M1: GATE CONTROL THEORY, PAIN RESPONSE FACTORS, & PAIN ASSESSMENT

\_____ in the dorsal horns act as gates that close to keep impulses from reaching the brain or open to permit impulses to ascend to the brain.

Synapses

Protective pain reflex

Gate closed: Pain sensation blocked

Gate Control Theory

What location does the primary neuron synapses (A-delta & C fibers) to secondary neuron

Substantia Gelitanosa

2 Components of Pain Assessment

A. Comprehensive pain assessment must be conducted upon initial interview.

B. Physical examination of Pain

Factors that Influence Pain Response:

Once a person experiences severe pain, that person knows just how severe it can be.

Past experience

Factors that Influence Pain Response:

\_____ often accompanies pain (threat of the unknown)

\_____that is relevant or related to the pain may increase the patient's perception of pain ; \_____that is unrelated to the pain may distract the patient and may actually decrease the perception of pain

Anxiety

Factors that Influence Pain Response:

Longer durations of pain are associated with an increased incidence of depression

Depression

Factors that Influence Pain Response:

Beliefs about pain and how to respond to it differ from one \_____ to the next

Culture

Factors that Influence Pain Response:

\_____ important variable that influences how people admit or describe pain and how they behave

• The way an older person responds to pain may differ from the way a younger person responds

Age

Factors that Influence Pain Response:

Women had higher pain intensity, pain unpleasantness, frustration, and fear compared to men; men being more anxious about their pain

Gender

Factors that Influence Pain Response:

When person responds to the medication or other treatment because of an expectation that the treatment will work rather than because it actually does so

Placebo Effect

Factors that Influence Pain Response:

None to mild discomfort to excruciating

Intensity

Factors that Influence Pain Response:

Onset, duration, relationship between time and intensity, and changes in rhythmic patterns; sudden or gradual increase

Timing

Factors that Influence Pain Response:

Have the patient point to the area of the body involved

Location

Factors that Influence Pain Response:

Patient describes the pain in his or her own words without offering clues (sharp, shooting, burning)

Quality

Factors that Influence Pain Response:

Effect of pain in person's daily life

Personal Meaning

Factors that Influence Pain Response:

Anything makes the pain worse and what makes it better; relationship between activity and pain

Aggravating, alleviating factors

Factors that Influence Pain Response:

Nonverbal and behavioral expressions of pain are not consistent or reliable indicators of the quality or intensity of pain, and they should not be used to determine the presence of or the degree of pain experienced

Pain behaviors

Act as gates that close to keep impulses from reaching the brain or open to permit impulses to ascend to the brain

Dorsal Horn

• Small-diameter nerve fibers carry pain stimuli through a gate

• Large diameter nerve fibers going through the same gate can inhibit the transmission of those pain impulses-that is, close the gate

Gate Control Theory

The pain gate in the spinal cord can be shut in several different ways

• Stimulation of touch fibers

• Release of endogenous opioids

• Electrical stimulation

• Morphine and other opioid drugs

• Normal and excessive sensory stimuli

• Cerebral cortex and thalamic inhibition of pain

Components of a comprehensive pain assessment and ways on how to elicit the information from the patient

1. Location

2. Intensity

3. Quality

4. Timing- onset, duration, pattern

5. Aggravating and alleviating factors

6. Comfort- function (pain intensity goal)- mild, moderate, severe

7. Personal Meaning

Uses number to assess a person's severity to pain from 0 to 10.

Numeric Rating Scale

Best tool for young patients (Consists of six pictures of faces)

Wong-Baker FACES pain rating scale

A self-report measure of pain intensity developed for children

Faces Pain Scale - Revised (FPS-R)

Uses different words or phrases to describe the intensity of pain, such as "no pain, mild pain, moderate pain, very severe pain &worst possible pain"

Verbal Descriptor Scale (VDS)

A 10cm line with word anchors at the ends. "no pain" & "pain as bad as it could possibly be"

Visual Analog Scale (VAS)

Identification of short term functional goals and reinforce to the patient that good pain control will more likely lead to successful achievement of goal.

Comfort function (pain intensity) goal

Pain Assessment using OPQRSTV

Onset (when, how long/often)

Provoking (what brings it on, makes it better/worse)

Quality

Region/radiation

Severity

Treatment

Understanding

Values

Prayer or other religious practices, withdrawal

Coping Resources

Pain characteristics that change

Variations

Repetitive or not

Patterns

Sleep, appetite, concentration, school, work, etc

Effects in ADL's (Activities of daily living)

N/V, dizziness., diarrhea

Associated Symptoms

Approaches used to control the pain & results & effectiveness

Current Pain Treatment