Pain

Nociceptive Pain Nociceptive pain is the most common type of pain. This type of physiologic (physical) pain occurs when nociceptors are stimulated in response to trauma, inflammation, tissue damage, or surgery. This pain is felt as sharp, burning, aching, cramping, or stabbing. Nociceptive pain originates in visceral and somatic locations, and may be referred or radiating. > Visceral Pain > Somatic Pain > Referred Pain > Radiating Pain

> Visceral Pain Originates from organs within the body. Gradual in onset and tends to last longer than other types of pain. Occurs from conditions such as chronic pancreatitis, inflammatory bowel disease, bladder distention, and cancer. Generally described as dull, cramping, or aching and lasts for a long duration. Somatic Pain Pain emanating from the skin, muscles, joints, and bones. Occurs from conditions such as sunburn, lacerations, fractures, sprains, arthritis, and bone cancer. Generally sharp, burning, stabbing, localized, and lasts for a short duration. Referred Pain Felt in a location of the body other than where it originated. Originates in internal organs, but is often felt in other locations. Example: pain from the pancreas is felt in the back, or pain from a heart attack is felt in the jaw or left arm. Radiating Pain Extends from the source of pain (injury) to an adjacent area of the body. Example: gastroesophageal reflux. Pain originates in the stomach and radiates up the esophagus.

How is pain classified? Select all that apply. By cause By pathophysiology By abnormality By intensity By duration

Answer: By cause By pathophysiology By duration Explanation: By cause Pain is classified by cause, such as pain that results from a nerve injury that persists without stimuli. By pathophysiology Pain is classified by pathophysiology, such as pain that stems from cancer or cancer treatment. By abnormality Pain is not is classified by abnormality. By intensity Pain is not classified by intensity. By duration Pain is classified by duration, such as acute pain lasting less than six months.

What is acute pain? Pain that lasts more than six months. Pain that is classified as a disease condition. Pain that lasts less than six months. Pain that never goes away.

Answer: Pain that lasts less than six months. Explanation: Pain that lasts more than six months. Chronic pain is pain lasting more than six months. It persists over a long period of time and is resistant to many medical treatments. Pain that is classified as a disease condition. Chronic pain is now believed to be a chronic disease condition in the same manner as diabetes and asthma. Pain that lasts less than six months. Acute pain results from disease, inflammation, or injury to tissues and lasts less than six months. Pain that never goes away. Acute pain is self-limiting, which means it is confined to a given period of time and severity.

What type of pain stems from trauma, inflammation, tissue damage, or surgery? Nociceptive pain Referred pain Chronic pain Phantom pain

Answer:Nociceptive pain Answer: Nociceptive pain Nociceptive pain occurs when nociceptors are stimulated by trauma, inflammation, tissue damage, or surgery. Referred pain Referred pain is felt at a site other than where the cause originated. Chronic pain Chronic pain persists despite the fact that the injury has healed. Phantom pain Phantom pain occurs when the brain continues to receive messages from an area of amputation.

Why may women report being in more pain than men? Due to childbirth experiences Differences in estrogen and testosterone Differences in body type Due to menstrual problems

Answers: Differences in estrogen and testosterone Explanation: Due to childbirth experiences Childbirth is not considered to be a factor in reporting pain. Differences in estrogen and testosterone Women report being in more pain than men, which may be due to differences between estrogen and testosterone. Differences in body type Differences in body types are not considered to be a factor in reporting pain. Due to menstrual problems Menstruation is not considered to be a factor in reporting pain.

What factors may be signs of pain in a person with impaired cognition? Select all that apply. Facial expressions Vocalization of noises Blinking of eyes Changes in physical activity Changes in routines

Answers: Facial expressions Vocalization of noises Changes in physical activity Changes in routines Explanation: Facial expressions Facial expressions may be a sign of pain in a person with impaired cognition because they are unable to communicate effectively. Vocalization of noises Vocalization of noises may be a sign of pain in a person with impaired cognition as their attempt to communicate their pain. Blinking of eyes Blinking of eyes is not considered to be a sign of pain in a person with impaired cognition. Changes in physical activity Changes in physical activity may be a sign of pain in a person with impaired cognition because the pain may prevent them from performing their normal tasks. Changes in routines Changes in routines may be a sign of pain in a person with impaired cognition due to reduced or limited abilities resulting from the pain.

