PAIN MANAGEMENT

Pain

Pain

is whatever the person says it is, and exists whenever he says it does.

Pain

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Pain by Margo McCaffery

Pain is whatever the person says it is, and exists whenever he says it does.

Effective Pain Management

is an important aspect of nursing care to promote healing, prevent complications, reduce suffering and prevent the development of incurable pain state.

Pattern Theory

This was presented by psychologist John Paul Nafe in 1929.

John Paul Nafe, 1929

Pattern Theory was presented by ______________________ in __________.

Pattern Theory

suggests that the nerves involved in detecting pain also detect other sensations.

Pattern Theory

According to this theory, there are no specific nerve fibers or endings used just for the sensation of pain. Instead, different sensations, such as cold, pain, heat and touch are detected by the same nerves, which then send specific signal patterns to the brain.

Pattern Theory

The brain interprets the pattern, which includes both the sensation and its intensity, and the specific sensation felt.

Phantom Limb Pain

a neuropathic pain experienced after a limb or part of a limb has been removed.

T

T OR F:
The pattern theory of pain was disproved when scientists discovered that there are unique nerve receptors for each type of sensation, including pain.

Specificity Theory

was developed by Max Von Frey in 1895.

Max Von Frey, 1895

The Specificity Theory was developed by ____________________ in __________.

Specificity Theory

The premise of the theory is that the brain has a completely separate area and system for perceiving pain, as it does for vision and hearing.

Specificity Theory

Pain is transmitted from independent nerve endings in the skin.

Specificity Theory

Pain signals that travel along dedicated pathways to a specific part of the brain called the “pain center”.

pain center

In Frey’s Theory, pain signals that travel along dedicated pathways to a specific part of the brain called the “_____________________”.

Specificity Theory

The brain processes the information in the pain center which creates the sensation of pain.

Specificity Theory

is no longer widely accepted.

Specificity Theory

It has been discredited by the study of phantom limb pain.

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T OR F:
People, who have undergone amputation of a limb may still report pain or other sensations that come from the missing limb (phantom limb pain).

Specificity Theory

is not supported in the case of phantom limb pain as there is no longer any tissue from which the individual should be receiving pain signals. Therefore, no pain would be experienced.

Specificity Theory

Another problematic issue with the theory is the use of hypnosis as anesthesia.

hypnosis

Another problematic issue with the specificity theory is the use of _______________ as anesthesia.

Gate Control Theory

First proposed in 1965 by Ronald Melzack and Patrick Wall.

Ronald Melzack and Patrick Wall, 1965

The Gate Control Theory was first proposed by _________________________________________ in _______.

Gate Control Theory

asserts that non-painful input closes the nerve “gates” to painful input, which prevents pain sensation from traveling to the central nervous system.

Gate Control Theory

describes how non-painful sensations can override and reduce painful sensations.

Gate Control Theory

A painful, nociceptive stimulus stimulates primary afferent fibers and travels to the brain via transmission cells.

closed gate

In the gate control theory, a __________________ describes when input to transmission cells is blocked, therefore reducing the sensation of pain.

open gate

describes when input to transmission cells is permitted, therefore allowing the sensation of pain.

substantia gelatinosa

Higher centers in the brain, especially those associated with affect and motivation, can capable of modifying the ___________________________.

substantia gelatinosa

influences the opening and closing of the gates.

Affect Theory

Originally attributed to the psychologist Silvan Tomkins.

Silvan Tomkins

Affect Theory was originally attributed to the psychologist _________________________________.

Affect Theory

a theory that seeks to organize affects or subjectively experienced feelings, into discrete categories and to typify their physiological, social, interpersonal, and internalized manifestations.

affect

Tomkins uses the concept of ___________ to refer to the “biological portion of emotion”, defined as the “hard-wired, pre-programmed, genetically transmitted mechanisms that exists in each of us”, which, when triggered, precipitate a “known pattern of biological events”.

biological portion of emotion

defined as the “hard-wired, pre-programmed, genetically transmitted mechanisms that exists in each of us”

Pain

is not simply a neurophysiological phenomenon, but also involves social and psychological factors.

Affect Theory

It says that factors like culture, family, nociceptive stimuli and environment influence pain perception and thus ultimately affect a person’s emotions, behaviors and cognition.

Parallel Processing Model

The brain’s ability to make sense of several different incoming stimuli at the same time.

senses

We use our __________ to take in information, which is then sent to the brain for processing.

cortex

the part of your brain responsible for thoughts and action, to give you an understanding of what you’re experiencing.

Parallel Processing Model

The entire process can be complicated and requires an understanding of many different brain and body systems. Many things are going on at the same time as your eyes and brain are working together to notice and understand the details of what is being experienced.

DEEP

Factors Influencing the Pain Experience

Ethnic and Cultural Values

Behavior related to pain is a part of socialization process.

Ethnic and Cultural Values

Individuals in one culture may learn to express more about pain, whereas individuals from another culture may have learned to keep those feelings to themselves.

cultural background

There appears to be little variation in pain threshold, _________________________ can affect the level of pain that an individual is willing to tolerate.

T

T OR F:
To become culturally competent nurses must become knowledgeable about differences in the meaning of an appropriate responses to pain.

