foundations exam 3 - pain

what is pain

whatever the person says it is, existing whenever they say it does even if no cause is found. individual and subjective experience that only the patient can describe and feel.

can pain be quantitative

no, we rely on what the pt says

activation of pain receptors (nociceptors) in periphery, painful stimuli converted to electrical impulses that travel from periphery to spinal cord

transduction

nociceptors

pain receptors that sense mechanical, thermal, and chemical stimuli

nociception

the ability to feel pain

mechanical stimuli examples

friction from bed linens, pressure from cast

thermal stimuli examples

sunburn, cold water on tooth

chemical stimuli examples

acid or chemical burn

electrochemical signals routed from nociceptors travel along the length of a nerve to the dorsal horn of the spinal cord and brain

transmission

Pain sensations are conducted along _____ pathways to the spinal cord and brain.

ascending

_____ fibers carry impulses from the pain receptors towards the brain with fast conducting ____ fibers and slow conducting ____ fibers

afferent, A-delta, C

A-delta fibers

myelinated, larger, transmit acute/well-localized pain

C fibers

unmyelinated, smaller, convey dull/achy/poorly-localized pain

interprets quality of pain

cerebral cortex

the pain stimulus reaches the cerebral cortex, where the brain interprets the quality of pain (sharp,dull,aching) and processes information from past experiences, knowledge, and cultural associations in the ____ of pain

perception

identifies location and intensity of pain. in this part of the pain pathway, triggers for anxiety, fear, and depression can occur with painful stimulus.

somatosensory cotrex

perception gives _____ to pain, resulting in a reaction that is both ____ and ____ responses

awareness, behavioral, physiologic

modulation

the process by which pain is inhibited or modified through the release of neuromodulators

where does pain relief begin

in the dorsal horn, chemicals such as endorphins are released to diminish the pain message from the injured site

endogenous opioid compounds that have analgesic effect that alters pain perception

endorphins

protective pain reflex

responsible for withdrawal of an endangered tissue from a damaging stimulus. A-delta fibers send impulses to the cord where they synapse with spinal motor neurons. The motor impulses travel by a reflex arc along efferent nerve fibers back to a peripheral muscle near the site of the pain stimulus where contraction to the muscle leads to protective withdrawal from pain source

the gate control theory of pain

model used to describe how pain works, painful stimuli can be blocked by nonpainful stimuli. neurological gate decides which pain signals can pass through

the gate control theory of pain example

rubbing an injured area to reduce pain

remission

disease is present, but person is not experiencing pain

exacerbation

symptoms reappear

Biases and Misconceptions About Pain

Nurses need an awareness of their own personal feelings towards pain (especially chronic pain) and the factors that affect pain if they are to assess and manage their patient’s pain creatively and effectively

normal pain process

nociceptive pain

treatment for nociceptive pain

nonopioids and opioids (acetaminophen, oxycodone)

pain caused by a lesion or disease of peripheral or central nerves (phantom limb pain or pain from spinal cord injury).

neuropathic pain

neuropathic pain tx

analgesics (gabapentin)

neuropathic pain is often ___ and ___ in duration

chronic, short

neuropathic pain is described as

burning shooting shock like tingling stabbing numbness

what is a common feature of neuropathic pain

allodynia

examples of neuropathic pain

sciatica, phantom limb

common complication of long term diabetes

diabetic peripheral neuropathy

diabetic peripheral neuropathy

tingling , pins and needles in legs and feet, reduced ability to feel temperature and pain in feet, sharp pain that worsens at night

nonopioid analgesics

aceptaminophen and NSAIDs

opioid analgesics

narcotics, controlled substances like morphine, codeine, oxycodone, vicodin

adjuvant drugs

drugs in other classes that are typically used for other purposes but can relieve some type of pain. they can be anticonvulsants, antidepressants, gabapentin)

what provides more analgesia than either drug taken alone

combining nonopioids with opioids

drug of choice for acute and moderate pain

nonopioid analgesics

drug of choice for moderate to severe pain

opioid analgesics

what pain is difficult to treat without opioids

cancer pain

opioids are very effective for what types of pain

peripheral/nociceptive, acute due to injury, chronic/arthritis, cancer