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61 Cards in this Set
- Front
- Back
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What is pain? |
it is whatever the experiencing person says it is; existing whenever the person experiencing says it does/ |
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Alternative definition |
is it unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. |
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define suffering |
is the state of severe distress associated with events that threaten the intactness of the person |
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Why does pain exist? |
Protective mechanism, or warning and cardinal sign of inflammation |
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why is untreated or under treated pain a bad thing? |
reactions to pain are tissue breakdown, increased metabolic rate, impaired immune function and negative emotions, prevents self care activities, hurts to cough, walk, etc. |
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Different types of pain |
mild or severe pain, chronic or acute, intermittent or intratable, burning, dull, or sharp poorly or precisely localized or reffered |
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Categorized into 3 main types |
acute, chronic nonmalignant , cancer |
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Referred pain? |
Pain felt at a site other than the injured or diseased for example in pain in coronary artery insufficiency that may be felt in left shoulder, arm, or jaw |
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Acute pain |
intense <6 months warns individual of actual or potential tissue damage. Autonomic response that originates in SNS, Flood boy with epinephrine "fight or flight response" |
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Acute pain cont. |
causes injury, medical conditions (pneumonia, angina) surgical procedure. described as aching or throbbing. Pt's may be agitated, restless, splint the area. Have increased heart rate, bp, resp rate |
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Chronic pain |
-pain >6 months -can be continuous or intermittent and may be as intense as acute -does not serve as a warning sign of tissue damage; may be due to damage that has already |
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Chronic pain cont. |
causes: arthritis, back problems described as dull, constant, shooting, tingling,burning don't usually see increases in pulse, BP,resp |
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Synergistic relationship |
Action of two or more substances or organs to achieve an effect of which each is individually incapable. examples: fatigue, sleep disturbance, and depression can change a person's perception of pain |
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Intractable pain |
pain that cannot be relieved such as from severe arthritis or cancer |
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superficial pain |
also called cutaneous pain originates in the skin or tissue just below the skin an injection |
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Visceral pain |
Deep pain originating in bones and muscles or organs, usually dull or diffuse an ulcer, angina, organ pain after surgical manipulation, fracture |
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radiating pain |
pain perceived at the source and extending to nearby tissue |
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phantom pain |
pain felt in an amputated body part nerves transmit messages of pain even though limb (body part) gone |
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Non pharmacological techniques |
pain caused by stimulation of nerve endings |
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Gate control theory |
pain impulses can be regulated or even blocked by gating mechanisms located along the CNS. Pain and other sensations of skin and muscle travel the same pathways through the large nerves in spinal cord.
When the dorsal horn gates are closed the pain is blocked. |
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Applied to nursing (gate theory) |
small diameter nerve fibers transmitting pain can be closed by stimulating large diameter nerve fibers thru vibration and massage -pressure of a backrub, heat of a warm compress, or the cold from ice applications, massage high sensory input close pain impulses to brainstem to distraction will help relieve pain (visitors, activities) |
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Applied to nursing cont. |
Gating mechanisms can be altered by thoughts, feelings, and memories
cerebral cortex and thalamus open pain gate when impulses originate from an increase in anxiety. |
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Endorphins |
-Naturally occurring opiate like substances within the body -stress and pain activate endorphins -analgesia results when certain endorphins attach to opioid receptor sites in the brain and prevent the release of neurotransmitters, thereby inhibiting the transmission of pain impulses. |
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endorphin cont. |
People who have less pain than others from a similar injury have higher endorphins levels. Pain relief measures, such a TENS, acupuncture, placebos decrease pain by increasing endorphins. |
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Nociceptive pain |
body's normal or physiological reaction to noxious stimuli |
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Neuropathic pain |
pain associated with injury to PNS or CNS and is non-physiologic- not localized, may involve other area along pathway -dm, gullain barre sydrome, cancer, HIV, shingles analgesics and opioids do not relieve pain |
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4 phases of nociceptive |
Transduction: tissue damage causes release of substances that stimulate nociceptors and start sensation of pain Transmission: movement of pain to the spinal cord Perception: pain impulses reach the brain and pain is recognized Modulation: neurons in brain send signals back down the spinal cord by release of neurotransmitters |
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Tx of the 4 phases |
NSAIDS block production of substances that trigger the nociceptors in the transduction phase opioids interfere with transduction phase |
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Tx of neuropathic pain |
adjuvant meds: NSAIDs, tricyclic anti-depressants, anticonvulsants, corticosteriods |
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Non invasive pain relief techniques |
