Pain Management and Sleep Disorders

Flashcards focusing on terms and concepts related to pain management and sleep disorders.

Aspirin

Medication that decreases platelet aggregation.

QUESTT

A pain assessment method: Question the patient, use appropriate pain rating scales, evaluate behavior & physiologic changes, secure family involvement, take cause into account, take action and evaluate results.

REM Sleep

Sleep necessary for brain tissue restoration.

Neuromodulators

Natural supply of morphine-like substances in the body.

Narcolepsy

Syndrome involving sudden sleep attacks that a person cannot inhibit. Uncontrollable desire to sleep may occur several times during a day

Referred Pain

Pain felt at a site away from the site of injury. Origin may be somatic (involving muscles or joints) or visceral (involving visceral organs) ; may be no where close to original site ; related to shared neural pathways

Moaning, Groaning

Verbal indicators of pain.

Adjuvants

Medications that have analgesic properties, enhance pain control, or relieve symptoms associated with neuropathic pain.

Addiction

A primary, chronic neurobiological disease (with genetic, psychosocial and environmental factors) characterized by compulsive drug seeking despite adverse consequences.

Naloxone

Medication that reverses analgesic effects and can initiate withdrawal symptoms. Use only when necessary!

PAINAD

Scale for clients with advanced dementia that assesses pain through facial expressions, breathing, and body language to assess for pain.

Neuropathic Pain

Type of pain caused by primary lesion or damage to the central nervous system and involves abnormal excitability of afferent neurons, central sensitization following peripheral activation of neurons and activation of pro inflammatory cytokines. Characterized by burning, shooting, stabbing, electric, and/or numb

PQRST

A tool for pain assessment: Provocative/Palliative factors, quality, region/radiation, severity, timing, U (how is the pain affecting you?)

Pseudoaddiction

iatrogenic syndrome created by the under-treatment of pain (“Drug-seeking behaviors” not rlly)

Constipation, Respiratory Depression

Common side effects of opioids.

PCA

Patient-controlled analgesia, a self-administered drug delivery system for pain management.

Visceral Pain

Deep pain resulting from pressure, stretch or damage to internal organs, often difficult to localize. Nausea or sweating as a response to stimulation of nerve endings that are at the site of pain and that relay signals to the CNS.

RASS

Richmond Agitation & Sedation Scale used to assess sedation levels. (Ranks clients from unarousable to combative)

Chronic Pain

Persistent pain lasting more than >3-6 months without an identifiable cause. Major cause of psychological and physical disability, leading to problems like job loss, inability to perform simple daily activities, sexual dysfunction, and social isolation.

Ibuprofen

Analgesic and anti-inflammatory, antipyretic medication; can cause gastrointestinal bleeding, increased MI, stroke, nephrotoxicity.

Phantom Pain

Pain perceived as coming from a body part that is no longer present.

Withdrawal syndroms

N& V, abdominal craping, muscle twitching, profuse perspiration, delirium and convulsions (ANS effects)

POSS

Pasero opiod- induced sedation scale; ranks clients from asleep, easy to arouse to somnolent

Somatic pain

Type of sharp, well-localized pain emanating from the skin due to superficial damage may be deep and originating from muscles, tendons or joints. It can be aching, throbbing, sharp but easy to localize

Acute pain

Type of pain that has an identifiable cause, is of short duration, and has limited tissue damage. Is protective; warns of danger, injury. If not adequately controlled, unrelieved can progress to chronic pain.

Blurred vision, slow response time

Physiological Sleep Deprivation Symptoms are some of the responses. Others include agitation, decreased judgment, and increased sensitivity to pain.

Melatonin

A neurohormone produced in the brain that helps control circadian rhythms and promote sleep

Sleep apnea

This is a disorder in which an individual is unable to breathe and sleep at the same time.

Acetaminophen

Medication useful for fever & mild pain; Often combined with opioids for moderate-severe pain. Maximum daily dose for most clients = 4 grams/day.

6-8.5 hrs

Normal sleep requirements for a young adult

Pain

This is the subjective, unpleasant sensation caused by noxious stimulation of sensory nerve endings.

Nonpharmacological approaches

Interventions that can be used alone or in combination with pharmacological measures to relieve pain; includes acupuncture, massage, osteopathic and chiropractic manipulation, cognitive-behavioral intervention, meditative movement and mind-body interventions, and dietary and self-management approaches to pain management

Faces Scale

Pain scale originally for pediatric patients that provides a pictorial representation of pain intensity

Tolerance

State of adaptation in which exposure to a drug results in a decrease in one or more of the drug’s effects over time

Morphine Sulfate

The standard medication by which other opioid effectiveness is compared.

Impacted of unrelieved pain

Repeated pain experiences may LOWER the pain threshold and contribute to pain syndromes later in life – especially if pain not well managed

Biases and Misconceptions

Why pain is often poorly managed

Visceral pain

P that is deep, resulting from pressure, stretch or damage to internal organs. Can nausea or sweating as a response to stimulation of nerve endings that are at the site of pain and that relay signals to the CNS. Pain is dull and aching and difficult to localize. 

Oversedation

Factors that increase the likelihood of a level of sedation at a greater level than desired. Factors include Renal or cardiac disease, Respiratory disease, COPD, asthma, OSA, snoring, smoker, Concurrent use of sedating medications, ↑Age, Obesity, neck circumference, length of surgery. “Opioid Naive”, “Opioid tolerant” who need much higher doses to control pain

Physical Dependance

Adaptation manifested by a drug-class–specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist

Age, Culture, Gender, Heridity

Factors Relating to the Client’s Experience of Pain

Insomnia

A symptom that patients experience when they have chronic difficulty in falling asleep, frequent awakenings from sleep, and/or a short sleep or non restorative sleep

Nociceptive pain

Normal or nociceptive pain is the protective physiological series of events that brings awareness of actual or potential tissue damage

OLD CARTS

O-Onset; L—Location; D—Duration:  C—Characteristics; A—Aggravating; R—Relieving; T—Treatment ;S—Severity

NREM Sleep

Sleep stage where body tissue is restored via • slowed biological functions (decreased HR, RR, BP etc.) • Release of human growth hormone for tissue repair & renewal

Chronic pain

Persistent pain; duration usually > 3-6 months; does not always have an identifiable cause.

A major cause of psychological and physical disability, leading to problems such as job loss, inability to perform simple daily activities, sexual dysfunction, and social isolation.

Comfort

State of physical ease and freedom from pain or contraint

Meperidine

Drug Removed from the world health organization’s list of essential medicines

Transduction

Process where energy produced by noxious stimuli is converted into electrical impulses

Rubbing, guarding

Non verbal pain indicators

WHO Analgesic Ladder

Recommended approach for the slow introduction and upward titration of analgesics for managing pain.

When to assess pain

5^th vital sign (Assess on admission & at least every 4 – 8 hours); Each report of pain; Before and after an intervention; Unexpected intense pain; Noted changes in a patient’s behavior

Withdrawl Syndroms

N&V, abdominal cramping, muscle twitching, profuse perspiration, delirium, and convulsions (autonomic nervous system effects)

Phantom Pain

Pain that feels like it's coming from a body part that's no longer there