Pain

Question 1

what are the different types of pain?

Answer 1

acute
chronic
neuropathic

Question 2

define pain per McCaffery

Answer 2

pain is whatever the person says it is, and existing whenever the person says it does

Question 3

pain is ____________

Answer 3

subjective

Question 4

what are three characteristics of acute pain?

Answer 4

1. sudden in onset, localized last less than 6 mo
2. result of tissue injury or inflammation
3. resolves with healing of disorder

Question 5

define pain per 1979 study of pain

Answer 5

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

Question 6

which kind of pain, results in a fight-or-flight response?

Answer 6

acute pain (tachycardia, tachypnea, ↑ BP, fear, anxiety)

Question 7

how is acute pain treated?

Answer 7

therapy is aimed at treating underlying cause and interrupting nociceptive signals

Question 8

how is chronic pain treated?

Answer 8

difficult to treat pharmacologically. complementary or alternative medicine approaches can provide relief.

Question 9

what is are some side effects of chronic pain?

Answer 9

-increased mortality from heart or respiratory disease
-decreased physical activity = reduced flexibility, strength, stamina or weight gain

Question 10

what are three characteristics of chronic pain?

Answer 10

1. pain lasting more than 6 months
2. may originate with injury, illness or no clear cause
3. accompanied by fatigue, sleep disturbances, ↓appetite, mood changes, depression, anxiety
   (normal vital signs)

Question 11

what are three characteristics of neuropathic pain?

Answer 11

1. abnormal pain from damage to nerve cells (shingles0
2. burning, numb, pins and needles, tingling, or shooting sensation
3. normal stimuli can produce significant discomfort

Question 12

how is neuropathic pain treated?

Answer 12

adjuvant therapies (antidepressants, anticonvulsants, capsaicin)
(opioids and NSAIDs ineffective)

Question 13

what are the 4 types of neuropathic pain?

Answer 13

1. central pain (damage to CNS multiple sclerosis)
2. peripheral neuropathies (diabetes)
3. differentiation pain (phantom limb)
4. sympathetically maintained pain (after injury or surgery, pain is out of proportion)

Question 13

how is pain classified?

Answer 13

cause
duration
origin

Question 14

what is intractable pain?

Answer 14

chronic or resistant to relief

Question 15

what are the ways pain is classified by origin?

Answer 15

-cutaneous
-deep somatic
-visceral
-radiating/referred
-phantom
-psychogenic

Question 16

what are the ways pain is classified by cause?

Answer 16

nociceptive (trauma)
neuropathic (nerve problem)

Question 17

what are the ways pain is classified by duration?

Answer 17

acute
chronic
intractable

Question 18

give an example of a cutaneous/ superficial pain cause:

Answer 18

cat scratches

Question 19

give an example of deep somatic pain cause:

Answer 19

cancer, artritis, fracture

Question 20

give an example of visceral pain cause:

Answer 20

organs, internal pain receptors (tight, pressure cramping)

Question 21

give an example of psychogenic pain cause:

Answer 21

believed to come from the mind, no medical reason can be found

Question 22

give an example of phantom pain cause:

Answer 22

amputation pain

Question 23

what is an example of referred pain?

Answer 23

felt in one place but may originate elsewhere (gallbladder pain felt in rt. shoulder)

Question 24

when describing pain what are the three categories we ask about?

Answer 24

quality periodicity intensity

Question 25

what are some examples of descriptors for quality of pain?

Answer 25

sharp, dull, aching, throbbing, stabbing, burning

Question 26

what are some examples of descriptors for periodicity of pain?

Answer 26

-episodic (related to something= period, migraines) -intermittent (comes and goes) -constant

Question 27

what are some examples of descriptors for intensity of pain?

Answer 27

mild (1-3), moderate (4-6), severe (7-10), intolerable

Question 28

what are the four mechanisms of pain perception?

Answer 28

1. transduction 2. transmission 3. perception 4. modulation

Question 29

what is perception?

Answer 29

recognizing and defining pain in the cortex

Question 29

what is transduction?

Answer 29

activation of nociceptors by stimuli

Question 30

what is transmission?

