Week 3 Pain

Is Pain one of main reason why people seek health care?

Yes

Is pain objective or subjective?

Subjective

What type of conditions would a paitent have to not be able to report pain?

Comatose

Dementia

Mentally Disabled

Aphasia

What are some biases that a healthcare provider can have that might cloud judgemtn of pain?

Different Culture

Personal Bias, way of viewing the paitent, like thinking if they are drug seeking

Lack of education of pain managemtn

What do Margo Mccaffery say for pain?

Whatever the person experiencing the pain says it is, existing whenever the person says it does.

What does the International Association for the study of Pain (IASP) say about pain?

An unpleasnt sensory and emotional experience assoicated with actual or potential tissue damanage or described in terms of such damange

What are 10 principles and Practice Stands for pain treatment

Continous assessment for pain

Hollistic approach

Pain managemnt for all

Use pain amnagemtn for acitivites that are supposed to help them

Use all drug types for more effective and least invasive

Collab with all healthcare team members

What is Nocicpetive Pain

Bodys normal healthy functionng response to tissue pain

What is the order of the 4 process that need to happen for nociception to happen

1) Transduction

2) Transmission

3) Perception

4) Modulation

What happens in the Transduction step of Nociception

1) Injured cell site releases mixture of chemicals to nerve endings (Nociceptors), which creates an action potential

Chemicals: Prostaglandins, Bradykinin, Serotonin Histamine

What happens in the Transmission step of Nociception

Action potential travels to nerve fibers and ending up in spinal cord to the cortex in brain for processing

What happens in the Perception step of Nociception

Pain is made concious

What happens in the modulation step of Nociception?

Substances are released back to periopherals in order to manage pain and modify incoming impulses

Whats the difference between Somatic and Visceral Tissue?

Somatic Tissue: Structures you can see and touch externally

Visceral tissue: Internal Organs and internal lining

What does Somatic: Superficial and Deep mean

Superficial: Skin, Mucous membrnes, subcutaneous tissue

Deep: Bone, JOin, Muscle,

What is Somatic: Superficial pain described as

Sharp, Burning Prickly

What is Somatic: Deep pain described as?

Aching or Throbbing

Where are teh nociceptors for Visceral pain

Interal Organs

Lining of body cavities

What is Visceral pain usally caused by

Inflammation, Strestching, Ischemia,

Stretching caused by tumor or obstruction

What is Neuropathic Pain

Pain caused by actual damage to nerves of the PNS or CNA

What does Neuropathic pain feel like?

Numbing, Hot, Burning, Shotting, Stabbing, Electric Shock Like

Sudden, Intense, Short Lived, Lingering

What are the causes of Neuropathic pain?

Diabetes, Trauma, Inflammation, Metabolic Diseases

What type of analgesic is used to treat neuropathy?

Adjuvant analgesics

• Medications that arent primarily used to treat pain

• Multimodal approach

When assessing a patient for pain subjectivley what Acromym shoudl be used

OPQRST

• Onset

• Precipitating Factors

• Quality

• Radiation

• Severity

• Timing

What assessing pain objectively for patient what tool should be used?

Behavior Pain Scale: For sedated adults

What are the ways to measure intensity of pain ?

Pain Scale: 0-10

Verbal Descriptor Scale

Visual Pain Scales for nonverbal paitents

What are the defining Quality of Neuropathic Pain

Stabbing

Quiick

Burning

Electric

Itchy

Numbing

Shooting

What are the defining qualities of Nociceptive Pain

Sharp

Aching

Throbbing

Dull

Cramping

Why is it important to reassess for Pain

Changes in

• Severity

• Physical and psychosical condition

• Intervention can change pain

• Adverse effecvts from treamnts

• Agency policy

Whats the differnce betwen Acute and Chronic Pain

Acute: Activates flight or fight.

Chronic: Baseline Vitals, body adapts

However behavior changes: Immobility Withdrawl Despair

What are examples of nondrug treatments

Hot and COld pads

Relaxation

Music, Massage

DIrection

What are examples of Drug Therapy?

Non Opiods

Opiods

Adjuvant

For a paitent with a functing GI system is Oral Admin route prefered?

Yes

Why do oral doses have to be larger compared to other routes of medication

First pass effect because it goes through the GI system

Liver metabolizes most of it

What is a paitent controlled analgesia (PCA)

IV pump controlled by paitent

IV Opoid

Can paitentes overdose on a PCA pump

NO

After giving IV pain medication how long shoudl the nurse wait to reasses for pain

15-30 minutes

After giving Oral pain medication how long should the nurse wait to reassesss for pain

30-60

What are some examples of nonopioids?

Acetaminophone

Aspirin

NSAIDs

Can you be be physically depedable on nonopoids

NO

Can you build a tolerance to nonopoids?

no

What is the opoid sparning effect?

