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NUR1022C ch.30 Pain Management
Terms in this set (68)
Margo McCaffery pain definition
"whatever the person says it is, and existing wherever the person says it does"
origin of pain
refers to the site where the pain is felt, not necessarily the source of pain
arises in skin or subcutaneous tissue; ex: touching a hot object
caused by the stimulation of deep internal pain receptors; most often experienced in the abdominal cavity, cranium, or thorax; ex: menstrual cramps, labor pain, GI infections, organ cancers
deep somatic pain
originates in the ligaments, tendons, bones, nerves, and blood vessels; more diffuse and lasts longer than cutaneous pain; ex: fracture, sprain, arthritis
starts at the origin but extends to other locations
occurs in an area that is distant from the original site
pain that is perceived to originate from an area that has been surgically removed
pain that is beleived to arise from the mind; pt perceives the pain despite the fact that no physical cause can be identified
2 types of physical pain
nociceptive and neuropathic
most common type of pain; occurs when pain receptors (nociceptors) respond to stimuli that are potentially damaging; most commonly described as aching
2 types of nociceptive pain
visceral pain and somatic pain
pain originating from the skin, muscles, bones, and connective tissue
complex and chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals, even in the absence of painful stimuli; often described as burning, numbness, itching, and "pins and needles"
short duration and rapid onset; it is protective in that it indicates potential or actual tissue damage
pain that has lasted for 6 months or longer and often interferes with daily activites; pt's may experience periods of remission and exacerbation; occurs in pt's with cancer
both chronic and highly resistant to relief
what body part has the most nociceptors?
the skin has the most, internal organs have the least
nociceptors become activated by the perception of potentially damaging mechanical, thermal, and chemical stimuli
activates nociceptors in surrounding tissues and also acts as a powerful vasodialator that triggers release of inflammatory chemicals that cause injured area to become inflamed
most frequent cause of pain
peripheral nerves carry pain messages to the dorsal horn of the spinal cord; pain is conducted to the spinal cord through either 2 types of fibers: A-Delta fibers or C fibers
large diameter, myelinated fibers that transmit fast pain impulses from acute, focused mechanical and thermal stimuli; pleasurable stimuli to skin receptors, such as massage, also stimulates A-Delta fibers
smaller, unmyelinated fibers that transmit slow pain impulses (dull, diffuse pain that travels at a slow rate); ex: if you bumpp your knee, the lingering ache is transmitted by the C fibers
A-delta fibers synapse with...
long fiber neurons that cross the spinal cord and transmit the message directly to the brain
C fibers synapse with...
shorter fiber neurons that pass through several synapses before reaching the brain
an important neurotransmitter required to communicate pain messages across any synapse
where are the pain impulses transmitted to?
the thalamus of the brain
3 regions of the brain the thalamus directs pain impulses to
1. somatosensory cortex
2. limbic system
3. frontal cortex
perceives and interprets physical sensations
involved in emotional reactions to painful stimuli
involved in thought, reason, and recognition of pain
the point at which the brain recognizes and defines the stimulus as pain
the duration or intensity of pain a person can endure
extreme sensitivity to pain
a process that changes the perception of pain either by facilitating or inhibiting pain signals; 2 methods of modulation: the endogenous analgesia system, the gate-control theory
endogenous analgesia system
provides pain relief via production of endogenous opioids and also blocks continuing pain impulses
naturally occuring analgesic neurotransmitters that inhibit the transmission of pain impulses and the release of substance P
3 neurotransmitters that endogenous opioids inhibit
where do endogenous opioids bind to?
opiate receptor sites in the central and peripheral nervous systems at 4 receptor sites:
what are the 4 opiate receptor sites also involved in?
reception when pt's take pain medication; each site has a different affinity for each medication
"gate" that either allows or blocks the transmission of pain sensation to the brain
steps in around-the-clock dosing
1st determine the dosage that relieves the pain to the pt's desired level, then observe how long the dose lasts; administer the next dose before the last dose wears off
how do NSAIDs act?
they act primarily in the periphearl tissues by interfering with the production of prostaglandins (which sensitize pain receptors and are involved with inflammation)
most common side effects of NSAIDs
why is aspirin a unique NSAID?
in addition to reducing inflammation, fever and pain, it can also inihibit platelet aggregation
is it ok to combine 2 NSAIDs?
no, it increases the risks of side effects and may not be more effective
very little anti-inflammatory effects; it does have analgesic and fever-reducing properties and is probably the safest of the nonopioids; it CAN cause severe hepatoxicity
which opiate receptor is the most effective in reducing pain?
drugs that stimulate the mu receptors and are used for acute, chronic, and cancer pain; ex: codeine, morphine, hydromorphine (Dilaudid), fentanyl, methadone, and oxycodone; excellent for breakthrough pain
pain that "breaks through" the relief provided by analgesics; drugs used for breakthrough pain should have rapid onset and brief duration
what is the maximum daily dose limit for opioid analgesics?
none, these drugs have no "ceiling" on their analgesic effects, but pt's can build tolerance to them and require a higher dosage
these medications stimulate some opioid receptors but block others; ex: Talwin, Nubain; THESE SHOULD NOT BE GIVEN TO PT'S TAKING MU-AGONISTS because they act as antagonists at the mu receptor sites and reduce or reverse the analgesic effect
side effects of opioids
- respiratory depression
patient controlled analgesia; safe and effective and gives pt a sense of control over the pain
why should you educate the patient about the "lockout" feature on the PCA pump?
because they may not activate the pump enough to relieve the pain in fear of overdosing
used in conjunction with opioids to reduce the amount of opioid needed
chemical pain relief measures
- nerve blocks
- epidural injections
- local anesthesia
- topical anesthesia
an anesthetic agent is injected into or around the nerve that supplies sensation to a specific part of the body
radiofrequency ablation therapy
uses electromagnetic waves that rtavel at the speed of light to target nerves that carry pain impulses; provides long-term pain relief
interrupts pain and temperature sensation below the tract that is severed
interrupts the anterior and posterior nerve route that is located between the ganglion and the cord; can be done safely at any level on the spine but is most commonly used for head and neck pain associated with cancer
used to eliminate intractable localized pain; the pathways of the peripheral or cranial nerves are interrupted to block pain transmission
severs the path to the sympathetic division of the autonomic nervous system
4 physiological steps involved in the pain process
what are some of the common pain scales used?
- VAS, visual analog scale
- NRS, numerical rating scale
- SDS, simple descriptor scale
- Wong-Bkaer scale, faces scale
who should determine if the patient is in pain?
in which patients are NSAIDs contraindicated for?
pt's with impaired blood clotting, renal disease, GI bleeding or ulcers
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