test 4 - pain and sensory perception

transduction

activation of pain receptors

transmission

conduction along pathways (A-delta and C-delta fibers)

perception of pain

awareness of the characteristics of pain

modulation

inhibitor or modification of pain

first step of the pain process

transduction

second step of pain process

transmission

third step of pain process

perception of pain

fourth step of pain process

modulation

pain threshold

the exact point at which a physical stimulus (such as heat, pressure, or cold) first begins to be perceived as pain rather than just a non-painful sensation like touch or warmth

modulation of pain

neuromodulators

endorphins, dynorphins, enkephalins

definition of pain

an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

acute pain

< 3-6 months, a sudden, short-lived physical warning sign that starts abruptly

chronic pain

>3 -6 months persistent or recurring pain

cancer pain

occurs when tumors press on or destroy bones, nerves, or organs, or as a side effect of cancer treatments like surgery, chemotherapy, and radiation

localized pain

discomfort that is confined or restricted to one specific, easily identifiable area of the body

somatic pain

a type of nociceptive pain that originates from receptors in your skin, muscles, bones, joints, ligaments, and tendons

visceral pain

a type of pain that comes from the activation of nociceptors (pain receptors) in the body's internal organs within the chest, abdomen, and pelvis

cutaneous pain

pain that originates in the skin or superficial tissues, usually caused by the activation of specialized nerve endings called nociceptors

referred pain

discomfort that you feel in a part of your body other than where the actual injury, damage, or disease is located

sensory pain feels like

sharp, stabbing, shooting

acute pain reactions

moaning, grimacing, anxiety, and reflex musculoskeletal spasms

chronic pain is associated with what

withdrawal, despair, anxiety, depression, loss of appetite, sleep disturbances

3 types of chronic pain

limited

intermittent

persistent

how is chronic pain dealt with

not readily treatable, response depends on duration and intensity, treatment needs to be multidisciplinary

nociceptive pain

physical, chemical, or thermal stimuli that activate specialized pain receptors called nociceptors in the body's tissues

how does nociceptive pain feel

sharp, throbbing, aching, sore, or cramping sensation

neuropathic pain

caused by damage, disease, or dysfunction of the nervous system (including the peripheral nerves, spinal cord, or brain) that sends abnormal pain signals to the body

how does neuropathic pain feel

stabbing, shooting, burning sensation

nociplastic pain

a distinct category of chronic pain caused by altered central nervous system (CNS) processing and heightened nerve sensitivity, rather than ongoing tissue damage or direct nerve injury

how does nociplastic pain feel

widespread, deep, or diffuse aching, throbbing, or burning

intractable pain

a severe, constant, and debilitating chronic pain condition that does not respond to standard medical treatments, surgeries, or ordinary pain medications like NSAIDs and weak opioids

what does intractable pain feel like

a relentless, crushing, and constant physical storm that does not stop, sleep, or respond to standard medical treatments

phantom pain

miscommunication between the brain, spinal cord, and severed nerve endings after a body part is removed

sympathetic stimulation

fight or flight

sympathetic stimulation reactions

increase in respiratory rate

increase in HR

peripheral vasocontrisction

increase blood glucose

diaphoresis

increased muscle tension

parasympathetic stimulation reactions

pallor

muscle tension

nausea and vomitting

weakness

rapid irregular breathing

responses to pain

behavioral (voluntary)

physiologic (involuntary)

affective (psychological)

cultures affecting the pain experience

cultural and ethnicity variables

environment and support people

anxiety and other stressors

past pain experiences

underreporting

reluctance to use pain medications

prejudice and discrimination, ethnocentrism

cultural and ethnicity variables affecting the pain experience

family, biological sex, gender, age variables, religious beliefs and spirituality

how often do you assess pain

initial assessment

diagnostic evaluation

after PT or other activities

regular intervals

each new report of pain

pre/post treatments

after each pain intervention/medication

subjective

patient self-report

who can give a report about the patient regarding pain

family member, person close to the patient, or caregiver familiar with the patient

objective pain report

identify pathological conditions or procedures that may be causing pain

nonverbal behaviors

physiologic measures

nonverbal behaviors

restlessness, grimacing, crying, clenching fists, protecting the painful area

physiologic measures

increased blood pressure and pulse

basic methods of assessing pain

use the same pain scale over time

assess when pain is both reported or suspected

re-assess routinely

dont assume pain is incisional or related to obvious trauma-investigate

consider the individual, the patients culture, values and beliefs

intervention used for general assessment of pain

old carts

P from PQRST

provocative/palliative

Q from PQRST

quality

R in PQRST

region/radiation

S from PQRST

severity

T from PQRST

timing

quality of pain

sharp

dull

diffuse (spreading)

shifting

severity of pain

severe or excruciating

moderate

slight or mild

periodicity for pain

continous

intermittent

brief or transient

pain assessment tools

0-10 numeric rating scale

adult nonverbal pain sclae

behavioral pain scale

checklist of nonverbal indictators

COMFORT behavior scale

critical-care pain observation tol

pain assessment in advanced dementia scale (PAINAD)