Non opoids are combined with opoids in order to lower the dose of opoids given to smoeone

IS there a dosage ceiling to nonopoids

yes there is a max ceiling meaning they are only so powerful

Opoids have no ceiling

Does Aspirin reduce inflammation

Yes

What are the organs at risk when taking aspirin

GI

Kidney

Hypertension

What does aspirin do for platelet aggregation (clotting)

Decreases clotting

Compared to Aspirin, Acetaminophin doesn’t have

Antiplatelet or antiinflammatory effects

What is the organ at risk when taking aceteamenophin?

Liver-Hepatotoxicity

Are NSAIDS, opoids or nonopioids? What does it stand for

NONOPIOIDS

Non Sterioidal Anti Inflammitory drugs

What do NSAIDs inhibit?

cyclooxygenase (COX)

-Stops Prostaglanis formation

Is Aspirin a NSAIDs

Yes

What is the difference in how Opiods work and Nonopioids

Opioids Bind to Opioid Receptors in CNS

Nonopioids block prostaglandis from forming

Is it true Opoids bind to receptors in the CNS to block the pathway for Nociceptive Pain

Yes

Do Opiods alter limbic system activity

Yes

This allows for decreased emotional response to pain

What are mu receptors

Receptors on Nerves that wen activated, provide strong pain relief

What are Pure Agonists?

Drugs that when attatched to someone turn it one 100%

What are examples are pure agonist that bind to mu receptors

Morphone

Oxycodone

Codeine

Do opiods have a analgesic ceiling

no

They will be more powerful as you dose up

What is the biggest danger with opioids?

Respiratory depression

What is special about the opioid Methadone

Mu Agonist

NMDA receptor anatgonist - stops nerve over activation

What is the opioid Methadone used for

Chronic Pain

Neuropathy

What are the Common side effects of opioids

Constipation

Nausea/vomiting

Sedation

Repiratory depression

Itching

What drug reverses the effects of opioid overdose

Narcan

Can people on opoids build dependence

Yes

In opioid naive paitents are they at a high or low risk of opioid induced repiratory depression

High risk

In opioid tolerant paitents are they at a high or low risk of opioid induced repiratory depression

Low risk

What is the main complaint about epidural and intrathecal routes of opioid admin

Itching

For a standard paitent what type of medication plan would you see, and frequency?

PRN Acetaminophine, PRN NSAIDS, PRN opioids

For a paitent post operation what medication plan would you see

Schduled Acetaminophone and SAIDS and PRN opiods

When given a dose range like 5-10 mg how much should you admin for the first time

5 mg

Why should you not use IV meds to pre medicate for anticipated pain

Because they act fast and wear off rapidy

How is titration level determined

Based on assessment of analgesic effect and side effects

What is Equianalgesic Dosing

Making one dose of a medication equivilant to another medication

When would you do Equianalgesic dosing

When switching medication from IV to PO

When discharing a patient home

Changing of medication

According to the WHO step ladder what are the 3 steps catagorized for

Step 1: Mild Pain

Step 2: Moderate Pain

Step 3: Severe pain

What is Pseudo Addiction

Apperance of drug seeking behavior from paitents who don’t have adequate pain managemnt

What are examples of interventional ( tiny tools) therapy?

Nerve Blocks

Neuroablative Techniques (Permanently destroying painful nerve pathway)

What are some physical nondrug therapies

Physical

• TENS

• Exercise

• Hot or Cold Therapy

• Massage

• Acupuncture

What are some cognitive therapies for nondrug pain managment

Cognitive Therapy

• Distrction

• Relaxation

• Teaching

What are the benefits of nondrug therapy for pain

Reduces the actual drug doses, reducing side effects

Increase personal control

Why is tolerance a barrier to effective pain management?

Because it increases the dose needed for analgesic effects causing worse side effects

causes Opioid Rotation

Opioid induced hyperalgesia

Why is physical dependence a barrier to effective pain management

Body adapts to opioids and therefore you need more

Withdrawl happens

What is the def of addiction

Neurobiologic cindition with a a drive to obtain and take substances for other than prescribed therapeutic value

Are tolerance and physical depdendce signs of an addiction

No

What are characteristics of addiction

Compulsive use

Loss of control when using

Continued used despite harmful effect

What are the effects of untreated pain to the endocrine system

Stress hormones released

What are the effects of untreated pain to the Cardiovascular/Respiratory system

Pain increases Sympathetic system

Causes increase output and overworking it

What are the effects of untreated pain to the GI system

Cahnges in appetitie

Causing decrease motility

Anorexia

Low energy

What are the effects of untreated pain to the to the Urinary system

Causes urine retention due to increase substances i body that retain urine

What are the effects of untreated pain to the muscular system

Muscule tention due to constant pain

Muscle antrophy

Contractures

What are the effects of untreated pain to the Neuro system

Complex Regional Pain Sydrome (CRPS)

Constant pain

When Geriatric paitents take pain meds what are items to remember

Slower metabolism of drugs

GI blooding

Polypharmacy

Cognitive Impairment