Fundamental Review

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Term 1
Definition 1
Cutaneous or Superficial Pain
arises in the skin or subcutaneous tissue ex. burn 3rd degree burn - no pain
Term 2
Definition 2
Visceral Pain
caused by stimulation of deep internal pain receptors most often in abdominal cavity, cranium, or thorax ex. menstrual cramps, labor pain, GI infections, bowel disorders, & organ cancers
Term 3
Definition 3
Deep Somatic Pain
originates in ligaments, tendons, nerves, blood vessels, & bones ex. broken bone, nerve problems
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Term 4
Definition 4
Radiating Pain
starts at the source but extends to other locations ex. heart burn - may radiate outward from the sternum to involve the entire upper thorax
Term 5
Definition 5
Referred Pain
occurs in an area that is distant from the original site ex. MI, gallbladder pain felt in shoulder
Term 6
Definition 6
Phantom Pain
perceived to originate from an area that has been surgically removed ex. amputations usually gets better with time
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Term 7
Definition 7
Psychogenic Pain
believed to arise from the mind can be just as severe as pain from a physical cause
Term 8
Definition 8
Acute Pain
following acute injury, disease, or surgery < 6 months typically know the cause potential or actual tissue damange generally disappears as tissue heals fast, sharp, or initial pain
Term 9
Definition 9
Chronic Malignant Pain
associated with cancer or other progressive disorders (Rheumatoid Arthritis, Lupus) > 6 months no current tissue injury periods of remission and exacerbation don't usually know the cause dull, slow, or delayed pain
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Term 10
Definition 10
Chronic Nonmalignant Pain
When tissue injury is nonprogressive or healed > 6 months
Term 11
Definition 11
Intractable Pain
both chronic and highly resistant to relief Highly resistant to medication
Term 12
Definition 12
Neuropathic Pain
often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli
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Term 13
Definition 13
Nociceptive Pain
most common type of pain pain receptors respond to stimuli that are potentially damaging may occur as a result of trauma, surgery, or inflammation
Term 14
Definition 14
Quality of Pain
may be described as: sharp or dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling may describe its periodicity as: episodic, intermittent, or contant
Term 15
Definition 15
Tranduction
Nociceptors become activated by the perception of potentially damaging mechanical, thermal, and chemical stimuli
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Term 16
Definition 16
Transmission
peripheral nerves carry the pain message to the dorsal horn of the spinal cord
Term 17
Definition 17
Pain Perception
the recognition and definition of pain in the frontal cortex the point at which the person becomes aware of the pain: 1) somatosensory cortex perceives & interprets physical sensations 2) limbic system - emotional reactions to stimuli 3) frontal cortex is involved in thought & reason
Definition 18
Term 18
Pain Threshold
the point at which the brain recognizes & defines a stimulus as pain repeated experience with pain can reduce a patient's threshold
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Term 19
Definition 19
Pain Tolerance
duration or intensity of pain that a person is willing to endure different for every person
Term 20
Definition 20
Hyperalgesia
extreme sensitivity to pain
Term 21
Definition 21
Pain Reaction
includes the ANS and behavioral responses to pain respirations may increase or decrease increased HR decreased O2sat facial grimaces
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Term 22
Definition 22
Modulation
pain signals can be either facilitated or inhibited can change the perception of pain 2 mechanisms: endogenous analgesia system & gate-control mechanism
Term 23
Definition 23
Nociceptors
pain receptors - want us to know when we're in pain nonadapting - to keep us constantly informed of the continuous presence of the painful stimulus that can damage tissues
Term 24
Definition 24
Endogenous Analgesia System
endogenous opiods block the continuing pain impulses and release of substance P to provide pain relief
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Term 25
Definition 25
Gate Control Theory of Pain Modulation
somatic signals from nonpainful sources can inhibit signals of pain by closing the gate stops impulses from getting to the brain to not feel pain stimulation of touch fibers by: rubbing, stroking, massage, vibration, application of ointments, heat, cold
Term 26
Definition 26
kids cannot report exact locations of pain; commonly experience acute pain Developmental Stages elderly - high prevalence of pain may falsely believe pain & suffering comes with old age - may not report pain
Term 27
Definition 27
Ethnic/Cultural Factors
some cultures do not readily report pain
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Term 28
Definition 28
Pain Assessment
considered the 5th vital sign if the patient is in pain, look at PRN meds pain history from clients - OLDCARTS behavioral & physiologic response assess before and after administration of meds - evaluate effectiveness
Term 29
Definition 29
Wong-Baker Faces
used with kids and neuro patients/cognitive impairements 10 point pain intensity scale rating of 3 - need to revise the pain treatment plan rating of 6 or more - demands immediate attention; the meds aren't working must always believe the client - pain is what the patient says it is
Definition 30
Term 30
acute pain - elevated BP, appear ashen chronic/unresolved pain - BP and P may be lower than normal, may report feeling faint Vital Signs changes in v/s generally last only a short time - after more than an hour, the v/s typically return to what they were previously normal v/s does not mean the patient is free of pain!
