Chapter 11: Pain Assessment

These flashcards cover the definitions, pathways, types, assessment tools, and developmental considerations for pain based on the Chapter 11 lecture notes.

Nociceptive pain

Pain that develops when functioning and intact nerve fibers in the periphery and CNS are stimulated; it is typically caused by physical or potential damage to the body or tissues from injury or inflammation.

Neuropathic pain

Pain due to a lesion or disease in the somatosensory system, indicating an abnormal processing of the pain message from damage to the nervous system.

Nociceptors

Specialized nerve endings designed to detect painful sensations and transmit them to the central nervous system via primary sensory afferent fibers.

$A\delta$ fibers

Myelinated and larger diameter nerve fibers that transmit pain signals rapidly to the CNS, resulting in localized, short-term, and sharp sensations.

C fibers

Unmyelinated and smaller nerve fibers that transmit signals more slowly, resulting in diffuse, aching sensations that persist after the initial injury.

Substantia gelatinosa

Specific area of the spinal cord, identified as Lamina $II$, which receives sensory input from various areas of the body and where fibers synapse with interneurons.

Transduction

Phase $1$ of nociception where noxious stimuli cause the release of chemicals like Substance P, histamine, prostaglandins, serotonin, and bradykinin to propagate a pain message.

Transmission

Phase $2$ of nociception where the pain impulse moves from the level of the spinal cord to the brain via the spinothalamic tract.

Perception

Phase $3$ of nociception characterized by the conscious awareness of a pain signal, involving cortical structures like the limbic system for emotional response.

Modulation

Phase $4$ of nociception where descending pathways release neurotransmitters such as serotonin, norepinephrine, and endorphins to inhibit or block the pain impulse.

Visceral pain

Pain originating from larger interior organs due to direct injury, stretching, ischemia, or distention; often accompanied by autonomic responses like nausea and diaphoresis.

Deep somatic pain

Pain derived from sources such as blood vessels, joints, tendons, muscles, and bone; described as aching or throbbing and is usually well localized.

Cutaneous pain

Superficial injury to the skin surface and subcutaneous tissues, characterized by a sharp, burning sensation.

Referred pain

Pain felt at a particular site that originates from another location because both sites are innervated by the same spinal nerve.

Acute pain

Short-term and self-limiting pain that follows a predictable trajectory and serves a self-protective purpose by warning of tissue damage.

Chronic (persistent) pain

Pain diagnosed when it continues for $6$ months or longer; it does not stop when the injury heals and outlasts its protective purpose.

Breakthrough pain

A transient spike in pain level with moderate to severe intensity in an otherwise controlled pain syndrome.

Subjective report

The gold standard of pain assessment, as pain exists whenever the patient says it does.

Brief Pain Inventory

A multidimensional assessment tool where the patient rates pain within the past $24$ hours on graduated scales ($0$ to $10$) regarding its impact on mood, walking, and sleep.

Short-form McGill Pain Questionnaire

A tool where patients rank a list of descriptors in terms of intensity and provide an overall intensity rating for their pain.

Numeric rating scales

Unidimensional pain assessment tools that ask the patient to choose a number that rates the level of pain on a scale from $0$ (no pain) to $10$ (worst pain).

PQRST Method

A mnemonic for pain assessment: P=Provocation/Palliation, Q=Quality/Quantity, R=Region/Radiation, S=Severity Scale, T=Timing.

Faces Pain Scale-Revised (FPS-R)

A tool for children aged $4$ or $5$ years consisting of $6$ drawings of pain intensity from "no pain" to "very much pain."

CRIES

A neonatal postoperative pain measurement score examining physiologic and behavioral indicators like Crying, Requires $O_2$ for Sat > $95$\%, Increased vital signs, Expression, and Sleeplessness.

FLACC

A nonverbal behavioral pain scale for infants and toddlers up to age $3$ assessing Face, Legs, Activity, Cry, and Consolability.

PAINAD Scale

The Pain Assessment in Advanced Dementia scale, which evaluates breathing, vocalization, facial expression, body language, and consolability; a score of $4$ or more requires treatment.

Complex Regional Pain Syndrome (CRPS)

A chronic progressive nerve condition (also known as RSD) characterized by intense pain triggered by an innocuous stimulus.