Untitled Flashcards Set

• Pathophysiology : is the study of how the body’s normal processes change when we get sick or injured. It explains what goes wrong inside the body when we have diseases or conditions. By understanding these changes, doctors and nurses can figure out why certain symptoms happen and how to treat them.

• Pain 

  • is the most common symptom prompting for one to seek healthcare 

  •  is an unpleasant , uncomfortable sensation that usually indicated there is some sort of tissue damage

  • Not managing pain may interfere with the quality of life and ability to perform activities of daily living

The somatosensory component of the nervous system

• Function : provides an awareness of body sensations such as touch,temperature,limb position and pain

• Composition : sensory receptors consist of discrete nerve endings in the skin and other body tissues

Pain Theories

• Specificity: This theory predicts how painful a specific acute injury may be , but does not encompass how the pain feels or how the person has experienced pain in the past 

• Pattern : group of theories that propose pain receptors share pathways with other sensory modalities but different patterns of activity signal painful versus non painful stimuli.

• Gate control theory : internuncial neurons involved are activated by larger diameter ,faster propagating fibers that carry tactile information. 

• Neuromatrix theory : it tackles the brains role and the multiple dimensions  and determinants of pain which helps understand chronic and phantom limb pain .

Central Processing of pain information 

• Transmission to the somatosensory cortex : how pain information is perceived and interpreted

• The limbic system : emotional components of pain are experienced

• Brain stem centers : ANS responses are recruited

Pain travel

• To feel pain , signal must travel 

• From the nociceptors in peripheral tissue to spinal cord  ( A - delta fibers and C fibers (the fiber type can affect the type of pain sensed)) ( dorsal horn ; relay station)

• From spinal cord to the brain ( thalamus : relay station) (cerbral cortex where pain is perceived)’

Transmission of Pain

• Neospinothalamic tract 

  • Provides for rapid transmission of sensory information to the thalamus 

  • Transmission of sharp - fast pain information to the thalamus ( pain is experienced as bright , sharp , or stabbing in nature) 

  • Synapses are then made; and the pathways continue to contralateral parietal somatosensory are to provide where precisely the location of pain is

• Palesospinothalamic Tract 

  • Slow conducting tracts that transmit sensory information that dont require precise localization

  • Diffuse,dull,aching, and unpleasant sensations that commonly are associated with chronic and visceral pain

• Pain Treshold

  • The point at which a stimulus is perceived as painful

• Pain tolerance 

  • The max intensity or duration of pain that a person is willing to endure before the person wants something done about the pain 

• Acute pain 

  • self limiting pain that does not last less than 6 months 

• Chronic Pain

  • Persistent pain that lasts longer than 6 months 

  • Lacks the autonomic and somatic response associated with acute pain 

  • Is accompanied by debilitating responses

Types of pains 

• Nociceptive pain 

  • Nonciceptors (pain receptors) are activated in response to actual or impending tissue injury 

• Cutaneous 

  • Shapr , burning pain 

  • Orgin in skin or subcuataneous tissues

• Deep somatic 

  • More diffuse and throbbing 

  • Origin in body structure s

• Visceral 

  • Diffuse and poorly defines 

  • Results from stretching , distention , or ischemia of tissue 

• Referred 

  • Originates at a visceral site but perceived as originating in part of body wall that is innervated by neurons entering the same segment of nervous system

Etiology 

• The cause of pain includes : nerve damage , tissue injury , cancer , and surgery 

• Classified according to : the orgin strctures . duration , and cause 

Tissue damage 

• Activities pain receptors in peripheral nerves

• Physical causes ( heat , cold , pressure ,strech , spasm , ischemia)

• Chemical causes ( substances released into extracellular fluid around nerve fibers 

Endogenous analgesia

• CNS has own system for relieving pain

Clinical manifestations

• Pain is subjective 

• Can be affected by mood , sleep disturbances, fatigue , medication ,culture , gender ,age , other psychosocial factors

• Mesaurement tools (nurmerical rating scales,picture scales.

• Verbal ( cring and moaning)

• Non-verbal ( grimacing , guardian , restlessness, anxiety)

• Changed in vital signs ( increase of BP or HR)

Pain and Pain syndromes

• Neuropathic pain ( originates from pathology)

• Trigeminal neuralgia ( facial tics or spasms)

• Postherpetic neuralgia ( pain or shingles / herpes infection)

• Complex regional pain syndrome ( autonomic and vasomoto instability )

Phantom limb pain 

• Neurological pain which follows amputation of a limb or part of a limb which can being as sensations of tingling , heat and cold. Orheaviness , followed by burning ,cramping, or shooting pain

Pain and children and other pain 

• For infants and noncommunicating children, adults with cognative impairment physiological symptoms must be used for assesment

• Children are able to also self-report pain

Nonpharmacologic interventions for pain 

• Cognitive behavioral : relaxation , distraction , imagery , biofeedback

• Physical agents : heat and cold

• Stimulus -induced analgesia

• Acupuncture and acupressure

Pharmacologic Treatment of pain 

• NSAIDS 

• Opioid analgesics

Opioid agonist 

• Used mainly to relieve acute or chronic moderate to severe pain 

• Morphin Sulfate (prototype)

  • Schedule II 

  • Oral (PO) , IM , IV routes of administration

  • It is matabolized in the liver and excretes in urine 

  • Duration of action is 5 to 7 hours 

  • Effects that can happen : CNS depression , with respiratory depression and sedation, 

  • Decreased GI motility 

  • Opioids prevent or relieve moderate to severe acute or chronic pain

  • Used in acute MI, biliary or renal colic , burns and other traumatic injuries, Postoperative states, Cnacer

  • Contraindications can occure from hypersensitivety to opiods, respiratory depression, acute or chonic lung disease, airway obstruction , pregnancy

  • Use with caution with hypotenstion , thyroid dysfunction , liver or kidney disease, head injury, seizures, severe alcholism ,