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| Physiological signs of acute pain? | Increased HR, increase respiratory rate, increased BP, diaphoresis/pallor, anxiety, agitation, confusion, urine retention
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| Physiological signs of chronic pain? | Flat effect, decreased movement/activity, fatigue, withdrawal from others and social interaction, waxing and waning, anxiety and depression
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| referred pain | must consider when interpreting location of pain
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| Somatic pain | superficial or deep
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| superficial pain | skin, mucous membranes, subQ tissue
sharp, burning, or prickly
well localized
ex) sunburn
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| deep pain | bone, joint, muscle, skin, or connective tissue
deep, aching, or throbbing
diffuse or radiating
EX) arthritis, tendonitis, myofascial pain
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| neuropathic pain | arise from abnormal processing of stimuli by nervous system
damage to peripheral nerve or structures in CNS
numbing, hot-burning, shooting, stabbing, electric-shock like
sudden, intense, short lived, lingering
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| causes of neuropathic pain? | trauma, inflammation, metabolic diseases, alcoholism, infections, tumors, toxins, neurological diseases
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| central pain | primary lesion or dysfunction in CNS
ex) poststroke pain, pain with MS
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| Peripheral neuropathies | pain felt along the distribution of one or many peripheral nerves caused by damage to the nerve
ex) diabetic neuropathy, trigmenial neuralgia, postherpetic neuralgia
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| differentiation pain | pain resulting from loss of afferent input
ex) phantom limb pain, postmastectomy pain
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| sympathetically maintained pain | pain that persists secondary to sympathetic nervous system activity
ex) phantom limb pain, complex regional pain syndromes
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| Complex regional pain syndrome | dramatic changes in color and temperature of the skin over the affected limb or body part
intense burning pain, skin sensitivity, sweating and swelling
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| CRPS type 1 | triggered by tissue injury
no underlying nerve damage
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| CRPS type 2 | diverse sympathetic dysfunction
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| Treatment for neuropathic pain | tricyclic antidepressants (Elavil, Pamelor, Norpramin)
SNRIs (Effexor, Cymbaltha, Wellbutrin, Zyban)
antiseizure drugs (Neurontin, Lyrica)
A2 - adrenergic agonists (Catapres)
NMDA (ketamine)
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| Visceral Pain | internal organs and lining of the body cavities
cutaneous sites
ex) appendicitis, pancreatitis, cancer affecting internal organs
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| stretching of hollow viscera in the intestines and bladder that occur from tumor involvement or obstruction produces? | intense cramping pain
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| types of visceral pain causes | surgical incision, broken bone, arthritis, pancreatitis, inflammatory bowel disease
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| Nociceptive pain treatment (somatic and visceral) | nonopiods (NSAIDs) and opiods
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| Phantom limb pain | deafferentiation pain - loss of afferent input secondary to either the peripheral nerve damage or CNS disease
Sympathetically maintained pain - associated with dysregulation of the autonomic nervous system
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| chronic pain | severity and function is disproportionate to objective findings
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| acute pain | functions as a signal, warning person of potential or actual tissue damage
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| Chronic pain | longer than 3 months, persistent
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| chronic pain | disabling
accompanied by anxiety and depression
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| acute pain leading to chronic pain | central sensitization
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| central sensitization | enhanced excitability of spinal neurons
peripheral tissue damage or nerve injury
some people experience pain from touch or tactile stimulation
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| similar to neuropathic pain | chronic pain
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| breakthrough pain | transient, moderate to severe pain that occurs in patients with otherwise controlled pain.
typically with cancer pain
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| end-of-dose failure | breakthrough pain that occurs before the duration of pain relief that is expected
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| acute pain treatment | analgesics for symptom control and treatment of the underlying cause
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| acute pain to chronic pain example | pain associated with herpes zoster subsides as the acute infection resolves, usually within a month. However, sometimes the pain persists and develops into a chronic pain state called postherpetic neuralgia
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| Early response withdrawal symptoms (6-12 hrs) | anxiety, lacrimation, rhinorrhea, diaphoresis, yawning, piloerection, shaking chills, dilated pupils, anorexia, tremors
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| Late response withdrawal symptoms (48-72 hrs) | excitation, diarrhea, restlessness, fever, nausea/vomiting, abdominal cramping pain, hypertension, tachycadia, insomnia
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| ibuprofen (Motrin, Nuprin, Advil) | use lowest effective dose for shortest possible duration.
Increase risk of GI adverse events
may increase risk of serous CV thromotic events, MI and stroke
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