OUCHER

FLACC

PAINAD is for what

advanced dementia

how is PAINAD rated

0,1,2

breathing categories for PAINAD

normal

occasional labored breathing

noisy labored breathing

negative vocalization for PAINAD

none, occasional moan/groan or low-level speech with negative quality, repeated trouble calling out and/or loud moaning/graoning/crying

facial expression for PAINAD

smiling or inexpressive, sad/frightened/frown, facial grimacing

body language for PAINAD

relaxed; tense, distressed pacing/fidgeting; rigid, fists clenched, knees pulled up, pulling/pushing away/striking out

consolability for PAINAD

no need to console; distracted or reassured by voice/touch; unable to console, distract or reassure

nursing interventions for pain

establishing trusting nurse-patient relationship

manipulating factors affecting pain experience

initiating complementary health approaches and integrative healthcare

managing pharmacologic relief measures

ensuring ethical and legal responsibility to relieve pain

udnerstanding the placebo controversy

monitoring the effectiveness of pain management

monitor the GCS and LOC of the patient

non pharmacological pain relief measures

positioning

distraciton

humor

music

imagery

mindfulness practice

cutaneous stimulation

acupuncture

hypnosis

biofeedback

healing/therapeutic touch

animal-assisted intervention

analgesic administration

opioid

nonopioid

adjuvant

patient controlled analgesia pump

a computerized medical device that lets you self-administer prescribed pain medication—usually opioids like morphine or hydromorphone—on demand by pressing a handheld button

pain management regimens for cancer or chronic pain

administer medications ATC rather than PRN

adjust the dose to achieve maximum benefit with minimum side effects

allow patient as much control as possible over the regimen

how should cancer or chronic pain patient be given meds

orally is possible

safety when on pain meds

avoid driving, operating machinery, alcohol or other CNS depressants

pain management education

should include family members or caregivers. explanation about pain scales and when to request pain meds. keep diary of pain and medications taken

what should a pregnant or person with an infant know when on pain meds

do not breastfeed without checking with provider

diet for people on pain meds

do not take on an empty stomach

barriers to effective pain management with patients

poor access to healthcare

receiving a poor pain assessment from an inexperienced health care provider

people w/ non-cancer pain

people with “good” performance status, such as someone who appears to be coping well and performing activities adequately

patients over 70

nonverbal or dementia patients

barriers to effective pain management regarding nurses

communication gaps

misconceptions about pain

inconsistent use of interventions

consequences of untreated pain

impaired sleep

depression

anxiety

delirium and confusion

decreased socializaition/loss of relationships

nutritional deficits

decline in ADLs

DECREASDE QUALITY OF LIFE

hyperglycemia

immune system dysfunction

alterations in coagulation

GI ileus

urinary retention

decreased lung volume

SNS stimulation

chronic pain syndrome

considerations regarding pain management

legal considerations

ethical cosniderations

moral considerations

end-of-life care

sensory

smell

taste

vision

hearing

touch

stereognosis

the ability to identify an object's three-dimensional shape, size, texture, and identity using touch alone, without any visual or auditory input

kinesthesia

the conscious awareness of body movement, position, and coordination, powered by sensory receptors in your muscles, tendons, and joints

visceral

things coming from deep, instinctive emotions rather than logic or reasoning, or things relating to the internal organs of the body

proprioception

the body's internal "sixth sense" that lets you know where your body parts are, how they are moving, and how much force you are using in three-dimensional space, without needing to look at them

conscious state of awareness

delirium, dementia, confusion, normal consciousness, somnolence, minimally conscious states, locked-in syndrome

locked-in syndrome

a rare neurological condition where a person is fully conscious, awake, and capable of thinking, but suffers complete paralysis of nearly all voluntary muscles in the body and cannot speak

unconscious state of awareness

asleep, stupor, coma, vegetative state

stupor state

a state of near-unconsciousness and severely reduced responsiveness where a person is almost entirely unresponsive, reacting only to intense or painful stimuli

sensory deficits

impaired sight or hearing

altered taste

numbness or paralysis

sensory deprivation

occurs when a person experiences decreased sensory input

sensory overload

patient experiences so much sensory stimuli that the brain is unable to respond meaningfully or ignore stimuli

sensory processing disorder

occurs when the brain struggles to organize and respond to information coming in from the senses

which patient are at high risk for sensory deprivation

environment with decreased or monotonous stimuli

impaired ability to receive environmental stimuli

inability to process environmental stimuli

manifestations of sensory deprivation

boredom, confusion, disorientation, drowsiness, irritability, and can present as a psychiatric illness

effects of sensory deprivation

perceptual disturbances

cognitive disturbances

emotional disturbances

how does a patient feel when they have sensory overload

out of control

manifestations of sensory overload

anxiety, restless, racing thoughts, mood swings, irritability

nursing care for sensory overload patients focuses on

reducing distressing stimuli and helping the patient gain control over the environment

factors affecting sensory stimulation

age

developmental considerations

culture

personality and lifestyle

stress and illness

medications

patient outcomes for sensory alterations

live in a developmentally stimulating and safe environment

exhibit a level of arousal that allows for meaningful organization of stimuli

schedule appropriate health screenings

maintain orientation of time, place, and person

respond appropriately to sensory stimuli while executing self-care activities

potential vision impairments

vision loss

refractive errors

cataracts

clouding of the sense of the eye