjust; appearance of withdrawal symptoms

31
Q

Guidelines for managing chronic pain.

A
  • DAILY SCREENING FOR THOSE AT RISK (self report standardized tool, assess with new report and evaluate after interventions; impact on sleep, mood, ADL’s; use of pain diary)
  • MULTIDISCIPLINARY MANAGEMENT OF PAIN
32
Q

What should be considered for paediatric pt?

A
  • MULTIPLE TYPES OF ASSESSMENT (behavioural, FLACC, physiological, self report faces for ages 4+)
  • COGNITIVE IMPAIRMENT CHALLENGES (see moaning, change in sleep and play patterns and in facial expression); ask caregiver how the child is usually
  • COMPLEX & CHRONIC PAIN: assess during triggers so you can isolate pain vs other symptoms
33
Q

What does FLACC stand for?

A

Faces, Legs, Activity, Cry, & Consolability tool

  • observer rates
  • higher the score means higher pain (scoring between 0-10)
34
Q

What are the main aspects of the guideline for chronic pain management?

A
  • Manage common side effects
  • Combine pharmacological and non-pharmacological methods
  • Use adjuvants (muscle relaxers, anit-emetics, sedatives, stool softeners, antidepresents)
  • Titration to effect (PO prefered)
  • Teach client/famliy
35
Q

Adjuvants.

A

help improve the function of other medications

36
Q

What side effects need to be managed for chronic pain management?

A

Nausea, vomiting, constipation, sedation

37
Q

What are some non-pharmacological things that could be combined with meds?

A

Heat & cold therapy, relaxation, distraction, guided imagery

38
Q

What are some typical adjuvants to txt?

A

muscle relaxants, anti-emetis, sedatives, stool softeners, antidepressants

39
Q

What is ‘titration to effect’

A

the dose of the med is enough to attain pain relief with the least amount of side effects

40
Q

What should be taught to the pt/family?

A
  • written Rx plan and health teaching
41
Q

When do you increase does with chronic pain?

A

Depends on the release of the drug (action), Immediate release- change every 24 hrs, controlled release- change every 48 hrs

42
Q

What are the guidelines for chronic non cancer pain?

A

1: begins with non-opioid analgesic (acetaminphen/NSAIDs; non pharm methods)
2: may need opioids; refer to pain clinic; non pharm methods
- thorough assessment
- trial dosing

43
Q

What is part of the thorough assessment and trial dosing in guidelines for non-cancer pain?

A

Assessment

  • Risk of addiction
  • Urine screening
  • Signed agreement (for treatment plan)
  • Collaborate on goals

Trial dosing

  • Goal: relieve pain with improved functioning and manageable side effects
  • below 200mg of MSO/day
  • may need to switch types of pain relief
44
Q

What is MSO?

A

Morphine sulphate per day

45
Q

Canadian guidelines for neuropathic pain?

A

1st line: tricyclic antidepresssants- AMITRIPTYLINE and or anticonvulsant GABAPENTIN (decreases excitatory neurotransmitters)
2nd line: SSRIs (replace tricyclics), continue with anticonvulsants and add topical lidocaine
**for breakthrough pain of 1st or 2nd line use short acting opioid
3rd line: add TRAMADOL (weak opioid) or other opioid
4th line: CANNABIS & METHADONE; continue with anticonvulsants
***all include non-pharm pain relief (PT, exercise, etc.)

46
Q

What is first line treatment for neuropathic pain?

A

1st line: tricyclic antidepresssants- AMITRIPTYLINE and or anticonvulsant GABAPENTIN (decreases excitatory neurotransmitters)
**for breakthrough pain of 1st or 2nd line use short acting opioid

47
Q

What is 2nd line treatment of neuropathic pain?

A

2nd line: SSRIs (replace tricyclics), continue with anticonvulsants and add topical lidocaine
**for breakthrough pain of 1st or 2nd line use short acting opioid
3rd line: add TRAMADOL (weak opioid) or other opioid

48
Q

What is 3rd line treatment of neuropathic pain?

