Ch. 44 Pain Management-Fundamentals

How would you describe the nature of pain?
Subjective and individualized, reduces quality of life, not objectively measurable, and may lead to serious physical, psychological, financial, and social consequences
What is transduction?
Converts energy produced by stimuli into electrical energy
Describe the pathway of pain?
Begins in the periphery
Pain producing stimulus sends impulse across pain nerve fiber (nociceptor)
Generates an action potention
What occurs after transduction is commplete?
Transmission of pain impulse begins
What is transmission?
The sending of an impulse across the nerve fiber
What is perception?
The point when a person is aware of pain
Somatosensory cortex=identifies the intensity of pain
Association Cortex=Determines how a person feels and reacts to pain
There is no single pain center
What is modulation?
Inhibits pain impulse; a protective reflex response that occurs with pain reception
What is the Gate-control theory of pain?
Gating mechanisms in the CNS regulate or block pain impulses
Pain impulses pass through when a gate is open and impulses are blocked when gate is closed
Closing the gate is the basis for nonpharmacology pain relief interventions
What occurs as pain impulses ascend the spinal cord?
The ANS is stimulated by a stress response
Continuous pain activates which part of the body?
The parasympathetic nervous system
What are some behavioral responses to pain?
Clenching teeth, facial grimacing, holding painful body part, bent posture (symptoms of acute pain)
Does lack of pain indicate that a patient is experiencing no pain at all?
No
What is Acute/Transient pain?
Protective, identifiable, short duration, with limited emotional response
What is Chronic/Persistent (non cancer) pain?
Not protective, has no purpose, and may/may not have an identifiable cause
What is Chronic Episodic pain?
Occurs sporadically over an extended duration
What is cancer pain?
Can be either acute or chronic
What is idiopathic pain?
Chronic pain with no identifiable physical/psychological cause
What should the nurse understand about a patient’s pain perception?
Everyone has a different perception of pain. Culture influences the way the express their pain and their understanding of pain. Spirituality factors may influence pain
How should pain management be termed?
Systematic; Pain management needs to consider the patient’s quality of life
What are clinical guidelines available to manage pain?
American Pain Society
Sigma Theta Tau
National Guidelines Clearinghouse
On your assessment, what should you consider?
To ask the patient of their pain level
Use the ABC of pain management
Remember that pain is not a number
What are the characteristics of pain?
Timing
Location
Severity
Quality
Aggravating/Precipitating Factors
Relief Measures
What are examples of non-pharmacological pain relief interventions?
Relaxation/Guided Imagery Therapy
Distraction
Music
Cold/Heat Application
Herbals
Transcutaneous electrical nerve stimulator
What are examples of acute pain pharmacological therapies?
Analgesics
Opioids
Nonopioids
Adjuvants/coanalgesics
What is patient controlled analgesics?
Allows a patient to administer with minimal risk of an overdose; maintains a constant plasma level of analgesic
What are topical analgesics?
Creams, ointments, patches
What is local anesthesia?
Local infiltration of an anesthetic medication to induce loss of sensation to a body part
What is epidural analgesia?
Regional and administered into the epidural space
What is physical dependence?
State of adaptation manifested by a drug
What is addiction?
A primary, chronic, and neurobiological disease with genetic, environmental factors that influence development
What is drug tolerance?
Exposure to a drug induces change that results in diminution of one or more effects of the drug over time