1. TENS- transcutaneous electrical nerve stimulation- provides a continuous, mild electrical current to the skin via electrodes causing release of endorphins which blocks pain impulses to the brain. 2. Distraction relaxation- pt think of things other than pain - music, reading, mediation, visiting, controlled breathing, watching TV, guided imagery, hypnosis, homeopathy, biofeedback |
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Invasive approaches |
Nerve blocks epideral analgesics neurosurgical procedures acupuncture |
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ceiling effect |
doses beyond which there is no improvement in analgesic effect and there may be an increase in adverse side effects |
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physical dependence |
physiological phenomenon that most people experience after a few weeks of continuous opioid use so should wean off. may experience withdrawal syndrome- sweating, tearing, runny nose, restlessness, irritability, tremors, dilated pupils, sleeplessness, nausea, vomiting, and diarrhea) |
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Tolerance |
takes larger dose to provide same level of pain relief |
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Addiction |
continued craving for opioid and the need to use the opioid for effects other than pain relief |
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Pseudoaddiction |
syndrome in which behaviors similar to addiction appear as a result of inadequate pain control or fear of inadequate pain control |
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Analgesics |
meds that relieve pain. 3 main classes opioids non-opioids (non-narcotic) adjuvants |
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Non-opioids |
generally 1st class of drugs used for pain tx have ceiling effect to analgesia do not produce tolerance or physical dependence most have antipyretic works at site of injury or peripherally (not CNS) |
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Opioids |
Classified by ability to bind to opioid receptor in brain and spinal cord and other areas similar to morphine added to nonopioids for pain not controlled No ceiling effect if used alone. Increases in dose can result in respiratory distress |
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Classification of opioids |
full agonist -complete response at receptor site partial agonist -partial response at receptor site mixed agonist -activates one type of receptor while blocking another antagonist affinity to cell receptor by binding to it thus preventing it to respond |
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Adverse effects of opioids |
sedation, constipation, nausea/vomiting, itching, respiratory depression*, constricted pupils* *not as common but alert nurse to possible overdose |
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Controlled or time-release meds |
never crush or chew for prolonged, continuous pain oxycontin, MS contin have immediate release med for breakthrough pain (pain occurs between controlled doses.) |
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Morphine |
Opioid of choice to treat to severe pain affordable convenient standard to which other analgesics compared |
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Hydromorphone |
aka dilaudid- mod to severe pain shorter acting than morphine and faster acting |
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Meperdine (demerol) |
for short term use or allergic to other opioids breaks down into metabolites (normeperidine) which can cause adverse effects (dysphoria,irrable mood, tremors, seizures) Avoid if over age of 65 , impaired renal function, recieving MAOI antidepressants |
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Fentanyl (Sublimaze, Durgesic) |
Parental, intraspinal,transdermal patch short acting and must give more frequntly patch is q 3 days |
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methdone (dolophine) |
potent, longer duration than morphine long half-life and accumulates with continued dosing very effective orally at similar dosing to IV used for pain, drug detoxification |
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Opioid antagonist |
Naloxone/ Narcan -pure opioid antagnist Tx of OD, respiratory distress |
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Agonist-antagonist |
Common ones include butorphanol, stadol, nalbuphine, nubain( for itching and nausea given in small doses will treat side effects but prevent analgesia |
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Adjuvants |
May potentiate effects of opioids or nonopioids, provide analgesia, counteract unwanted effects of other analgesics |
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Steroids |
Tx acute and chronic cancer related pain Decrease inflammation and compression standard tx of spinal cord compression |
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Benzodiazepines |
Tx anxiety or muscle spasms may cause sedation midazolam(versed) or diazepam (valium) |
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Tricyclic Anti-depressants |
Tx pain related to neuropathy and other painful nerve-related conditions must be taken for days to weeks to be fully effective elevates mood and improves ability to sleep amitrityline, imipramine,desipramine, doxepin |
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Anticonvulsants |
Relieves sharp or cutting pain caused by peripheral nerve syndromes must be taken regularly before full benefit carbamazepine (tegretol), gabapentin,neurontin |
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Stimulants |
Used to counteract sedating effects of opioids methylphenidate hydrochloride (ritalin) caffine-containing medications |
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Level 1 |
Mild pain pt able to sleep, perform ADLs, and work non-opioid analgesics (prn or OTC) |
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Level 2 |
Mild or moderate pain may not be able to sleep, trouble working, stayed focused add opioid |
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Level 3 |
Moderate to severe pain affecting quality of a pt's life, may not be able to perform ADLs Stronger opioid or increase |
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PCA |
patient controlled analgesia IV,allows pt to control at set intervals cannot overdose morphine,fentanyl, demerol |
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Epidural |
deliver anesthesia or strong opiates to major nerves at base of spinal cords placed by anesthesiologist meds given thru catheter fentanyl, morphine |
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Myth: A person who is laughing and talking is not in pain |
Fact: A person in pain is likely to use laughing and talking as a distraction. May be easily distracted when they have vistors and may ask for pain meds as soon as their family leaves |