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Term 31
Definition 31
alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the client Pain Management non-pharmacologic and pharmacologic - use the most effective & least invasive method
Term 32
Definition 32
Noninvasive Pain Management
patient can't have pain meds relaxation exercises - teach patient slow, rhythmic breathing distraction - watching TV, listening to music, family, reading, etc. guided imagery - use of images (ex. beach) biofeedback - using your mind to control the body (BP, HR, etc.) interpersonal skills - humor, gentle words physical care - bathing
Definition 33
Term 33
Cutaneous Stimulations
method of pain relief based on the gate-control theory of pain works best on pain that is localized and not diffuse massage - effleurage (use of slow, long, guiding strokes) used for women in labor; always obtain verbal permission transcutaneous electrical nerve stimulator (TENS) - pads directly applied to painful area; stimulates A-delta sensory fibers percuatneous electrical stimulation (PENS) stimulates peripheral sensory nerves; effective in short-term management of acute & chronic pain acupuncture - application of extremely fine needles to stimulate the endogenous analgesia
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Term 34
Definition 34
Immobilization
particularly helpful with arthritic joints remove splints at regular intervals so that the patient can exercise the area to prevent further injury
Term 35
Definition 35
Nonopiod Analgesics
relieve mild to moderate pain; many also reduce inflammation & fever ex. acetaminophen, aspirin, ibuprofen may be used for acute & chronic pain many are compounded with opoids allows for a lower dose of opoid to be administered
Term 36
Definition 36
primarily act in the peripheral tissues by interfering with the production of prostaglandins ex. aspirin, ibuprofen Nonsteroidal Anti-inflammatory Drugs common side effect of GI irritation (NSAIDS) take with food, lower the dose, or use enteric-coated pills Aspirin - can also inhibit platelet aggregation (clumping)
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Term 37
Definition 37
Acetaminophen
very little anti-inflammatory effect; has a analgesic & fever-reducing properties fewer side effects - probably safest nonopiod can cause severe hepatotoxicity in patients who consume alcohol & in patients with liver disease
Term 38
Definition 38
Opiod Analgesics
relieve intense pain by binding to opiate receptors & activating endogenous pain suppression in the CNS most common side effects - nausea, vomiting, constipation, & drowsiness opiod antagonist - naloxone (Narcan)
Term 39
Definition 39
A-delta fibers
transmit fast pain impulses from acute, focused mechanical & thermal stimuli
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Term 40
Definition 40
C fibers
trasmit slow pain impulses, that is, dull, diffuse pain impulses that travel at a slow rate conduct pain from mechanical, thermal, & chemical stimuli
Term 41
Definition 41
Body's Reaction to Pain
onset of acute pain - reacts automatically by activating sympathetic nervous system; fightor-flight response - minimizes blood loss, maintains perfusion to vital organs, prevents & fights infections, promotes healing pain continues - body adapts, parasympathetic nervous system takes over; actual pain receptors continue to transmit pain message so that the person remains aware of the tissue damage - largely protective
Term 42
Definition 42
Endocrine System
ongoing pain triggers release of excessive amounts of ACTH, ADH, GH, catecholamines, & glucagon insulin & testosterone levels decrease results in weight loss, tachycardia, fever, increased RR, & death
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Term 43
Definition 43
Cardiovascular System
unrelieved pain leads to hypercoagulation and an increase in HR, BP, cardiac workload, & O2 demand may lead to unstable angina, intracoronary thrombosis, & myocardial ischemia & infarction
Term 44
Definition 44
Musculoskeletal System
unrelieved pain causes impaired muscle function, fatigue, & immobility can affect ADL's & engaging in physical therapy
Term 45
Definition 45
Respiratory System
pain causes splinting (voluntary limiting of thoracic & abdominal movement in an effort to reduce pain), splinting reduces tidal volume & increases inspiratory & expiratory pressures can result in pneumonia & atelectasis
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Term 46
Definition 46
Genitourinary System
lead to decreased urinary output, urinary retention, fluid overload, hypokalemia, hypertension, & increased cardiac output
Term 47
Definition 47
Gastrointestinal System
in response to pain, intestinal secretions & smooth muscle tone increase, & gastric emptying & motility decrease
Term 48
Definition 48
Tolerance
can occur with opoids increasing the dose or changing the route of administration can correct the problem
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Term 49
Definition 49
Physical Dependence
leads to withdrawal symptoms when the drug is removed abruptly can be prevented by decreasing the dose slowly over time
Term 50
Definition 50
Psychological Dependence
addiction occurs in less than 1% of patients even after long-term prescribed use of opioids for pain
Term 51
Definition 51
Mu Agonists
stimulate Mu receptors and are used for acute, chronic, & cancer pain ex. codeine, morphine, Dilaudid, fentanyl, methadone, & oxycodone excellent meds for breakthrough pain
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Term 52
Definition 52
Breakthrough Pain
pain that "breaks through" relief provided by analgesics breakthrough analgesia - a rescue or extra dose drugs used - should have a rapid onset & short duration when possible - give the same drug as that given for ongoing pain relief no maximum daily dose limit & no "ceiling" to the level of analgesia from these drugs
Term 53
Definition 53
Agonist-antagonists
