Pain Assessment

Front 1

What is the clinical definition of pain?

Back 1

(Subjective) Pain is whater the person says it is, existing wherever the person says it does.

Front 2

What are nociceptors?

Back 2

nociceptors - specialized nerve endings, detect painful sensations from periphery & transmit them to the CNS. located within skin; CT, muscle, thoraci, ab & pelvis

- can be stimulated by trauma or secondarily by chemical mediators released from site of tissue damage

Front 3

What is the scientific definition of pain?

Back 3

an unpleasant sensory & emotional experience associatedw ith actual or potential tissue damage, or described in terms of such damage

Front 4

What is nociception?

Back 4

Activation of primary afferent nerves with peripheral terminals that respond differently to noxious (i.e. tissue damaging) stimuli

Front 5

Could nociception be perceived as pain?

Back 5

Nociception may or may not be perceived as pain, depending on a complex interaction within the nociceptive pathways

Front 6

what is neuropathic pain?

Back 6

occurs from altered processing of pain message in the CNS.
resulted from damage to the peripheral or central nervous system

Front 7

What are the types of nociceptive pain?

Back 7

somatic or visceral pain.

Front 8

..... pain is the most difficult to assess and treat.

Back 8

Neuropathic

Front 9

Why is neuropathic pain difficult to assess and treat?

Back 9

It is often perceived long after the site of injury heals, and at a neurochemical level that cannot be identified by technology

Front 10

What is somatic pain?

Back 10

nociceptive pain.
- usually on bone, joint, muscle, skin or CT.
- usually aching or throbbing in quality
- well localized

Front 11

What is visceral pain?

Back 11

nociceptive pain

- occurs on visceral organs (larger interior organs such as GI tract & pancreas)

- tumor involvement of organ capsule
---- aching & fairly well-localized pain

- obstruction of hollow organ
---- intermittent cramping
---- poorly localized pain

Front 12

What is cutaneous pain?

Back 12

from skin surface & subcutaneous tissues

- sharp burning sensation
- superficial injury

Front 13

What are the 2 primary sensory fibers that carry the pain signal from nociceptors?

Back 13

A-delta & C fibers

Front 14

What is A-delta?

Back 14

- afferent fiber that carries pain signal from nociceptors.
- myelinated, larger diameter
- transmits pain signal rapidly to CNS
- localized, short term & sharp sensations

Front 15

What is C fiber?

Back 15

primary afferent fiber that carries pain signal from nociceptors to CNS
- unmyelinated
- smaller
- transmit signal slowly
- diffuse & aching sensations
- persist after initial injury

Front 16

What is referred pain?

Back 16

pain felt at particular site but originates from another location
- both sites innnervated by same spinal nerve, difficult for brain to differentiate point of origin

Front 17

What are the common referred pain sites?

Back 17

Heart -- L chest & L arm
Kidneys -- R thigh, 2 areas on back where kidneys are
Liver -- Upper R quadrant, R shoulder

Front 18

Where could neuropathic pain be generated?

Back 18

centrally or peripherally generated

Front 19

What is centrally generated neuropathic pain?

Back 19

deafferentation pain (loss of sensory input to brain)

Ex:
- Phantom pain -- may reflect injury to the peripheral nervous system
- Sympathetically maintained pain -- dysregulation of the autonomic nervous system

Front 20

What is peripherally generated neuropathic pain?

Back 20

neurons become unusually sensitive and develop spontaneous activity

Polyneuropathies
-- Pain felt along the distribution of many peripheral nerves (i.e. diabetic neuropathy).

Mononeuropathyies
-- known peripheral nerve injury
-- pain is felt along the distribution of the damaged nerve

Front 21

What are spinal dermatomes?

Back 21

circumscribed skin area that is supplied mainly from 1 spinal cord segment through a particular spinal nerve
-- overlap, one nerve severed, most sensations can be transmitted by one above or below
-- Cervical : arms
-- Thoracic : trunk
-- Lumbar : front legs
-- Sacral : back legs

Front 22

Definition of suffering

Back 22

the state of severe distress associated with events that threaten the intactness of the person

Front 23

8 symptom characteristics

Back 23

1. location
2. character/quality
3. quantity/severity
4. timing - onset, duration, freq
5. setting
6. aggravating/relieving factors
7. associated symptoms
8. patient perceptions

Front 24

What is localized pain?

Back 24

- confined to original site
- doesn't radiate
- cutaneous hyperaglesia (increase pain sensation)
- allodynia (normal stimulus interpreted as pain)
- deep tenderness

Ex: tendonitis, athritis, surgical incisions

Front 25

What happens in referred pain?

