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21 Cards in this Set
- Front
- Back
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Definition of Pain
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An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
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Margo McCaffery's Def of Pain
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"Pain si whatever the experiencing person says it is, existing in terms of such damage."
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What is the most reliable indicater of pain?
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The patient's self-report
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Sxs of Acute Pain
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- increased blood pressure
- increased pulse rate - increased respiratory rate - dilated pupils - perspiration - focuses on pain - reports pain - cries and moans - rubs painful part - increased muscle tension - frowns and grimaces - last 3 to 6 months - protective physiological mechanism that informs us when something is wrong - prevents additional tissue damage by limiting movement in injured parts - usually respnsive to treatment - subsides when healing occurs |
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Sxs of Chronic Pain (Chronic nonmaligant pain, Chronic benign pain)
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- normal blood pressure
- normal pulse rate - normal respiratory rate - normal pupil size - dry skin - no report of pain unless asked - quiet, sleeps or rests - turns attention to things other than pain - physical inactivity or immobility - blank or normal facial expression - last longer than 3 to 6 months - pain no longer serves as a protective mechanism - pain may be continuous, intermittent, recurrent or intractable |
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Malignant Pain
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Associated with progressive terminal illness:
Tumor Treatment related |
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End of Life Pain
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- Pain vs. Suffering - part of pain is emotional
- Intractable pain - hard to manage - hastening of death - quality of life |
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Terminal Sedation (palliative sedation or sedation for intractable distress)
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The practice of relieving distress in a terminally ill person in the last hours or days of their life, usually by means of a continuous IV or subq infusion of a sedative drug such as nidazolam (versed) a benzodiazeping.
- Opioids are no used as much such as morphine because patients build up a tolerance quicker and not as sedating. - If the patient is already on an opioid for pain relief this is continued. - Terminal sedation is used only if the patient perceives their distress to be unbearable, and there are no other means of relieving that distress. - It is legally acceptable and done purely for comfort. |
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** Tolerance **
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A state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drug's effects over time.
A loss of drug effectiveness due to physical adaptation over a period of use. Higher doses required for same effect. True narcotics like morphine have no cealing effect so they can be increased as much as patient needs. |
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** Physical Dependence **
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A state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by a rapid cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
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** Addiction **
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A primary, chronic, neurobiological disease with, genetic, psychosocial and environmental factors influencing its development and manifestations.
A pattern of compulsive drug use characterized by continued craving for opioid and hte need to use is for effect other than pain relief. - impaired control over drug use - compulsive use - continued use despite harm - physical and psychological craving |
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** Pseudo Addiction **
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The iatrogenic syndrome resulting from the misinterpretation of relief seeking behaviors as though they are drug-seeking behaviors that are commonly seen with addiction.
- something we cause - they are under tx |
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Assessment of Pain: The 5th Vital Sign
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- Existing painful diagnose location and type of pain.
- Past pain experiences - Pain intensity rating before and after medication - The worse the pain gets - The best the pain gets - Acceptable levels of pain - Pain quality - Onset, duration, variations - Manner of expressing pain - What causes or increases the pain - An other symptoms with the pain - Sleep patterns - Appetite - Physical activity - Relationships with others - Emotions - Cognition |
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Functional Assessment Related to Pain
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- Can you get up from and down to a toilet?
- Can you get up and down a curb, steps, etc? - Can you dress, groom, bathe yourself? - Have you fallen or almost fallen? Do you now require help to do things you formerly did independently? |
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Increased Endorphins
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- Brief pain
- Brief stress - Physical exercise - Massive Trauma - Acupuncture - TENS - Placebos - Sexual activity |
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Decreased Endorphins
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- Prolonged pain
- Recurrent stress - Prolonged use of morphine or alcohol |
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Levels of Pain
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Level 1 (Mild)
- rates pain at 1-3 - tylenol, aspirin, or motrin - fully controls pain, pain does not return Level 2 (Moderate): - rates pain at 4-6 - codeine, tylenol #3 pain may not be fully controlled, pain more continuous Level 3 (Severe): - Rates pain 7-10 - Morphine - titrate up until pain controlled without fall in LOC or respirations fall to 5 or below. |
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Atypical Pains
(Non-opiate dependent pain) |
Bone Pain:
- motrin - prednison Neuropathic Pain: - Tricyclic Antidepressants - amitriptyline (evlavil) - Anticonvulsants - Gabapentin (neurontin) - Antihypertensives - Clonidine (Catapres) |
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Atypical Medication for Pain Mangement
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- Anticonvulsants
- Tricyclic Antidepressants - Corticosteroids - Antihistamines - Psychostimulants: Ritalin, dexedrine - Antihypertensives - Topical Agents: Capsaicin (Zostrix) |
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Management of Pain in Patients with Active Addiction
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- Accept and act on hte patient's report of pain
- Addiction treatment is not a priority when the patient has unrelieved pain - Prescription of opioids to a known addict for the management of pain is not illegal - Persons with addictive disease may be relatively pain intolerant - Begin with nondrug or nonopioid analgesia - If the patient is physically dependent on opioids, so not administer mixed opioid agonist/antagonist (Talwin, Nubain, Stadol) for analgesia because withdrawal will be precipitated. - When opioids are no longer needed for analgesia, taper them very slowly to minimize emergence of withdrawal symptoms. |
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Pain Management
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- Use pain scale consistently
- Appropriate medication, dose, and route - If appropriate, use a multiple approach with medications (NSAID and opioids) - Use adjuvant analgesics (tricyclic antidepressants, anticonvulsants, etc) - stay on top of pain - nondrug approaches: heat, cold, distraction, relaxation, massage, etc |
