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Nursing
Pain Perception and Management
| Question | Answer |
|---|---|
| Pain | Exists whenever person says it does. Serves as an injury prevention mechanism. Highly individual. |
| Pain influenced by | Affective: fatigue, Behavioral: age, cognitive, physiological sensory |
| Nociception | Processing of painful stimuli |
| Transduction | Impulses travel along afferent (sensory) nerve fibers |
| A-Delta | Sharp, localized pain associated with injury |
| C-fibers | Slow conducting, dull poorly localized pain after injury. First vs second. |
| Transmission | Spinal Dorsal Horn- processing of message. Most important pathway for pain sensation. |
| Impulse Route | A-delta & C-fibers in peripheral tissues -> dorsal route-> spinal dorsal horn -> spinothalmic tract -> brain stem -> thalamus |
| Neurotransmitters | All cellular damage results in release of: prostaglandins, substance P, serotonin. Produce a pain-sensitizing inflammatory response. |
| Perception | Personal awareness. Once the impulse reaches the cerebral cortex, the brain interprets the quality of pain based on past experiences, knowledge, and culture. |
| Modulation | Inhibition of nocioceptive impulses in CNS. Once brain perceives pain, it releases endogenous opioids to produce analgesia: serotonin, norepinephrine. |
| Gate Control Theory | Dorsal horn cells act as a gate: close to prevent nociceptive impulses from reaching the brain. A-delta & C-fibers open the "gate". Alpha and beta fibers close the gate. |
| Significance of the Gate Theory | Provides ideas for pain relief emphasizing multiple dimensions of pain: sensory, emotional, behavioral, cognitive. Different pain relief interventions may be used to address various dimensions of pain for a more holistic approach to therapy. |
| Types of pain | Acute-follows nociceptive pain process, persistent (chronic)- no useful purpose, cancer-first symptom to seek tx, nociceptive- somatic, visceral, neuropathic- nerve damage |
| Acute Pain | Occurs abruptly with injury or disease. Lasts less than 6 months. May be associated with anxiety and fear. Typically increases with wound care, ambulation, coughing, deep breathing. |
| Chronic pain | Lasts for prolonged period of time. Typically greater than 6 months. Associated with prolonged tissue pathology. May be associated with depression, frustration, or fear. Cause may be unidentifiable: Idiopathic. |
| Malignant pain | Progressive pattern of recurrent, acute pain or persistent chronic pain. Resistant to treatment or cure. Intractable. Interferes with quality of life. May be described as all-consuming. |
| Lifespan considerations | Newborn/infant- under treatment of pain. Toddler/preschooler- cannot ID pain. Schoolage/adolescent- can rationalize pain. Adult/older adult- MS pain. Cultural- communication/devalued. |
| Verbal Pain | Subjective, most dependable indicator of pain, suffering. |
| Nonverbal Pain | Gives clues to location of pain: rubbing, frowning, grimacing, guarding, immobilization, increase muscle tension. |
| Behavioral and Cognitive Factors | Usual activities, anxiety, fear, aggression, physical withdrawal from activities, meaning associated with disease, cultural belief. |
| Manifestations of pain | Increase BP, HR, resp. |
| Metabolic changes of pain | Increase metabolism, O2 consumption, blood glucose, free fatty acids, blood lactate, ketones. |
| Pain Assessment | Onset, duration, location, intensity, quality, pattern, relief |
| When to assess pain | At regular intervals throughout treatment, with each report of pain, before and after nonpharmacologic treatment and medication administration. |
| Pain Onset | Day and time that pain began. Any precipitating factors associated with pain onset. |
| Pain duration | Temporal patterns: brief, momentary, transient, rhythmic, periodic, intermittent, continuous, steady, constant, breakthrough |
| Pain location | May be measured objectively. Ask client to mark areas of pain- different symbols may indicate various types of pain and intensity. Ask client to point directly at area of pain. May be referred pain from another area. |
| Pain Intensity | Typically measured on a scale of 0-10. Varies depending on: personal experience, personal expectations, ability to be distracted, level of consciousness, activity level |
| Pain threshold | Amount of pain stimulation a person requires before feeling it. |
| Pain tolerance | highest intensity of pain that person is willing to tolerate. |
| Pain quality | How the pain is felt by a client: stabbing, crushing, burning, sharp, shooting, throbbing |
| Addiction | A psychological state in which an individual seeks medications for purposes other than the prescribed purpose |
| Dependence | A physiologic response of clients who take opioids regularly for greater than 10 days. Abrupt discontinuation elicits withdrawal symptoms. |
| Withdrawal Symptoms | Anxiety, Nervousness, Irritability, increase salivation, increase perspiration, diarrhea, chills, hot flashes, nausea and vomiting, abdominal cramps |
| Tolerance | Develops when a dose of opioid becomes less effective on repeated administration. Tolerance is not addiction. Involves physiologic changes r/t drug metabolism, nervous system's adaption to the med. |
| Need for increasing drug dosage may indicate | Disease progression, new pathology. |
| Titration | Adjusting drug dosage to clients response, balance of desired and adverse effects to maintain client comfort. |
| Tolerance Treatment | Change to a different drug in the same classification. Add an adjuvant analgesic. May require increased doses of med. |
| Pain relief Non-Pharmacologic | Relaxation, guided imagery, deep breathing, distraction, biofeedback, meditation, positioning, hygiene, cutaneous stimulation: massage, heat, cold, acupressure |
| Pharmacologic Management for Pain relief: Nonopioids | Acetylsalicylic acid (ASA): analgesic, antipyretic, anti-inflammatory: decrease platelet aggregation. |
| Pharmacologic Management for Pain relief: NSAIDS | Analgesic, antipyretic, anti-inflammatory |
| Adjuvant Analgesics | Tricyclic antidepressants, antihistamines, caffeine, muscle relaxants, anticonvulants, antiemetic |
| Opioid agonists | Morphine, codeine, hydromorphone, oxycodone, meperidine, fentanyl, methadone. |
| Opioid antagonist | Narcan |
| Common side effects of opioids | Constipation, nausea and vomiting, sedation, dizziness, pruritus, headache, dry mouth. |
| More serious side effects of opioids | Resp depression, apnea, resp arrest, circulatory depression, hypotension, shock |
| Invasive Pain Management | Intraspinal- Epidural/Intrathecal Used to control postop pain, chronic non-malignant pain, severe cancer pain. May be placed in the cervical, thoracic, lumbar, or caudal spinal regions. |
| Principles of Nonpharmacologic Pain Management | Basic comfort measures-environment. Cutaneous stimulation-interrupts pain signal. Heat-vasodilation. Cold-vasoconstriction. Massage-tactile stimulation. |
| Pain evaluation/Documentation | Ongoing assessment- character of client's pain. Client's response to interventions: nonpharmacologic, pharmacologic. Clients perception of pain relief measure effectiveness. |
Created by:
senmark
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