A

3rd line: add TRAMADOL (weak opioid) or other opioid ***all include non-pharm pain relief (PT, exercise, etc.)

49
Q

What is the 4th line treatment of neuropathic pain?

A

4th line: CANNABIS & METHADONE; continue with anticonvulsants
***all include non-pharm pain relief (PT, exercise, etc.)

50
Q

What are some non pharm pain relief methods?

A
  • CUTANEOUS STIMULATION (massage, hot/cold, etc)
  • DISTRACTION (good for procedural)
  • RELAXATION (slow, rhythmic breathing (lowers pain perception and anxiety)
  • ACUPUNCTURE (involves inserting sterile needles in specific points to allow energy flow and therapeutic effect)
  • MEDITATION (practice of concentrated focus upon a sound, object, visualization, the breath or movement reduce stress and promote relaxation)
51
Q

What type of non pharm method of pain relief is best for procedures?

A

distraction

52
Q

What is the benefits of cutaneous stimulation?

A

release endorphines

53
Q

What is chronic fatigue?

A

Self-recognized state of at least 6 months

  • overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work
  • not relieved by sleep or rest
  • It is not related to activity and can affect one’s quality of life
  • Can become a disabling condition- affect all aspects of one’s life
54
Q

How can chronic fatigue become disabling?

A
  • Experience weakness & can’t complete normal activities
  • Can lead to SOCIAL
  • ANXIETY&DEPRESSION can be cause & effect
55
Q

What are the components of the multidimensional experience?

A

TEMPORAL- perception of fatigue duration
SENSORY – mental, physical, emotional symptoms
COGNITIVE- concentration, drowsiness, irritability
AFFECTIVE – emotional aspects
BEHAVIOURAL – slowing, withdrawal
PHYSIOLOGICAL- muscle weakness, spasticity

56
Q

What are some causes of fatigue?

A

anemia, chronic pain depression, physical deconditioning, side effects of medications, cancer, CHF, stroke, MS

57
Q

What impact can fatigue have on a person?

A
  • interferes with ADLs
  • impacts self-esteem, mood, role performance
  • social isolation
  • sexual functioning
  • other: depression occurs with fatigue, chronic pain; pain leads to fatigue, anorexia (less available energy for ADLs)
58
Q

What are some interventions for fatigue?

A 
Assessment
Support groups
Develop realistic schedule
Pacing
Priority setting
Energy conservation
Client and family edu
Sleep hygiene
Exercise
CBT with energy management strategies
59
Q

Fatigue assessment.

A 
Assessment- based on self-report (rate from 1-10)
Experience- any previous with fatigue
length & timing of episodes
affect with activities
Keep a diary of what helps
60
Q

Fatigue support groups.

A

What is the perception of the quality of the support
Support groups can help with problem-solving
Encourage expanding support networks

61
Q

Fatigue; setting realistic goals.

A

use relaxation techniques

62
Q

Fatigue pacing.

A

Pacing-
prevents fatigue d/t over-activity;
plan for rest& active periods
Break into smaller tasks

63
Q

Fatigue priority setting.

A

do high priority task when energy is highest

64
Q

Fatigue energy conservation.

A 
focus on meaningful activities
Assign tasks to others , anticipate triggers
Use energy saving tips:
Eliminate unnecessary steps
Use assistive devices
65
Q

Sleep hygiene.

A 
Can contribute to fatigue
No caffeine in the evening
bed for sleep only
Regular time for sleeping, naps & waking
Need good pain management which can interfere with sleep
Medications as a last resort
66
Q

What types of exercises are recommended for fatigue?

A

yoga, tia chi, aerobics

67
Q

What kind of CBT is done for fatigue

A

energy management strategies

Chronic Health Challenges (5 decks)

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