Answer 30

conduction of pain message to dorsal part of spinal cord

Question 31

what is modulation?

Answer 31

changing pain perception (non-pharmacological interventions can promote the release of endogenous opioids during this stage- perception of pain changes)

Question 32

what are endogenous opioids?

Answer 32

pain relief from your own body not ingested

Question 33

what is a nociceptor?

Answer 33

a nerve receptor that transmits pain located at the ends of small afferent neurons

Question 34

what are nociceptors stimulated by?

Answer 34

direct cell damage

Question 35

how is nociceptive pain described?

Answer 35

as aching or throbbing

Question 36

what type of pain responds to non opioid and opioid analgesics

Answer 36

nociceptive pain

Question 37

what are the two types of nociceptor fiber types?

Answer 37

C fiber non-myelinated (slow) A-delta myelinated (fast)

Question 38

what type of pain do C fibers transmit? What is an example?

Answer 38

dull, aching, burning pain slow onset, longer duration ex: bump knee

Question 39

what is the "gate theory" of pain?

Answer 39

gate is opened by nociceptor input, anxiety, worry, concentrating on pain gate is closed by non-nociceptor input, positive mood, concentrating on other than pain

Question 39

what type of pain to A-delta fibers transmit? what is an example?

Answer 39

sharp localized pain short duration ex: paper cut

Question 40

what are six factors that influence pain?

Answer 40

1. emotions 2. experience with pain 3. developmental stage 4. sociocultural factors 5. communication skills 6. cognitive impairments

Question 41

when asessing pain it is important to obtain a __________ pain history including ___________, ____________, and_____________.

Answer 41

complete onset location aggravating/alleviating factors

Question 42

what are some nonverbal signs of pain?

Answer 42

elevated pulse/ BP crying, moaning sweating shaking grimacing guarding silence

Question 43

what are the 6 pain scales?

Answer 43

1. numeric rating scale (NRS) 2. vusual analogue scale (VAS) 3. wong-baker faces pain scale 4. PAINAD 5. FLACC behavioral (kids) 6. neonatal infant pain scale

Question 44

what scale is used for normal adults?

Answer 44

numeric rating scale

Question 45

what pain scale is used for children?

Answer 45

wong-baker faces scale FLACC (behavioral pain scale) kids <7

Question 46

what scale is used for people with dementia?

Answer 46

PAINAD

Question 47

what scale is used for infants?

Answer 47

neonatal infant pain scale

Question 48

what is a visual analog pain scale?

Answer 48

a tool that help pt. mark their pain on a continuum (line) from no pain to worst pain shown above faces scale usually

Question 49

FACES is a _______________ pain scale

Answer 49

self-report. the pt. is telling YOU. used on 3+ kids able to say "i am here"

Question 50

what are the 4 types of non-pharmacological pain management methods?

Answer 50

1. cutaneous stimulation 2. immobilization 3. cognitive-behavioral interventions 4. oral sucrose

Question 51

what is oral sucrose used for?

Answer 51

babies in pain

Question 52

what are some cognitive-behavioral interventions?

Answer 52

distraction (music) sequential muscle relaxation guided imagery hypnosis animal therapy therapeutic touch

Question 53

what are some example of cutaneous stimulation for pain management?

Answer 53

-transcutaneous electrical nerve stimulation (TENS) -spinal cord stimulator (SCS) - acupuncture -acupressure -massage -use of hot and cold -contralateral stimulation

Question 54

what types of cutaneous stimulation is the nurse able to do?

Answer 54

massage use of heat and cold contralateral stimulation

Question 55

who uses transcutaneous electrical nerve stimulation (TENS)?

Answer 55

chiropractors physical therapist people in labor

Question 56

what do CAM promote the release of?

Answer 56

endogenous opioids (endorphins and enkephalins)

Question 57

what are some pharmacological measures for pain management?

Answer 57

non-opioid analgesics adjuvant analgesics opioid analgesics

Question 58

give an example of non opioid analgesics?

Answer 58

NSAIDs acetaminophen

Question 59

give an example of opioid analgesics?

Answer 59

(IV, transdermal and epidural forms) nerve block local or topical anesthesia epidural injection