Back 25

- from deep somatic or visceral site to cutaneous region distant but within several segments
- +/- hyperalgesia or alloydnia, deep tenderness, muscle spasm
- no muscle atrophy or weakness
- no change in peripheral reflexes

Ex: shoulder pain - subphrenic abscess

Front 26

What is projected pain?

Back 26

Could be transmitted or transferred
radiates along nerve in a segmental or peripheral distribution

Ex: (segmental): herpetic neuralgia
Ex: (peripheral): trigeminal neuralgia

Front 27

What drugs can be used for nociceptive pain?

Back 27

non-steroidals -- acetaminophen, NSAIDS, opiods

Front 28

What drugs can be used for neuropathic pain?

Back 28

adjuvant (immunological) drugs -- tricyclic antidepressants, anitconvulsants, neuroleptics

Front 29

Rocheaux(euse)

Back 29

rocky

Front 30

What is the distribution of neuropathic pain?

Back 30

Along a nerve or a nerve root segment.

Front 31

What is present in neuropathic pain?

Back 31

1. allodynia -- normal stimulus interpreted as pain
2. hyperalgesia -- increase pain sensation

Front 32

What is the purpose of the Initial Pain Intensity Score?

Back 32

1. gross clue to appropriate drug to relieve pain based on WHO analgesic ladder
2. clue to starting dose

Front 33

What is the purpose of Subsequent Scores?

Back 33

1. Guide dose titration
2. Guide decision to switch to another drug

Front 34

What are the stages at analgesic effect point for drugs?

Back 34

1. Onset : starts to work
2. Peak : Its maximal effect and time point when another dose can be safely adminstered
3. Duration: Its length of effect & time point when another dose is needed.

Front 35

What is the purpose of the pain pattern?

Back 35

Clue to timing of drug & nondrug therapies

Front 36

What is acute pain?

Back 36

-- conventional view of pain: signal of injury, helps with protection of the body.

-- short term and self limiting, often follows a predictable trajectory, dissipates after an injury heals.
e.g. appendicitis, physical injury

Front 37

What is chronic pain?

Back 37

Related to changes in the nervous system
-- may not correspond to any current structural problem
-- maladaptive
-- nerves get more efficient at transmiting pain
-- can result in allodynia -- nonpainful stimuli elicit painful sensations
-- diagnosed if continues for 6+ months
-- malignant (cancer related) or non-malignant (musculoskeletal)
-- outlasts its protective purpose
-- originates from abnormal processing of pain fibers from peripheral or central sites.
-- transmitted on a cellular level, cannot be detected by technology, must rely on patient report

Front 38

What is aura?

Back 38

subjective sensation that precedes seizure

Front 39

What is PQRSTU?

Back 39

P : provocative/palliative
Q : quality / quantity
R : region/ radiation
S : severity scale
T : Timing
U: understand patient's perspective

Front 40

what are the multiple dimensions of pain?

Back 40

ABCs of Pain
A = affective dimension
B = behavioral dimension
C = cognitive dimension
P = physiological sensory dimension

Front 41

What is the affective dimension of pain?

Back 41

negative or positive emotions

Front 42

What is the behavioral response/dimension of pain?

Back 42

Control the pain:
- Prevent onset of pain
- Reduce pain intensity
- Tolerate the pain

Front 43

What are the behavioral clues to pain?

Back 43

- Diaphoresis
- BP/Pulse increase, RR decrease
- Restless behavior
- Social withdrawal
- Altered time perception
- Impaired thought process

Front 44

What are the cognitive responses of pain?

Back 44

- Beliefs
- Attitudes
- Meaning of pain
- Memory of pain
- cognitive resources to cope
- locus of control (internal/external)
- catastrophizing & chronic pain

Front 45

What are some nondrug nursing interventions?

Back 45

- Back massage prior to bed
- Guided imagery
- Assist with physical therapy exercises
- provide warm compresses
- Educate patient about PCA use & address PT fears about addiction

Front 46

Definition of Cure?

Back 46

Treatment of disease or illness with intent to overcome it

Front 47

Definition of Palliation?

Back 47

Treatment to relieve the symptoms and distress of the disease process or illness

Front 48

What are the 4 phases of nociception?

Back 48

1. transduction 2. transmission. 3.perception 4. modulation

Front 49

What is transduction?

Back 49

noxious stimuli occurs in periphery

Front 50

What is transmission?

Back 50

pain impulse moves from spinal cord to brain

Front 51

What is the 3rd phase of nociception (perception)?

Back 51

conscious awareness of painful sensation

Front 52

What is the 4th phase of nociception (modulation)?

Back 52

when pain message is inhibited

Front 53

What are the gender differences of pain?

Back 53

Women 2-3X more likely to experience migraines during childbearing years, more sensitive to pain during premenstrual period, and 6X more likely to have fibromyalgia