NURS 308: UNIT 1 - TOPIC 3: PAIN

What is pain?

Pain is a difficult phenomenon to understand, meaning different things to different people.

How many people experience acute pain from injury or surgery?

25 million people experience acute pain from injury or surgery.

How many American adults are affected by chronic pain?

Chronic pain affects over a million American adults.

What are the consequences of untreated pain?

Unnecessary suffering, physical and psychosocial dysfunction, immunosuppression, and sleep disturbances.

Which population is especially affected by unnecessary suffering from untreated pain?

Older adults.

What are examples of physical and psychosocial dysfunction caused by untreated pain?

Depression, interruption of social activities.

How can untreated pain affect the immune system?

It can lead to immunosuppression.

What are potential effects of untreated pain on sleep?

Sleep disturbances that can manifest in dangerous ways.

What are the two main classifications of pain by underlying pathology?

Nociceptive and neuropathic pain.

What is nociceptive pain?

Pain caused by damage to somatic or visceral tissue.

What is neuropathic pain?

Pain caused by damage to peripheral nerves or structures in the central nervous system.

Can a patient experience more than one type of pain?

Yes, a patient can have both nociceptive and neuropathic pain.

How is pain classified by duration?

Acute pain and chronic pain.

What defines acute pain?

Pain lasting less than 6 months or as long as it takes for normal healing to occur.

Give an example of acute pain.

A patient has major surgery but takes 1 year to recover; the pain is considered acute until healing occurs.

What defines chronic pain?

Pain lasting more than 6 months, which may start as acute but continues past the normal recovery time.

What is nociceptive pain?

Damage to somatic or visceral tissue, such as from surgical incision, broken bone, or arthritis; usually responsive to opioids (for surgery) and nonopioid medications.

What is somatic pain?

Pain arising from skin, mucous membranes, subcutaneous tissues, bones, joints, muscles, or connective tissue; includes superficial and deep types.

What is superficial somatic pain?

Arises from skin, mucous membranes, and subcutaneous tissues; described as sharp, burning, or prickly.

What is deep somatic pain?

Arises from bone, joint, muscle, skin, or connective tissue; described as aching or throbbing.

What is visceral pain?

Pain from activation of nociceptors in internal organs and body cavity linings, often due to inflammation, stretching, or ischemia.

What are common causes of visceral pain?

Stretching from tumor or obstruction, inflammation, ischemia, surgical incision; affects organs like intestines and bladder.

What is neuropathic pain?

Damage to the peripheral nerves or central nervous system (CNS) causing abnormal pain sensations.

What are common sensations associated with neuropathic pain?

Numbing, hot-burning, shooting, stabbing, or electrical sensations.

How can neuropathic pain occur in terms of duration and intensity?

It can be sudden, intense, short-lived, or lingering.

What is centrally generated neuropathic pain?

Pain caused by a lesion or dysfunction in the CNS.

What are examples of centrally generated neuropathic pain?

Multiple sclerosis (MS), stroke, and phantom limb pain.

What is peripherally generated neuropathic pain?

Pain caused by injury to the peripheral nerves in the PNS.

What are examples of peripherally generated neuropathic pain?

Polyneuropathy, mononeuropathy, and complex regional pain syndrome.

What physical system is activated during acute pain?

Sympathetic nervous system (SNS)

What are the manifestations of acute pain?

Increased heart rate, increased respiratory rate, increased blood pressure, other signs of SNS activation

What is the treatment goal for acute pain?

Control pain with eventual elimination and enable participation in recovery activities

What are the manifestations of chronic pain?

Decreased physical activity, fatigue, social withdrawal, possible anxiety and depression, can be disabling

What is the treatment goal for chronic pain?

Control pain as much as possible, with main focus on enhancing function and quality of life

What is a fundamental principle regarding every patient and pain management?

Every patient deserves adequate pain management.

What approach should nurses use when assessing and managing pain?

A holistic approach that treats the whole person, including nonpharmacological methods like guided imagery, meditation, deep breathing, as well as pharmacological medications.

How should a pain treatment plan be developed?

It should be based on the patient’s goals.

What types of therapies should be used for pain management?

Both drug and nondrug therapies, using a multimodal approach when appropriate.

How should pain be addressed in the healthcare setting?

Using an interprofessional approach.

What should be done after implementing pain management therapies?

Evaluate the effectiveness of all therapies to ensure they meet the patient’s goals.

How should medication side effects be handled?

Prevent and/or manage them as part of the pain management plan.

What role does patient and caregiver education play in pain management?

Teaching should be incorporated throughout assessment and treatment.

What are the three categories of pain medications?

Nonopioids, opioids, and adjuvant drugs

Which pain medications are used for mild pain rated 1–4?

Nonopioids

What type of pain do nonopioids treat?

Mild pain

What is an example of a nonopioid pain medication?