Developmental Stage

is an important variable that will influence both the reaction to and the expression of pain

Developmental Stage: Children

less to articulate their experience or needs related to pain, which results to be undertreated.

Developmental Stage: Puberty

emergence of some pain syndromes in young women; pain related to occupation or risk taking patterns, burn pain, trauma pain, HIV/AIDS pain in young men

Older Adults

constitute the largest group of individuals seeking health care services prevalence of pain is higher due to acute and chronic disease conditions.

T

T OR F:
A needless and racial disparities in pain and health exist and continues.

Environmental and Support People

Education related to the assessment and management of pain can positively affect the perceived quality of life for both clients and their caregivers.

T

T OR F:
Expectations of significant others can affect a person's perceptions and responses to pain.

PPE

This alters the client's sensitivity to pain.

T

T OR F:
People who have personally experienced pain or who have been exposed to the suffering of someone close to them are often more unthreatened by anticipated pain that people without pain experience.

pain relief measures

The success or lack of success of ____________________________ influences a person's expectations for relief and future response to interventions.

T

T OR F:
Some clients may accept pain more readily than others, depending on the circumstances and the client's interpretation of its significance.

Positive Meaning of Pain

These clients may view the pain as a temporary inconvenience rather than a potential threat or disruption to daily life.

Negative Meaning of Pain

Unrelenting chronic, persistent pain may suffer more intensely and affects the body, mind, spirit and social relationship in an undesirable way.

Chronic Pain

changes the person’s outlook becoming more pessimistic often to the point of helplessness and hopelessness.

Mental Factor

Chronic pain changes the person’s outlook becoming more pessimistic often to the point of helplessness and hopelessness.

Mood

becomes impaired when pain persists sadness becomes being unable to do important or enjoyable activities combines self-doubts and learned helplessness to produce depression.

Anxiety

worry and uncertainty about coping with the pain may escalate emotionally to the point of panic.

Spiritual Factor

punishment for wrongdoing, betrayal by the higher power, a test of fortitude, threat to the essence of who the person is.

Social Factor

pain often strains part because of the impaired valued relationships, in ability to fulfill role expectations.

Nociception

The physiological processes related to pain perception.

PNS

includes specialized primary sensory neurons that detect mechanical, thermal or chemical conditions associated with potential tissue damage.

Transduction

Specialized pain receptors or nociceptors can be excited by mechanical, thermal or chemical stimuli. Harmful stimuli trigger the release of biochemical mediators bradykinin, serotonin, (prostaglandins, histamine and substance P) and painful stimulation causes movement of ions across cell membranes which sensitize or excites nociceptors.

Ibuprofen and Local Analgesics

Transduction’s Pain Control

Transmission 1st Segment

The pain impulses travel from the peripheral nerve fibers to the spinal cord. Substance P serves as a neurotransmitter.

Unmyelinated C Fibers, A-Delta Fibers

2 types of nociceptor fibers

transmit dull and aching pain

Unmyelinated C Fibers

transmit sharp and localized pain

A-Delta Fibers

Transmission 2nd Segment

Transmission of the pain signal through an ascending pathway in the spinal cord of the brain.

Transmission 3rd Segment

Transmission of information to the brain where pain perception occurs.

Opioids

Transmisson’s Pain Control

Perception

Is when the client becomes conscious of the pain.

Perception

The sum of complex activities in the CNS that may shape the character and intensity of pain perceived and give meaning to the pain.

distraction, imagery

Cognitive-behavioral therapy and approaches such as _________________ and ____________ can influence pain perception.

Modulation

occurs when neurons in the brain send signals back down to the dorsal horn of the spinal cord.

descending fibers

release substances such as endogenous opioids, serotonin, and norepinephrine, which can inhibit or reduce the ascending painful impulses in the dorsal horn.

descending system

Modulation is also known as

Sympathetic Nervous System

responds in fight-or-flight response with increase in HR and BP, holds his or her breath, short and shallow breathing.

T

T OR F:
Natural response to pain is to stop activity, tense muscles, and withdraw from the pain provoking activities.

Uncontrolled Pain

impairs immune functions, slows healing, increase susceptibility to infection and dermal ulcers.

F, atelectasis

T OR F:
The short, shallowing breathing that accompanies pain produces infarction, lowers circulating oxygen levels and increase cardiac workload.

Windup Phenomenon

result of repeated pain signals that cause stronger and longer responses in the CNS.

Referred Pain

Appear to arise in different areas to other parts of the body.

Visceral Pain

Results activation of pain receptors in the organs and or hollow viscera.

Acute Pain

Sudden or slow onset, regardless of its intensity. Pain that is directly related to tissue injury and resolves when tissue heals.

Chronic Pain

Aka persistent pain, prolonged, usually recurring, or lasting 3 months or longer, and interferes with functioning.

Cancer Pain

Result from the direct effects of the disease and its treatment, or maybe unrelated.

Rating Scale

is recommended for persons age 3 years and older.

Superficial Somatic Pain

Originates in the skin, muscles, bone, or connective tissue

cutaneous pain

Superficial Somatic Pain is also known as

Intractable Pain

Generally severe pain for which no cure is possible even after accepted medical evaluation and treatments have been implanted.

Phantom Pain

The feeling that a lost body part is present. Occurs in most people after amputation