Chronic Conditions EOS - Chronic Pain

Explain the difference between acute and chronic pain
Acute: Sudden onset, usually temporary, localised. Lasts for less than 3 months, most often resulting from tissue injury, surgery or trauma
Chronic: Ongoing and prolonged. sometimes idiopathic, often results from acute pain
- Narcotic Opioid
- Used to treat 'breakthrough' pain (cancer)
- AE: weak, shallow breathing, pale skin, light headedness, SOB, N&V, constipation
Nociceptive Pain
Caused by damage to body tissue
Usually sharp, aching or throbbing
Can be caused by cancer cells
Neuropathic Pain
Occurs when there is actual nerve damage
Nerves connect the spinal cord to the body and allow the brain to communicate with the skin, muscles and internal organs.
Often described as a burning, heavy sensation, or numbness along path of effected nerve
Inflammatory Pain
Results from natural response following tissue damage (combination of inflammation and tissue damage causes pain)
Spontaneous Pain
Pain that is unpredictable and not associated with any activity or event.
heightened response to painful stimuli
stimuli normally a little uncomfortable become really uncomfortable
Secondary hyperalgesia
Heightened sensitivity to pain in tissue surrounding a damaged area.
Pain due to a stimulus which does not normally provoke pain
activation of sensory transduction in nerves by thermal, mechanical, or chemical energy impinging on specialized nerve endings; the nerves involved convey information about tissue damage to the CNS
Kim is being admitted to your surgical ward for an elective cholecystectomy (she also has gall bladder inflammation). What are the risks for Kim postoperatively given that she is already taking opioids for her chronic pain?
Cholycystectomy = removal of gall bladder

As she is already taking opioids, she has a higher tolerance which means a normal dose will no be sufficient in managing her post operative pain. pain is major stimulus of the surgical stress response which can increase blood glucose levels, blood pressure, cause clots and decrease digestion and immune response and the immune system is supressed which can result in an increase chance of infection. If not effectively managed can be responsible for a lot of post op complication and can slow down the healing process and time
Consider immediate analgesia that would be appropriate for burns
IV narcotic analgesics essential for client comfort
- monitor LOC, respiratory status and effectiveness of analgesia
How is fentanyl metabolised and excreeted?
Metabolised in liver
Excreted in kidney
What would be an appropriate long term analgesic for an 18 month old?
Paracetamol, ibuprofen or codeine
What pain assessment tools are available?
1. Visual Analogue Scale (VAS - long arrow from worse pain ever to no pain)
2. Numerical Rating Scale (1-10)
3. Faces Rating Scale (Crying - happy)
What does PQRST stand for in relation to pain
P - precipitating factors
Q - quality of pain
R - region/radiating
S - Severity - using rating scales
T - Timing
Apart from medication, what are 3 other ways to manage pain
1. physiotherapy
2. psychology - develop coping mechanisms etc.
3. occupational therapy - help manage daily tasks
What are some adverse effects of opioids?
Consipation - secondary to inhibition of GI motility
Sedation - usually short lasting before tolerance develops, use smaller doses more frequently
Respiratory Depression
Immune Suppression
Pt. presents at with right upper limb and shoulder pain following a fall, Pain described as dull aching and sharp
when moves arm, No other health issues, Recent still birth, Non smoker, occasional alcohol. Lives with partner and 3 children

What type of pain does she have?
What treatment would you expect her to have?