NURM-102 Pain Exam Review

Chronic Pain Examples

• Fibromyalgia

• Arthritis (aging)

• Neuropathy (primarily diabetics)

Fibromyalgia

CNS pain processing system disease that amplifies pain

Somatic pain

Comes from bones/tendons

Visceral/Splanchnic Pain

Most common, poorly localized pain

• Originates from a body organ

Referred pain

Thinking pain is somewhere but originates elsewhere

• WOMAN WITH A HEART ATTACK

Neuropathic pain

Caused by lesion/disease of peripheral or central nerves

• Commonly in legs/feet, mostly in diabetics

Intractable pain

Persistent cancer pain (both acute and chronic)

Gate Control Theory

New sensation intercepts nerve and closes the gate on pain signal

FLACC Scale

For infants up to 7 months old

• Faces, Legs, Activity, Crying, Consolability

Opioid analgesic EXAMPLE

Morphine

Non-opioid analgesic EXAMPLES

Acetaminophen and NSAIDs

Adjuvant analgesics

Used for other purposes

• Tranquilizers, muscle relaxants, antidepressants

PRN

Educate patient to ask for analgesics as needed

Pain Assessment Factors

• Onset, duration, location, intensity, quality

• Aggravating/Alleviating factor

• Behaviors observed

• Physical s/s present

• ADL affliction

• Physio/socio/psychosocial indicators

Cutaneous stimulation

Massaging, acupressure, TENS, heat/cold app

Opioid Action and Use

Bind to opioid receptors in CNS, for MOD-SEVERE PAIN

• Caution with “opioid-naive” (never had before)

Side effects of OPIOIDS

• Resp depression

• HYPOtension

• Sedation

• Constipation

• Urinary retention

Non-opioid analgesics

Inhibits at pain receptor sites of PNS

• Mild to moderate pain

NSAID side effects

Bleeding and stomach ulcers

Acetaminophen side effects

Liver toxicity

Chronic neuropathic pain is treated with…

ANTIDEPRESSANTS/CONVULSANTS

Steroids treat…

Inflammation pain

Physical dependence

NOT addiction, need it to avoid withdrawal/symptom return

• CAN perform ADLs

Addiction

Psychological, following dependence

• NOT performing ADLs

Most common salicylate

ASA