Palliative Care, End-of-Life Care, and Pain Management

Flashcards covering pain assessment, different pain types, pharmacological and nonpharmacological treatments, and physical/psychosocial manifestations of end-of-life care based on the Week 1b lecture notes.

Pain (IASP Definition)

An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Subjective Nature of Pain

The concept that pain is whatever and whenever the person experiencing it says it is; the patient’s self-report is the most essential assessment tool.

Transduction

The first phase of the pain process where noxious stimuli cause cell damage and the release of sensitizing chemicals (e.g., prostaglandins, bradykinin, serotonin, substance P, histamine) that activate nociceptors.

Transmission

The process by which an action potential continues from the site of injury to the spinal cord, then to the brainstem and thalamus, and finally to the cortex for processing.

Perception

The conscious experience of pain.

Modulation

The process where neurons originating in the brainstem descend to the spinal cord and release substances, such as endogenous opioids, that inhibit nociceptive impulses.

Nociceptive Pain

Pain caused by damage to somatic or visceral tissue; it is usually responsive to opioid and nonopioid medications.

Somatic Pain

A type of nociceptive pain that is aching or throbbing, well-localized, and arises from bone, joint, muscle, skin, or connective tissue.

Visceral Pain

A type of nociceptive pain arising from internal organs like the intestine or bladder, which may result from stimuli such as tumour involvement or obstruction.

Neuropathic Pain

Pain resulting from damage to a peripheral nerve or the central nervous system, characterized as burning, shooting, stabbing, or electrical.

Step $1$ Analgesics

Nonopioid medications used for mild pain, such as Ibuprofen, Acetaminophen, or ASA.

Step $2$ Analgesics

Opioid analgesics or mixed opioid/nonopioid combinations used for mild to moderate pain, such as codeine or tramadol.

Step $3$ Analgesics

Potent opioids used for moderate to severe pain, such as morphine, fentanyl, or dilaudid.

Adjuvants

Medication classes used alongside opioids and nonopioids, including corticosteroids, antidepressants, muscle relaxants, and anaesthetics.

Tolerance

A state of adaptation to drug effects over time, which is not the same as addiction.

Physical Dependence

A pharmacological effect produced by abrupt cessation, rapid dose reduction, or decreasing blood levels of a drug.

Substance Misuse (Addiction)

A neurobiological disease influenced by genetic, psychosocial, and environmental factors, characterized by impaired control over drug use, compulsive use, craving, and continued use despite harm.

Palliative Care

An approach that improves quality of life for patients and families facing life-threatening illness by preventing and relieving suffering through early identification and treatment of pain and other physical, psychosocial, and spiritual problems.

End-of-Life Care

Care provided during the last months, weeks, and days for a person with a life-limiting illness.

Palliative Performance Scale (PPSv2)

A tool used to assess a patient's functional level based on ambulation, activity/evidence of disease, self-care, intake, and conscious level.

Cheyne-Stokes Respirations

A pattern of irregular breathing involving alternating periods of apnea and deep, rapid breathing, often seen at the end of life.

Terminal Secretions

Grunting, gurgling, or noisy congested breathing caused by an inability to cough or clear secretions, also known as the "death rattle."

Mottling

Purple or blotchy skin discoloration appearing on the hands, feet, arms, and legs as the body systems slow down during the dying process.

Grief

The normal reaction to loss, involving psychological responses (anger, guilt, sadness) and physiological reactions (sleep disruption, appetite changes).

Anticipatory Grief

Grief that takes place before the actual death occurs.

Bereavement

The state of loss and the subsequent period after death during which grief is experienced and mourning occurs.

Kübler-Ross Model

A model describing five stages of grief: Denial, Anger, Bargaining, Depression, and Acceptance.

Spirituality

Beliefs, values, and practices that relate to the search for existential meaning and purpose.

Allow Natural Death (AND)

A term increasingly used to replace the instruction "Do Not Resuscitate" (DNR).

Palliative Sedation

The intentional production of sedation to relieve intractable symptoms in the last days of life, intended to relieve suffering rather than hasten death.