Types of Pain

Radiating Pain

Extends from the source of pain (injury) to an adjacent area of the body. Ex. gastroesophageal reflux. Pain originates in the stomach and radiates up the esophagus.

When caring for a psychiatric patient who is complaining of headaches with no relief, a nurse asks a nursing student how psychogenic pain may present. Which response indicates that the nursing student understands what psychogenic pain is? "It is pain lasting greater than six months." "It is pain perceived by a person when there is no physical cause." "It is pain that starts at a point in the body and travels to another area." "It is pain that is felt in an area in the body different from where it originated."

"It is pain perceived by a person when there is no physical cause."

Somatic Pain

- Emanates from skin, muscles, joints, bones - Occurs from: sunburn, lacerations, fractures, sprains, arthritis, bone cancer - Feels like: sharp, burning, stabbing, localized - Short duration

Diversity Considerations (Disability)

- Impaired cognition: not able to communicate pain -- use noncognitive pain assessment tools - patients intubated may write or point - If people cannot, blood pressure elevations, restlessness, or other physical parameters can be used to assess for pain.

Diversity Considerations (Culture, Ethnicity, Religion)

- Nonhispanic white adults report more pain than other races - AA and Hisp under treated and wait until pain is severe before taking meds - Asians hide cancer pain because it is a punishment for sins of the past

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.

Diversity Considerations (Age)

- Preterm infants display different behaviors than regular infants due to neuro immaturity - young children display pain by crying - pain sensation is just as acute as older adults - older adults who are depressed or cognitively impaired may be unable to accurately describe pain

Acute Pain

- rapid onset - short duration - subsides with healing of injury - A/W: trauma, OB labor, acute distress

Neuropathic Pain

- from nerve injury - continues after stimuli is gone - numbness, tingling, burning, aching, crushing, stabbing, shooting - Other associated conditions: dysesthesia, allodynia, hyperalgesia, hyperpathia - A/W: tumor, infection, chemo, diabetes, CVA, viral infection, carpal tunnel, phantom limb

Diversity Considerations (Morphology)

- obese people experience more pain in more locations that those of average weight - adjust medication doses based on height/weight and body SA and metabolic differences

Visceral Pain

- originates from organs - gradual onset, tend to last longer than other types of pain - Occurs from: chronic pancreatitis, IBD, bladder distention, cancer - Described as: dull, cramping, aching - long duration

Chronic Pain

- persistent, longer duration (greater than 6mo) - episodic or continuous - leads to disability - A/W: Arthritis, fibromyalgia, neuropathy - breakthrough pain

Diversity Considerations (Gender)

- women report more pain than men (may be due to differences in estrogen and testosterone) - women seek help more often but less likely to receive treatment - women more likely to be given sedatives, men more likely to be given analgesics

The triage nurse in the emergency department realizes that which patient is more likely to report being in pain? A 65-year-old female with a history of thyroid cancer A 44-year-old male with a history of heart failure A 72-year-old male with Alzheimer's disease A 3-year-old female with asthma

A 65-year-old female with a history of thyroid cancer

When the nurse in the primary care provider's office reviews past medical histories, which patient should she be concerned may hide a past diagnosis of cancer pain due to cultural beliefs? African American males Caucasian females Asian females Hispanic males

Asian females

A nurse has been caring for a patient with osteosarcoma. The patient recently had surgery and is now complaining of pain around the surgical site in addition to the dull pain in the leg. The nurse suspects that the patient has chronic pain, but is currently experiencing which type of pain? Breakthrough pain Acute pain Phantom limb pain Chemo pain

Breakthrough pain

A nurse is caring for a patient on the cancer floor. The patient states that she has been battling breast cancer and associated pain for over two years. She claims that the worst pain is the numbness in her fingers that she has been experiencing for the past three months due to the chemotherapy treatments. Which identifies the cause, pathophysiology and duration (in the correct order) of this patient's acute pain? Chemo, hospital, two years Cancer floor, treatment, two years Chemo, breast cancer, three months Cancer, numbness due to chemo, three months

Cancer, numbness due to chemo, three months

A nurse can adequately classify pain by asking the patient questions focusing on which factors? Select all that apply. Cause of pain Intensity of pain Pathophysiology of pain Personal thoughts of pain Duration of pain

Cause of pain Pathophysiology of pain Duration of pain

Ways to classify pain

Cause: Cancer, cardiac Pathophysiology: Nociceptive, physiologic, neuropathic Duration: Acute pain (lasting less than six months), chronic pain (lasting more than six months)

At eight months post-knee surgery the patient still complains of tenderness of the knee and finds it difficult to walk without feeling a tingling pain. Which nursing diagnosis is priority for this patient? Chronic pain Acute pain Psychogenic pain Neuromatrix pain

Chronic pain

Diversity Considerations

Gender Culture, ethnicity, religion Disability Morphology Age

An older adult male is complaining of chest pain. The nurse is able to identify that the patient is experiencing acute pain by asking which question? Have you been in pain longer than six months? Have you been in pain less than six months? Is the pain worse when you are sitting or standing? On a scale of 1-10, how bad is your pain?

Have you been in pain less than six months?

Breakthrough pain

Increase in pain when chronic pain already exists - A/W: surgery, injury, fluctuation in pain from existing condition such as cancer

The patient feels a dull achy, pain, which originated in his side. It has lasted for a while, but had a gradual onset. Knowing this patient presents with visceral pain, what might the patient be experiencing? Headache Arthritis Inflammatory bowel disease Stomach cramps

Inflammatory bowel disease

Types of Pain

Neuropathic Psychogenic Acute Chronic

Most common type of pain

Nociceptive

A nurse is caring for an amputee who often asks for pain medication. The nurse realizes that the patient is experiencing neuropathic pain, but more importantly what specific type of neuropathic pain? Breakthrough pain Acute pain Chronic pain Phantom limb pain

Phantom limb pain

A pregnant patient in her last trimester is unable to eat due to the amount of pain she is experiencing because of gastrointestinal reflux. When the nurse is charting her pain, what type of pain is identified? Physiologic pain Somatic pain Neuropathic pain Radiating pain

Radiating pain

An older adult patient presents to the emergency department complaining of sharp jaw pain. The triage nurse knows this is one of the classic signs of a heart attack. What type of pain does the triage nurse understand this patient is experiencing? Radiating pain Referred pain Visceral pain Somatic pain

Referred pain

The nurse is caring for a one-year-old with fever. He is crying continuously and cannot be comforted with food or by being held. What are the most appropriate actions for the nurse to do next? Select all that apply. Keep trying to feed the child. Sing a song to the child. Document the pain. Ask for additional assistance. Assess the child's pain.

Sing a song to the child Assess the child's pain

A pediatric patient presents to the pediatrician's office complaining of ankle pain. The mother states that the child wakes up every day complaining and the ankle seems to be swollen, but the swelling goes down throughout the day. After many tests are completed, the patient is diagnosed with juvenile arthritis. What type of nociceptive pain will the child have to endure with this diagnosis? Visceral pain Somatic pain Referred pain Radiating pain

Somatic pain

Which medication is a woman more likely to be prescribed for pain? Tylenol Motrin Versed Toradol

Versed

Referred Pain

pain felt in a part of the body other than its actual source - Originates from internal organs Ex. pain from the pancreas is felt in the back, or pain from a heart attack is felt in the jaw or left arm.

Nociceptive Pain

physiologic (physical) pain occurs when nociceptors are stimulated in response to trauma, inflammation, tissue damage, or surgery. Felt as: sharp, burning, aching, cramping, or stabbing. Originates: visceral and somatic locations, may be referred or radiating