Pain

Acetaminophen

(Tylenol) Hepatotoxic

NSAIDs

(ibuprofen) Renal-toxic

What are some caring and empathetic behaviors we use with

- creating therapeutic environment - providing meaning behind painful stimuli/explaining everything you are doing - identifying maladaptive beliefs/CBT

general ascending pain pathway

1. Tissue damage causes a release of prostaglandins (PG), among other inflammatory mediators, which trigger special pain-sensing nerves, nociceptors 2. nociceptors transmit this signal back to the brain via the spinal cord

Central Sensitization

A state in which the CNS (thalamus) amplifies sensory input across many organ systems so you are having nehanced response to that sensation. Any nerve that constantly fires, b/c neural plasticity, that nerve pathway will get stronger - learned response increased excitation --> neural plasticity encouraging nerve to continue to fire --> predisposing people to future stimulation (benign sensations in the body that are amplified and become painful)

What are nociceptor fibers that connect to the dorsal horn comprised of?

A-delta and C-fibers

What part of the ascending pain pathway do opioids act upon

Activate opioid receptors on nerves that inhibit firing of the first order nerve and depolarization of second order nerve. Cause euphoria in brain

Somatic pain

Arises from bone, joint, muscle, skin or connective tissue Usually aching or throbbing in quality and is well localized

Thalamus - Limbic System

B/c of involvement of limbic system, negative emotions or memories can amplify pain signals

Diphenhydramine

Benadryl

What part of the ascending pain pathway do Gabapentinoids act upon

Block Ca++ channels and prevent first order neuron from firing Good for neuralgia/neuropathic pain

What part of the ascending pain pathway do NMDA atagonists act upon

Block Ca++ channels on first order neuron so doesn't allow first order neuron to depolarize Good for neuralgia/neuropathic pain

What part of the ascending pain pathway do NSAIDs act upon

Block PG production

Referred pain

Experienced in clients with tumors Pain is felt in a part of the body other than its actual source.

An older adult client with postherpetic neuralgia reports deep tissue pain. Which skin infection does the nurse expect to observe in the client's electronic medical record?

Herpes Zoster. Herpes Zoster can leave the client with deep pain after the lesions have resolved.

General Descending pain pathway

Inhibitory pathway Analgesic pathway Inhibits pain signal transmission back to the brain Releases chemicals into the synapses of the ascending pathway

What happens when PG is released?

It triggers sensory nerve fibers which will carry the nerve impulse to the dorsal horn of the spinal cord

What part of the ascending pain pathway do Lidocaine/Bipuvicaine act upon

Local anesthetic Block NA- channels and prevent first order neuron from firing

Cellulitis is associated with

Lymphadenopathy and fever

Hyperalgesia

More pain than expected from a given stimulus

ACEs in pain

Need to treat underlying psychosocial trauma too

Descending pathway is controlled by what

Nerves that contain serotonin and norepinephrine

intractable pain

Neuropathic pain that is severe, constant paint that is not curable Chronic pain

Allodynia

Pain due to a stimulus that does not normally provoke pain

Pain cannot be measured objectively

Pain is a complicated biopsychosocial phenomenon. Genetics influence how frequently peripheral nerves fire and how robust descending pain pathway is. Also, everyone has different past experiences that influence how thalamus reacts to pain signal

Thalamus role in Pain Pathway

Relay Station Can either amplify or inhibit pain signals

How do SSRIs work for pain

Serotonin reuptake inhibitors

A client who had thoracic surgery reports pain at the incision site when coughing and deep breathing. Which action would the nurse take?

Supporting the wound with a pillow when coughing relieves some of the pain because it provides support to the incised chest wall. Pain at the incision site when coughing and deep breathing is expected; it does not indicate a need to place the client in the supine position and to inspect the wound site.

Why is caring and empathetic behavior important when caring for someone in pain?

Thalamus acts as the "relay station" in the brain and can decrease or amplify these pain signals based on a variety of contextual signals

What do serotonin and norepinephrine do in the descending pain pathway

They inhibit the first order nerve from firing and second from depolarizing

Drug habituation

a mild form of psychologic dependence on a drug - individual developed a habit of taking the substance

What do inflamed damaged cells release

cytokines, specifically prostaglandins (PG)

Psychological dependence

emotional reliance on the substance to maintain a sense of well-being

What are C-fiber nerves responsible for?

mechanical and thermal (less pain) This is why if you have muscle pain and you rub your muscle, the c fibers override the transmission of pain - overriding before getting to the brain

Candidiasis is associate with

oral whitish lesions

Visceral pain

pain arising from internal organs

Physical addiction

related to biochemical changes in body tissues, especially the nervous system. The tissues come to require the substance fo usual function.

Descending pain pathway role

responsible for controlling and inhibiting ascending pathway

Ascending pain pathway role

responsible for transmitting pain signal to brain Spinal cord (via the spinothalamic tract) --> medulla --> pons --> midbrain --> thalamus --> respective part of the brain

What pain are A-delta nerve fibers responsible for

sharp, discriminatory pain

Methadone therapy

substitutes a legal drug for an illegal one

Herpes simplex is associated with

vesicles that evolve to pustules that rupture, weep, and crust