| Types of Pain |
| #1 |
Where does pain begin? |
Nociceptors - the nerves which sense and respond to potential irritation and actual damage. It is part of the afferent (sensory) neurons. Nerve endings are located in skin, periosteum, joint surfaces, and arterial walls. |
| #2 |
What is somatic pain? |
Localized, stems from bone, joints, cutaneous, muscle; described as achy, throbbing, or dull |
| #3 |
What is referred pain? |
Pain is experienced at a site distant from the injury. For example: someone who has had their gall bladder removed, may feel pain in their sholder |
| #4 |
What is visceral pain? |
Body organ pain resulting from stretching, distention, inflammation; described as squeezing, pressure, cramping, deep stretching, and distention |
| #5 |
Explain neuropathic pain? |
The nerves themselves are causing the pain. Injury or malfunction in either the central or peripheral nervous system. Centrally generated (ex. phantom limb pain), can be described as burning, shooting, electric. Can be peripherally generated (ex. a tumor pressing on nerve cells), can persist for months or years beyond apparent healing, often chronic, has a poor response to opioids, reacts well to adjuvant drugs |
| Alternative Treatments of Pain |
| #1 |
List 5 alternative treatment methods |
Acupressure/Acupuncture, relaxation/guided imagery, distraction, music, biofeedback, self hypnosis, treating alternate symptoms, cutaneous stimulation (heat, cold, massage) |
| #2 |
List 3 benefits of massage |
Produces physical and mental relaxation, reduces pain, enhances effectiveness of pain medication, promotes sleep and comfort, relieves anxiety and tension, improves insomnia, easy to do |
| #3 |
Describe music therapy |
The patient selects music that they prefer. It diverts the patient's attention away from the pain to promote relaxation and produces an altered state of consciousness through sound, silence, space, and time. Can decrease the use of medications |
| #4 |
Describe active progressive relaxation |
Practice while lying down or seated with feet firmly on the floor. Begin with the hands by tightening for 7 seconds and then relaxing for 20-30 seconds. Include the hands, forearms, biceps, head, face, throat, shoulders, chest, abdomen, lower back, thighs, buttocks, calves, and feet, Move head to toe. Not for post operative patients |
| #5 |
When do alternative measures work best? |
Works well with patients who are receptive to alternative treatment, effective for patients expressing anxiety and fear, works with patients who benefit by avoiding or reducing drug therapy, works in patients with incomplete relief by medication |
| Analgesics |
| #1 |
What are the three types on analgesics? |
Non-opioids like tylenol, Opioids (narcotics), and adjuvants |
| #2 |
What are adjuvant medications? |
A variety of medications that enhance analgesics or have analgesic properties that were previously unknown. Developed for things other than pain ex. Corticosteroids relieve pain related to inflammation |
| #3 |
What are the 3 rungs of the analgesic ladder |
1) Non opioid Adjuvants, 2) Opioids for mild to moderate pain in addition to non-opioids and adjuvants, 3) Opioids for moderate to severe pain in addition to non opioids and adjuvants |
| #4 |
How do opiates work? |
They bind to the opioid receptors in the CNS to increase the pain threshold, alter pain perception, and inhibit the ascending pain pathway |
| #5 |
List 5 common side effects of narcotics |
Constipation, lowered BP, hypotension, respiratory depression, urinary retention, nausea and vomiting, antitussive effects |
| Facts about Pain and Pain Management |
| #1 |
List 3 positive outcomes of effective pain relief |
1)Reduces physical Discomfort 2) Improves quality of life 3) Promotes early mobility and return to ADL 4) Results in fewer hospitalizations and doctor visits 5) Shortens hospital stays 6) Reduces health care costs |
| #2 |
List 3 features of pain (ex. pain is universal) |
Pain is: Protective, the most common reason for seeking health care, poorly understood, subjective, exhaustive, can interfere with personal relationships, cause psychological pain, influence metal state, environment, and culture, relief is a basic human right |
| #3 |
Define and explain Acute pain |
Sudden onset, protective, has an identifiable cause, has a short duration, has a predictable end, can threaten recovery if not relieved, may not be totally eliminated, it is realistic to reduce it to an acceptable level |
| #4 |
Define and explain Chronic pain |
Can happen when acute pain is unrelieved, not protective - no longer serves a purpose, may not have an identifiable cause, can lead to suffering, usually non-life threatening, duration is uncertain, major cause of psychological and physical disability |
| #5 |
Is chronic pain better or worse than acute? Explain |
Chronic pain does not show overt physical signs of pain ( like increased BP, increased pulse), but this is not a sign of adapting to the pain. Patients with chronic pain often suffer more over time due to increased exhaustion from coping. Patients may "doctor shop" and be labeled as "drug seeking" when they are simply trying to get relief from pain (pseudoaddiction) |
| Myths about pain |
| #1 |
Explain the myth: All patients will display observable signs of pain |
Patients in chronic pain or patients of different cultural backgrounds may not always show pain in the ways that we would expect. It is not the patient's responsibility to prove that they are in pain |
| #2 |
Explain the myth: Pain is an unavoidable part of growing old |
While chronic pain is common after age 65, it is not inevitable and it does not have to be tolerated without treatment. The prevalence of pain in nursing homes is 45-83% |
| #3 |
Explain the myth: Pain is mostly an emotional/psychological problem |
There are physiological reasons for pain. Often times negative emotions can worsen a patient's perception to the severity of pain. |
| #4 |
Explain the myth: People in pain will report it |
If a chronic pain patient feels as though their health care provider does not believe that they are in pain, they may stop reporting in an effort to avoid looking like an addict. In some cultures, reporting pain may even seem like weakness. Confrontation is a type of therapeutic communication that may help identify those that are suffering without relief |
| #5 |
Explain the myth: Too much pain medication to frequently constitutes substance abuse, causes addiction, will result in respiratory depression and hasten death |
Adequate assessment in conjunction with opioid titration based on patient response can provide maximum pain relief without affecting respiratory status negatively. Unrelieved pain can actually slow recovery times and have serious negative health impacts. It is unwarranted to withhold medications from patients for fear of causing respiratory depression |