stimulate some opioid receptors but block others ex. Talwin & Nubain (mixed), Buprenex (partial agonists) appropriate for acute moderate to severe pain inappropriate for severe escalating pain not recommended as first-line drugs in any kind of pain - there is a limit to the analgesia they can provide & must be administered parenterally should not be given with mu agonists
Definition 54
Term 54
Routes of Adminstration for Opoid Analgesics
use the safest & least invasive route Oral - preferred route unless rapid onset of analgesia is desired; relief for mild to severe pain Transdermal - effective for ongoing pain relief but does not provide immediate relief; fever will increase absorption Rectal - when patient is vomiting, has a GI obstruction, or is at risk for aspiration Subcutaneous - intermittent injections or continuous administration of opioids (patients who cannot tolerate oral opioids or who have dose-limiting side effects from oral administration & have limited venous access); used for chronic cancer pain Intramuscular - painful, slow onset of action, &
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Term 55
Definition 55
Equianalgesia
approximately equal analgesia that a variety of opioids will prodide dose calculations provide a starting point when changing from one opioid to another
Term 56
Definition 56
Adjuvant Analgesics
may be used as primary therapy for mild pain or in conjunction with opioids for moderate to severe pain reduce the amount of opioid the patient requires useful if the patient experiences significant side effects from escalating doses of opiods
Term 57
Definition 57
Nerve Blocks
type of regional anesthesia anesthetic agent injected into or around the nerve that supplies sensation to a specific part of the body most affect a plexus (network of nerves) may be used for short-term pain (surgical procedures) or long-term pain management of chronic pain
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Term 58
Definition 58
Local Anesthesia
injection of local anesthetics into body tissues short-acting - lidocaine long-acting - marcaine
Term 59
Definition 59
Topical Anesthesia
applying an agent that contains cocaine, lidocaine, or benzocaine directly to the skin, mucous membranes, wounds, or burns quickly absorbed & provides pain relief for mild to moderate pain
Term 60
Definition 60
Surgical Interruption of Pain Conduction Pathways
permanent destruction of nerve pathways used as a last resort for intractable pain
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Term 61
Definition 61
Cordotomy
interrupts pain & temperature sensation below the tract that is severed most frequently done for leg & trunk pain
Term 62
Definition 62
Rhizotomy
interrupts the anterior or posterior nerve route that is located between the ganglion and the cord anterior - generally used to stop spastic movements most often used for head and neck pain produced by cancer
Term 63
Definition 63
Neurectomy
used to eliminate intractable localized pain pathways of peripheral or cranial nerves are interrupted to block pain transmission
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Term 64
Definition 64
Sympathectomy
severs the paths to the sympathetic division of the ANS outcomes - improvement in vascular blood supply & elimination of vasospasm used to treat pain from vascular disorders
Term 65
Definition 65
Managing Pain in Patients with Substance Abuse or Active Addiction
take a substance abuse history for all patientsshould include information on alcohol intake Symptoms: -repeated requests for opioid injections even though surgery was several days ago - refusal to try oral medication - continued high opioid dose, even though surgery or acute illness has passed observe patient carefully - S/Sx my also indicate untreated withdrawal or increased pain due to complications be careful not to undertrea pain with patients whom you know to abuse substances
Definition 66
Term 66
Pain Relief from Placebos
placebo - any medication or procedure, including surgery, that produces an effect in a patient because of its implicit or explicit intent, not because of its specific physical or chemical properties usually tablets containing sugar, saline, or water placebos do not have a useful place in pain management: - if the patient responds to placebo, it does not mean that the patient did not have pain - placebos may be effective at one time and not at another - their use involves deceit
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Term 67
Definition 67
thoroughly document the pain management plan and the patient's response: Pain Documentation
- expected outcome - patient's pain level at the present time - patient's response to any intervention - any adverse reactions - planned interventions to improve the pain relief
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Cutaneous or Superficial Pain

Deep Somatic Pain

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Chronic Malignant Pain

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Chronic Nonmalignant Pain

When tissue injury is nonprogressive or healed > 6 months

both chronic and highly resistant to relief Highly resistant to medication

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extreme sensitivity to pain

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Endogenous Analgesia System

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Gate Control Theory of Pain Modulation

some cultures do not readily report pain

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Noninvasive Pain Management

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Body's Reaction to Pain

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Routes of Adminstration for Opoid Analgesics

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Surgical Interruption of Pain Conduction Pathways

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Managing Pain in Patients with Substance Abuse or Active Addiction

Pain Relief from Placebos

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