206- Pain

Acute pain

Temporary, protective pain with a clear cause (injury/surgery) that resolves with healing.

Rationale: Pain lasting <6 months, persists beyond healing, not protective, affects quality of life.

Tip: Untreated can evolve into chronic pain

Chronic Pain

Not protective and often does not alter vital signs, but it deeply affects a patient's quality of life

Tip: Lasts longer than >6 months, is ongoing or frequent, and persists beyond tissue healing

Breakthrough pain

Sudden flare of pain despite ongoing pain medication.

Nociceptive pain

Pain from tissue damage/inflammation; aching, throbbing, localized.

Neuropathic pain

Pain from nerve damage; burning, shooting, pins & needles.

Ex: phantom limb pain, diabetic neuropathy, and sciatica

Tip: Treat with adjuvants (antidepressants, anticonvulsants)

Cutaneous pain

Superficial pain (skin/subcutaneous tissue).

Ex: paper cuts, burns, shingles

Somatic pain

Pain in muscles, bones, joints.

Ex: sprains, fracture

Visceral pain

Pain from organs; can cause referred pain.

Ex: gallstones

The 5th vital sign

Pain

Transduction

Pain stimulus activates nociceptors (sensory pain nerve fiber).

Ex: like a hot surface

Transmission

Pain signal travels along nerve fibers.

Rationale:

A-delta fibers = fast lane 🚗💨

• Move signals quickly

• You feel sharp, sudden, well-defined pain

• Example: touching a hot stove → instant “OUCH!”

C fibers = slow lane 🚶‍♂

• Move signals slowly

• You feel dull, aching, hard-to-pinpoint pain

• Example: the lingering soreness after you burn yourself

Perception

How brain interprets pain.

Subjective

Modulation

The body releases endorphins/serotonin to reduce pain.

PQRST

Provocation, Quality, Region, Severity, Timing

OLDCARTS

Onset, Location, Duration, Characteristics, Aggravating, Relieving, Treatment, Severity

What bias exists in pain management?

Minority patients (especially Black patients) often receive less adequate pain treatment.

Gate Control Theory

Pain signals are regulated by a “gate” in the CNS.

Closing the “gate”: Stimulate large fibers (A-beta) → reduces pain transmission.

Ex: Massage, heat/cold, TENS, pressure.

Physiologic response to acute pain

↑ BP, ↑ HR, ↑ RR, diaphoretic, dilated pupils.

Behavioral signs of pain

Grimacing, guarding, moaning, restlessness.

Affective responses to chronic pain

Depression, fatigue, withdrawal, ↓ focus.

What increases pain perception?

Fatigue, anxiety, fear.

How does culture affect pain?

Influences expression (stoic vs expressive).

Adult vs. Kid pain scale

Adults: Numeric (0–10)

Kids: Wong-Baker FACES

Infants: CRIES

Best scale for cognitive impairment

Nonverbal patients: FLACC

Advanced dementia: PAINAD

When should you reassess pain after intervention?

After treatment to evaluate effectiveness.

Patient-Controlled Analgesia (PCA)

Allows patients to safely self-administer preset doses of opioids (like morphine, fentanyl, or hydromorphone) by pushing a demand button

Tip: Monitor respiratory rate, LOC, dose.

Epidural analgesia

Medication (like fentanyl) injected into epidural space (around spine) to block pain. Common in: labor, post-op, and chronic pain

Tip: Monitor for respiratory depression, hypotension, and urinary retention

Local anesthesia

Administered topically or via injection to numb a highly specific area by stopping local nerves from sending signals

Ex: lidocaine, bupivacaine