module 3: pain

Question 1

what is an analgesic?

Answer 1

relieves pain without causing loss of consciousness

Question 2

what is an opioid?

Answer 2

any drug natural or synthetic that has actions similar to morphine

Question 3

what is an opiate?

Answer 3

applied only to compounds present in opium

Question 4

endogenous opioid peptides?

Answer 4

• enkephalins, endorphins, dynorphins
• NT, neurohormones, neuromodulators
• CNS and peripheral tissue

Question 5

what are opioid receptors?- Mu and Kappa

Answer 5

• opioids dont interact with delta
• Mu receptors: activation linked to physical dependence (analgesica, resp depression, euphoria, sedation)
• Kappa receptors (analgesia, sedation, psychotomimetric effects)

Question 6

3 classifications of drugs that act at opioid receptors?

Answer 6

• pure opioid agonists
• agonist-antagonist opioids
• pure opioid antagonists

Question 7

what are pure opioid agonists?

Answer 7

-activate mu and kappa. analgesia, euphora, sedation, resp depression, physical depedence, constipation (codeine)

Question 8

what are agonist-antagonist opioids?

Answer 8

-antagonize analgesia caused by pure agonist

Question 9

what are pure opioid antagonists?

Answer 9

-do not produce analgesia or anything. used to reverse resp and CNS depression (nalaxon)

Question 10

other strong opioids?

Answer 10

none are better than opiods

Question 11

what are adjuvant analgesics and off-label uses?

Answer 11

• complement the effects of opioids (combination)
• enhance analgesia
• treat side effects caused by opioids
• neuropathic pain
• pain relief= limited and less predictable

Question 12

antidepressants?

Answer 12

• AMITRIPTYLINE
• can reduce pain or neuropathic origin
• elevate mood
• dosing at bedtime is best
• effects start after 1-2 weeks, max after 4-6

Question 13

antiseizure drugs?

Answer 13

• can help relieve neuropathic pain
• acute pain such as sharp, darting, burning pain
• GABAPENTIN

Question 14

marijuana?

Answer 14

• most commonly used illicit drug

- cannabis sativa: the source of marijuana (indian hump plant)

Question 15

psychoactive component of marijuana?

Answer 15

THC (high lipid solubility), highest concentration in female flowers in the flowering tops

Question 16

pain is… the 5th..

Answer 16

vital sign

Question 17

who decides what pain is?

Answer 17

what the patient says it is!

-most common reason for seeking health care

Question 18

basic physiology of pain?

Answer 18

-travels up neuroreceptors through spinal cord–> brain–> brain back to area of pain

Question 19

different types of pain (4)?

Answer 19

acute pain- fall down stairs and break a leg
procedural pain- get appendix removed
chronic pain- persistent, starts acute and can cause chronic pain
cancer- related pain, can be chronic but is its own category

Question 20

factors influenced the pain response?

Answer 20

• past experience
• anxiety and depression
• culture
• age (elderly neurons less)
• gender
• genetics
• expectations

Question 21

pain assessment?

Answer 21

NOPRQRSTUV
norma
onset
provoking
quality
region/radiation
severity
treatment
understanding
values

Question 22

Interventions (non-pharmacological) for pain?

Answer 22

• acupuncture
• massage
• heat
• cold
• meditation
• relaxation therapy
• art/music therapy
• physical care
• support persons

Question 23

WHO analgesic ladder?

Answer 23

bottom of ladder: nonopioid +/- adjuvant
middle of ladder: pain persisting or increasing, opioid +/- nonopioid, adjuvant
top of ladder: pain persisting or increasing, opioid for moderate to severe pain

Question 24

what is actually a definition of pain?

Answer 24

unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 25

most common reason for seeking health care?

Answer 25

pain

Question 26

what disables and distresses more than any single disease?

Answer 26

pain

Question 27

what is acute pain?

Answer 27

recent onset, specific injury - usually decreases as healing occurs if no lasting damage or systemic disease - can last from days to 6 months

Question 28

what can lead to poor assessment or uncontrolled pain?

Answer 28

lack of knowledge and misconceptions regarding pain

Question 29

what is procedural pain?

Answer 29

brief intense after diagnostic, therapeutic and preventative procedures - seconds to hours, may become acute pain - needle puncture or wound debridement and cleaning

Question 30

what is chronic pain?

Answer 30

constant or intermittent pain that persists beyond the expected healing time, usually not attributed to a specific cause or injury -unrelieved= socioeconomic burdens

Question 31

3 categories of chronic pain?

Answer 31

-nocireceptive, neuropathic, and mixed type

Question 32

chronic nocireceptive pain?

Answer 32

-arises from constant stimulation of pain receptors and signals tissue damage in skin, bone, joints, or viscera (arthritis, fibromyalgia)

Question 33

what is allodynia?

Answer 33

pain arising from a nonpainful stimulus such as a breeze or light touch of cling or bedding. postherpetic neuralgia, diabetic neuropathy, phantom limb pain/sensation

Question 34

mixed chronic pain?

Answer 34

mix of neuropathic and niciceptive- migraine pain

Question 35

what is neuropathic chronic pain?

Answer 35

Triggered by nerve damage or malfunction of peripheral & central nervous systems resulting in abnormal signaling. May be due to nerve compression by tumors, nerve inflammation by infection, nerve impairment from systemic disease such as diabetes. Burning, tingling, piercing.

Question 36

harmful effects of acute pain

Answer 36

changes to pulmonary, CV, GI, endocrine, immune systems - more harmful to those who: age, illness, injury - stress response - unable to deep breath, fatigued, decreased mobility

Question 37

harmful effects of procedural pain

Answer 37

-cycle of pain, anxiety, fear that leads to avoidance of procedure

Question 38

harmful effects of chronic pain

Answer 38

- suppression of immune system- promote tumor growth | - depression, disability, low quality of life, can disrupt life

Question 39

what are nociceptors?

Answer 39

neurologic transmission of pain

Question 40

do large organs have nociceptors?

Answer 40

no, you feel pain in these organs from intense stimulation of receptors that have other purposes (stretch, spasm, ischemia, dilation)

Question 41

culture and pain?

Answer 41

ppl learn from early childhood how to respond to team. no stereotyping! understand cultural differences

Question 42

gerontological considerations and pain?

Answer 42

- loss of fibres- decreased nerve function- diminished pain perception (secondary to disease process, not really a part of normal aging) - smaller doses may be okay because slower metabolism - confusion may mean pain - dont base pain relief on age