Tylenol

Which pain medications are used for pain rated 5–7?

Opioids

What type of pain do opioids treat?

Moderate to severe pain

Which pain medications are used for pain rated 8–10?

Adjuvant drugs

What type of pain are adjuvant drugs commonly used for?

Neuropathic pain

What medications are considered non-opioid analgesics?

Acetaminophen, aspirin and other salicylates, and NSAIDs.

How do non-opioids affect tolerance and dependence?

They do not produce tolerance or physical dependence.

What level of pain is aspirin effective for?

Mild pain.

Why is aspirin use limited?

Risk of bleeding, especially gastrointestinal bleeding.

What are common side effects of NSAIDs?

GI problems, renal insufficiency, and hypertension.

How does acetaminophen relieve symptoms?

Provides analgesic and antipyretic effects.

What effects does acetaminophen not have?

No antiplatelet or anti-inflammatory effects.

Why is acetaminophen potentially dangerous in some patients?

Risk of hepatotoxicity because it is metabolized in the liver.

Which patients should avoid acetaminophen?

Patients with liver disease.

What routes is acetaminophen available in?

Oral and parenteral.

Are most non-opioid analgesics prescription or over-the-counter?

Many are available OTC.

Why are non-opioids often given with opioids?

They provide an opioid-sparing effect and reduce opioid requirements.

How do opioids relieve pain?

They bind to receptors in the CNS and inhibit transmission of nociceptive input so the pain signal is blocked and the patient cannot perceive pain, even though the pain stimulus still exists.

What receptors do pure opioid agonists bind to?

Mu receptors in the CNS.

Which medications are examples of pure opioid agonists?

Morphine, oxycodone, and codeine.

What are the key characteristics of pure opioid agonists?

Very potent, no analgesic ceiling, multiple routes of administration, effective for moderate to severe pain.

What is a serious adverse effect associated with morphine?

Respiratory depression.

How are opioids commonly used for moderate pain?

They are combined with nonopioids.

What are common opioid–nonopioid combinations?

Acetaminophen with codeine and hydrocodone with acetaminophen or ibuprofen.

Why does adding acetaminophen to opioids limit dosing?

It limits the total daily dose due to acetaminophen toxicity risk.

What is the most common side effect of opioids?

Constipation.

What nursing interventions help manage opioid-related constipation?

Hydration, increased fiber intake, and stool softeners.

What other common side effects occur with opioid use?

Nausea and vomiting, sedation, respiratory depression, and pruritus.

What is the priority adverse effect to assess with opioids?

Respiratory depression.

When should naloxone (Narcan) be prepared or administered?

When respiratory rate drops below 8–10 breaths per minute with low oxygen saturation and the patient does not respond to vigorous stimulation.

What does pruritus mean in opioid therapy?

Itching.

What is adjuvant analgesic therapy?

Medications developed to treat other conditions that also help manage pain

How are adjuvant analgesics used in pain management?

Used alone or combined with opioids and nonopioids

Why are adjuvant analgesics effective for pain?

They target specific pain pathways even though they were developed for other purposes

What is an example of an adjuvant analgesic and how does it work?

Gabapentin, originally for seizures, effective for neuropathic pain

What are some drug classes used in adjuvant analgesic therapy?

• corticosteroids

• antidepressants

• antiseizure drugs

• GABA receptor agonists

• α2-Adrenergic agonists

• local anesthetics

• cannabinoids

What is the focus of pain medication scheduling?

Prevention or control of pain.

Why should nurses avoid waiting until pain is severe before giving medication?

Early administration improves pain control and prevents escalation.

How should constant pain be managed with medications?

Around-the-clock dosing rather than PRN.

What type of medication is used for breakthrough pain?

Fast-acting analgesics.

What is titration in pain management?

Adjusting the dose based on pain relief and side effects.

What is the goal when titrating pain medications?

Use the smallest effective dose with the fewest side effects.

What is the oral route used for?

Route of choice when the GI system is functioning

Why are oral doses usually larger?

First-pass metabolism reduces drug amount before reaching circulation

What is the buccal route?

Medication absorbed through the cheek mucosa

What is the transdermal route?

Medication absorbed through the skin for systemic effect

What is the benefit of the intranasal route?

Absorption through vascular mucosa and avoidance of first-pass effect

When is the rectal route useful?

Severe nausea or vomiting

What are parenteral routes?

Intramuscular, subcutaneous, and intravenous

What is intraspinal delivery?

Medication delivered into the spinal space

Why are smaller doses used with intraspinal delivery?

Highly potent due to direct CNS access

What are implantable pumps?

Devices that deliver medication continuously or intermittently inside the body

What is patient-controlled analgesia (PCA)?

Pain management where the patient self-administers opioid doses

How does PCA deliver medication?

Patient presses a button to receive an IV bolus dose

What key teaching is required for PCA?

Patient cannot overdose due to safety limits