What are some characteristics that play a role in how a patient may react to pain? Select all that apply. Gender Culture Blood type Disability Age

Answers: Gender Culture Disability Age Explanation: Gender Gender plays a role in how a patient might react to pain. For instance, women tend to seek help for pain more than men do. Culture Culture plays a role in how a patient might react to pain. For example, African-Americans and Hispanics tend to wait until pain is severe before taking medication. Blood type Blood type does not play a role in how a patient might react to pain. Disability Disability plays a role in how a patient might react to pain. For example, patients with impaired cognition may not be able to communicate their pain effectively. Age Age plays a role in how a patient might react to pain. For example, young children generally display pain by crying. Distraction may be useful when treating their pain.

Differences in individual characteristics play a role in how patients react to pain and in their perception of pain. Studies of pain and patient's perception of pain provide insight into factors that influence a person's pain experience. Some of those considerations are: Gender Culture, Ethnicity, Religion Disability Morphology Age

Gender Pain management can be influenced by gender. Studies indicate that: Women report being in more pain than men, which may be due to differences in estrogen and testosterone levels (Mitchell, 2010). Women seek help for pain more often than men do, but women are less likely to receive treatment (Partners Against Pain, 2014). Women are more likely to be given sedatives for pain, while men are more likely to be given analgesics for pain (Partners Against Pain, 2014). Culture, Ethnicity, Religion Individuals of the same culture, ethnicity, or religion may express pain differently, and pain treatment may vary depending on that person's beliefs. Studies indicate that: Non-Hispanic white adults report more pain than other races (Mitchell, 2010). African Americans and Hispanics are undertreated and wait until pain is severe before taking pain medication (Mitchell, 2010). Asian patients may try to hide cancer pain because it is believed by some to be a punishment for sins of the past (IM, Lee, Lim, et al, 2009). Disability Some patients cannot respond to pain while others may require adjustments in pain dosages to meet their needs. Patients with impaired cognition may not be able to communicate pain. Facial expressions, vocalization of noises, or changes in physical activity or routines may be signs of pain. Non-cognitive pain assessment tools should be used for these patients. Patients who are intubated may be able to write or point to a pain assessment tool to indicate their level of pain. If they cannot, blood pressure elevations, restlessness, or other physical parameters can be used to assess for pain. Morphology Research indicates that obese people tend to experience more pain in more locations than individuals of average weight (Janke, Collins, and Kozak, 2007). For these individuals, pain medication dosages may need to be adjusted on the basis of height and weight, due to body surface area and metabolic differences. Age Preterm infants may display behaviors different from those of term infants due to neurologic immaturity (Holsti and Grunau, 2007). Young children generally display pain by crying. Distraction may be useful when treating their pain. Pain sensation is just as acute in older adults as in young-adult patients, but the transmission of pain impulses may be altered by chronic diseases or conditions (D'Arcy, 2009). Older adults who are depressed or cognitively impaired may be unable to accurately describe their pain. Alternate pain assessment methods should be employed.

Types of Pain Other types of pain include neuropathic, psychogenic, acute, and chronic pain. Neuropathic Pain Psychogenic Pain Acute Pain Chronic Pain

Neuropathic Pain Originates from nerve injury. Pain continues even after the painful stimuli is gone. Sensations may include numbness, tingling, burning, aching, crushing, stabbing, or shooting. Other associated conditions include:Dysesthesia (unpleasant, abnormal sensation)Allodynia (pain from non-injury stimuli)Hyperalgesia (excessive sensitivity)Hyperpathia (greatly exaggerated pain reaction to stimuli) Associated with tumors, infection, chemotherapy, diabetes mellitus, cerebrovascular accident (such a stroke), viral infections, carpal tunnel syndrome, and phantom limb pain (brain continues to receive messages following amputation of a limb). Psychogenic Pain Pain perceived by a person when there is no physical cause for pain. Caused, increased, or prolonged by mental, emotional, or behavioral factors. Sensations may include headache, back pain, stomach pain. Acute Pain Rapid onset. Short duration (less than 6 months). Subsides with healing of injury. Associated with trauma, obstetrical labor, acute distress, or trauma. Chronic Pain Persistent pain. Long duration (greater than 6 months). May be episodic or continuous. May lead to disability. Associated with arthritis, fibromyalgia, and neuropathy. Breakthrough pain is an increase in pain when chronic pain already exists.Breakthrough pain is associated with surgery, injury, or a fluctuation in pain from an existing condition, such as cancer.

Classifying Pain

There are different ways to classify pain, for example, by: > Cause: Cancer, cardiac > Pathophysiology: Nociceptive, physiologic, neuropathic > Duration: Acute pain (lasting less than six months), chronic pain (lasting more than six months) Treatment for each type of pain, regardless of how pain is classified, is different because each person's response to pain is different.