Pain Management

Potter & Perry Ch. 44

Acupressure 

Applyin pressure to specific points on the body to promote energy flow, relieve pain, and improve health 

• It is used for a variety of things such as headaches, nausea, and anxiety 

Acute Pain 

• Protective — warns people of injury or disease

• Usually has identifiable cause

• Short duration

• Limited tissue damage and emotional response

• Common after acute injury, disease, or surgery

• Resolves, with or without treatment, after the injured area heals

Addiction

A compulsive, chronic, physiological or psychological need for a habit-forming substance, behavior, or activity having harmful physical, psychological, or social effects and typically causing well-defined symptoms (nausea, tremors, anxiety, irritability) upon withdrawl or abstinence 

Adjuvants

• AKA coanalgesics 

• Drugs originally developed to trat conditions other than pain but that also have analgesic property

• Ex. tricyclic antidepressants, anticonvulsants, corticosteroids, bisphosphonates, lidocaine, calcitonin

• Can be given alone or with traditional analgesics

Analgesics

The most common and effective method of pain relief

• Nonopioids (acetaminophen and NSAIDs), opioids (narcotics), and adjuvant analgesics / coanalgesics 

Biofeedback 

Non-invasive treatment that helps individuals gain voluntary control over involuntary body processes such as heart rate, muscle tension and brain waves

• Uses electronic senso to monitor these processes and provide real time feedback which allows patients to learn how to influence these processes

Breakthrough Cancer Pain (BTCP)

Many patients with cancer experience BTCP, which is a temporary increase in pain in someone who has a relatively stable and adequately controlled level of baseline pain 

• Occurs either spontaneously or in relation to a specific, predictable or unpredictable trigger 

• Negative impact on quality of life of patients and family caregivers 

Chronic Pain

• Not protective

• Prolonged — usually lasts longer than 3-6 months 

• Varies in intensity 

• May result from initial injry or there may be an ongoing cause 

• Cancer, arthritis, low back pain, headaches, neuropathy 

• Significant psychological, physical and cognitive effects 

Cutaneous Stimulation

Stimulation of the skin through a massage, warm bath, cold application or TENS unit reduces pain perception in some patients 

• May release endorphins (block painful stimuli), close the gate in the Gate-Control theory of pain 

• Helps reduce muscle tension 

• Do not use on sensitive skin areas 

Drug Tolerance 

A diminshed response to a medication or substance that occurs when the body adapts to its repeated presence

• Progressively larger doses of the drug are required to achieve the same effect that was initially attained in a smaller dose

Epidural Analgesia

A form of regional anesthesia

• Injection of anesthesia into the patient’s epidural space in the spinal cord

• Treats acute postoperative pain, rib fracture pain, labor and delivery pain, and chronic cancer pain

• Reduces a patient’s overall opioid requirement

• Short or long-term

Guided Imagery

A type of relaxation exercise where a patient visualizes positive, peaceful settings to relax and relieve pain 

• Decreases pulse, blood pressure, respirations (oxygen demand), muscle tension, and metabolic rate 

• Heightened awareness, sense of peace 

Idiopathic Pain

Chronic pain that has no underlying identifiable cause (no apparent structural or physiological abnormalities) 

Local Anesthesia 

Use of an anesthetic medication to induce loss of sensation to a body part

• Often used during brief surgical procedures 

Modulation

Process of alterin pain signals to reduce or inhibit their transmission

Multimodal analgesia

Combines drugs with at least two different mechanisms of action to optimize pain control

• Meds are combined to target different sites in the peripheral or central pain pathways 

• Allows for lower than usual doses of each medication 

• Lowers the risk of side effects while providing pain releif that is as good or better than giving the meds indiviudally 

Nocioception

Observable activity in the nervous system that allows people to detect pain

• Protective physiological series of events that brings awareness of actual or potential tissue damage 

• Four processes: pain transduction, pain transmission, pain perception, and pain modulation 

Opioids 

Class of analgesics, often call narcotics, for moderate to severe pain relief

Pain Threshold

Pain tolerance

Level of pain a person is willing to accept and tolerate

Patient-Controlled Analgesia (PCA)

Drug delivery system that allows patients to self-administer opioids (usually morphine, hydropmorphone, fentanyl) with minimal risk of overdose

• Goal is to maintain plasma level of analgeic 

• IV or SQ admin, sometimes oral 

• Computerized pumps, delivers a small preset dose of medicine 

• Patient can push a button to receive a demand dose, limit set on how many they can do 

Physical Dependence 

Refers to a state in which the body becomes accustomed to a substance and experiences withdrawal symptoms when its use is reduced or discontinued 

Placebos

Pharmacologically inactive preparations or procedures that produce no beneficial or therapeutic effect

• Many organizations discourage the use of placebos to treat pain 

Pseudoaddiction

Describes drug-seeking behaviors that mimic addiction but are primarily drive by inadequate pain-management 

• Not true addiction but rather a response to chronic pain that is not being effectively treated 

Regional Analgesia

Injection or infusion of local anesthetics to block a group of sensory nerve fibers

• Produce temporary loss of sensation by inhibiting nerve conduction 

• Block motor and autominc functions, depending on the amount used and the location / depth of administration 

Transcutaneous Electrical Nerve Stimulation (TENS) 

• Type of cutaneous stimulation

• Uses a small battery powered devide to send low-voltage electical currents through pads on the skin to relieve muscle tension and bain

Transduction

Pain transduction converts energy produced by stimuli into electical impusles

Transmission

• After the transduction of pain is complete

• The process where chemical nerve signals from a site of injury are relayed along nerve pathways to the brain