Unit 4: Pain Management

What are some factors influencing pain?

1. Age 2. Fatigue 3. Genes 4. Neuroligical function

How can you as a nurse assess pain?

-Checking vital signs -Watching the pt's behaviors -Questioning the pt -Ask them about the effects its having on their ADLs. -Ask how they are dealing w/ the pain -Do they have good support system to help?

What are characteristics of pain?

-When it started and how long has it been hurting (onset and duration) -Where does it hurt? (location) -Intensity of pain? -What does it feel like, sharp, dull, ache, crushing, tingling? (quality of the pain) -Is it constant or intermittent (pain pattern) -What makes it feel better or worse? (relief measures) -What kind of effect does it have on the pt? (emotions or ADLs)

What are the different types of pain?

1. Acute 2. Chronic 3. Nonalignment 4. Intractable or chronic malignant 5. referred 6. radiating 7. Phantom

Physiological responses to pain

1. Mild to moderate- initiate the fight or flight response 2. Continuous, severe, or deep pain (typically involving the visceral organs)- initiate the rest and digest response

Fight or flight responses from Pain (Sympathetic Nervous system)

1. Pupils become dilated 2. Increase respiratory rate 3. Increase Blood Pressure 4. Increased Heart Rate 5. Decrease Peristalsis 6. Increased blood glucose

What are the classifications of pain?

1. Somatic- superficial or deep pain arises from the skin, mucous membranes and subcutaneous tissue described as sharp, burning or prickling 2. Visceral- arises from the bodies organs described as dull and poorly localized accompanied by N/V, hypotension and restlessness 3. Neuropathic- caused by damaging the nerves in the CNS described as numbing, hot, burning, shooting, stabbing, sharp or electric shock can be sudden, intense, short-lived

What are the four process of pain?

1. Transduction 2. Transmission 3. Perception 4. Modulation

What are the psychological factors that influence pain?

1. anxiety 2. coping style 3. cultural factors

What are the social factors that influence pain?

1. attention 2. previous experience 3. family and social support 4. spiritual factors

Rest and Digest responses from Pain (Parasympathetics Nervous System)

1. decrease Heart rate 2. Rapid irregular breathing 3. Increase peristalsis 4. Nausea and vomiting

What is intractable/chronic malignant pain?

A type of pain caused by uncontrolled cancer, aggressive pain management needed

Pain assessment and Management- ABCDE

A: Ask, asses systematically B: believe/report and try to relieve their pain C: choose pain control options appropriately D: deliver interventions timely, logically, and coordinated E: empower patient, enable them to have some control

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Neuropathic pain is?

Caused by damage to peripheral nerves or structures in the CNS. Typically described as numbing, hot, burning, shooting, stabbing, sharp, or electric shock-like It can be sudden, intense, short lived or lingering. Its often not well controlled by opioids alone. Usually combined with TCAs, SNRIs, anti-seizure, etc.

What are nonverbal cues of pain?

Grimacing pt is hunched over slow movements protecting of the spot in pain

Visceral pain is?

It arises from bodies organs Dull and poorly localized Accompanied by n/v, hypotension, and restlessness. Can come from surgery of abdomen, appendicitis, chest pain, etc.

Whats classifications does pain fall under?

It can be: Somatic pain Visceral pain Neuropathic pain

What are the behavioral responses to pain?

It is influenced by a person's culture, pain experience, perception of pain, and ability to manage stress, Everyone handles pain differently

Does successful pain management mean the pt no longer has pain?

NO! It does not always mean there is no longer pain. Its just managing the pain. Helping to make sure pt can do ADLs.

Unit 4: A Pain management

P&P: Chapter 44

PQRRSTU

P= What provokes it (exertion, inspiration) Q= the quality (dull ache, sharp, stabbing, pressure) R= relief measures (what helps) R= region (show me where you hurt) S= Severity (scale 1-10) T- Timing (constant, intermittent, or both?) U= effect of pain (what can you not do because of your pain)

What is chronic pain?

Persistent or recurring, lasts 3-6 months, often difficult to treat

What is modulation?

The last and final stage of the pain process. This is where your brain perceives the pain and released inhibitory neurotransmitters (endomorphines, serotonin, norepinephrine) to help hinder the transmission pain. During this stage, your body is going to produce a protective reflex to contract your muscles to pull away from the object causing pain.

What is transmission?

The second phase of nociception where pain impulse moves from the site of the injury to the spinal cord and then to the brain

gate control theory of pain

The theory that pain is a product of both physiological and psychological factors that cause spinal gates to open and close therby modulating the perception of pain. Example: Factors such as stress and exercise increases the release of endorphins that often raise an individuals pain threshold.

What is perception?

This is the point at which a person is aware of pain Perception gives awareness and meaning to pain, resulting in a reaction. The reaction to pain includes the physiological and behavioral responses that occur after an individual perceives pain.

What is nonmalignant pain?

Type of chronic pain that is ongoing and doesn't respond to treatment Example: Pancreatitis

Is the patient always right about their pain?

Yes

What is pain?

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

What is transduction?

conversion of one form of energy into another. This is where substances activate nociceptors and lead to the generation of an action potential.

What is referred pain?

pain felt in a part of the body other than its actual source

Somatic pain is?

pain originating in skin or subcutaneous pain. superficial or deep pain

What is acute pain?

sudden onset and short duration

What are some misconceptions about pain?

1. patients who abuse substances overreact to pain 2. patients with minor illnesses have less pain 3. Administering analgesics lead to drug addiction 4. Patients/infants who cannot speak do not feel pain 5. Patients who are hospitalized experience pain

What is radiating pain?

pain that extends from the source to surrounding tissues or another area

What is phantom pain?

pain that seems to come from a limb that has been amputated

What is pain according to Margo McCaffery?

whatever the person experiencing the pain says it is, existing whenever the person says it does