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32 Cards in this Set

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What is pain?

An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Potentially damaging mechanical, thermal, and chemical stimuli that are detected by nerve endings on skin, internal organs, and on internal surfaces; it is a neural response to noxious stimuli

Nociception

4 steps of nociception:

Transmission, transduction, perception, and modulation

Name the tissues where pain receptors are located

Everywhere but the brain

Substances released by cells during injury or inflammation

Prostaglandins

3 types of nociceptive pain:

Superficial somatic- sharp pain on skin or in mouth



Deep somatic- dull pain from muscles, joints, bones, and tendons.



Visceral pain- from internal organs. Often from inflammation, spasms, over stretching

Where can heart pain feel like it's coming from?

Can be felt down the arm

Where does gallbladder pain feel like it's from?

The shoulder blade

How do you explain pain that feels like it is coming from skin in a different area than the internal organ?

Referred pain due to fibers entering the same segment of spinal cord

Compare acute & chronic pain

Acute pain has a short duration, caused by injury or disease and may cause restlessness, anxiety, and irritability, and sleep disturbances.



Chronic pain lasts over 3 months or indefinitely. May be nociceptive including cancer and non cancer. May result in fatigue, insomnia, social and financial burdens and depression.

List several mechanisms in which cancer can cause pain:

Local pressure, neuropathy, inflammation

What is the term for pain due to damage or dysfunction of the sensory system?

Neuropathic pain

Name 4 examples/causes of neuropathic pain:

Stroke, M.S, phantom limb, CNS injuries

How does damage to nerves lead to neuropathic pain?

When nerve fibers are damaged they send incorrect signals to pain centers; hyper excitability of neurons causes increase in responsiveness to stimuli

What is the most reliable indicator of pain?

The patient; pain is what the patient says it is

What aspects of pain should be assessed?

Location, quality, severity, timing, progress, response to treatment, pain scale and effects on life (mood, sleep, work, relationships)

What group of analgesics is used initially to treat mild/moderate pain?

Non- opiods


Acetylsalicylic acid (aspirin), ibuprofen (Advil), and acetaminophen (Tylenol)

What group of analgesics are most effective at treating pain?

Opioids :


Morphine, codeine, oxycodone, fentanyl

How and where do NSAIDS work?

They work in the transduction step by blocking prostaglandins

What are side effects of NSAIDS?

Upset stomach, nausea, rash, fluid retention, kidney/heart problems

Why is acetaminophen (Tylenol) not an NSAID?

Tylenol is a pain and fever reducer. It is not an anti-inflammatory drug

How and where do opioids work?

Thy act in the central nervous system and block the signal where pain is felt.

What are 4 common side effects of opioids?

Drowsiness, constipation, nausea, dry mouth (also dependency)

What's the difference between tolerance, dependence, and addiction?

Tolerance refers to physiological state where the effectiveness of the drug has decreased (higher dose needed to reach therapeutic effect); dependency refers to physiologic adaption in response to drug use (withdrawal symptoms may occur of drug use is stopped abruptly); addiction is compulsive use of a drug for non medical reasons

Mind/body methods of pain relief:

Relaxation techniques, hypnosis, imagery, music therapy, distraction

Physical non drug methods:

Hot/cold packs, massage, chiropractic, acupuncture

How does TENS work?

(1) stimulating nerve closes a "gate" mechanism in the spinal cord


(2) electric currents release endorphins

Converts one form of energy into another; free nerve endings transduce noxious stimuli; in most body tissue; shows little sensory adaptation

Transaction

Has two types of nociceptor fibers; cfibers (un myelinated with slow onset & dull); a-delta fibers ( myelinated, fast onset & sharp)

Transmission

Signal travels on axons to dorsal horn of spinal cord and then to the thalamus

Conduction

Person is becoming consciously aware of pain; involves 2 brain areas ( parietal lobe of cerebral cortex and limbic system); receptors respond to stimulus but sensation is felt in the brain

Perception

Examples of chronic, non-cancer pain:

Arthritis, low back pain, fibromyalgia syndrome