Chronic Exam #1
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| Physiology of Pain | Pain sensing neurons are stimulated and carried by pain fibers to the dorsal horn of the spinal cord (Bradykinin rel along with substance P) then transmitted upward via spinothalamic tract to thalamus to cerebral cortex where it is perceived
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| What are Type A Delta Fibers? | Carry rapid, sharp, pricking sensation; quick transmisison; found in skin and muscles; may be localized
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| What are C fibers? | Carry dull, burning, aching sensation; slow transmission; found in muscle, periosteum. viscera; more continuous and constant pain
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| What is the Closed Gate Theory? | synapses in the dorsal horn of the spinal cord act as a gate that opens or closes to allow/ prevent impulses from reaching the brain (small fibers transmit pain and open gate, large fibers close the gate...massage, heat, vibration)
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| Pain threshold | amount of a painful stimulus required to perceive as pain
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| pain tolerance | amount of pain a person is willing to endure
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| intractable | pain not responsive to conventional treatment
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| psychogenic | pain for which no pathologic condition can be found
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| radiating | diffuse pain around the site of origin, not well localized
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| localized | confined to the site of origin
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| projected | pain along a specific nerve(s)
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| Two types of pain | Acute and Chronic
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| Characteristics of Acute pain | short duration(<6months), identifiable onset, often has a useful function, accompanied by sympathetic responses (increased RR, HR, BP)
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| Characteristics of Chronic Pain | longer duration (>6months), persistent and recurrent, no forseeable end, "observable" pain expression often absent
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| Acute vs. Chronic Pain | Acute-physiologic changes, limited lifestyle impact, treatment usually has high success; Chronic- low/no physiologic changes, impacts behavior, cognitive, social roles and lifestyle. treatment is more difficult
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| Two major types of pain | Nocioceptive pain and Neuropathic pain
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| Nocioceptive Pain | normal processing of stimuli that damages normal tissues or has the potential to do so
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| Neuropathic pain | abnormal processing of sensory input by peripheral or central nervous system
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| Nocioceptive pain arises from 3 major types of structures | cutaneous (somatic) skin, deep somatic (bones, ms, joines, conn tissues), visceral (organs)
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| Cutaneous (somatic) | Nocioceptive pain- superficial structures of skin and subcutaneous tissue, well defines, localized
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| Deep somatic | Nocioceptive pain- originate in bone, bl vessels, nerves, ms and other tissues, dull, poorly localized
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| Visceral | Nocioceptive pain- arises from body organs, known for referred pain (distant from site of origin)
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| referred pain | felt in an area distant from the site of origin
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| 2 types of neuropathic pain | centrally generated pain, peripherally generated pain
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| centrally generated pain | injury to either peripheral or central nervous system or dysregulation of the autonomic nervous system
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| peripherally generated pain | pain along one or more peripheral nerves
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| Types of chronic pain | Nonmaligant (not cancerous), intermittent (occurs at specific intervals), malignant (may have elements of both acute and chronic)
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| History of Pain (analysis of a symptom) | COLDSPA (character, onset, location, duration, severity, pattern, alleviating factors)
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| Pain Behaviors | facial expression, vocal behavior, aggressive behavior, increase or decrease in body movements, changes in ADLs, irritability, confusion, withdrawn, agitated)
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| Clinical signs of pain | elevation of pulse, BP, RR, dilated pupils, sweating, guarding, muscle rigidity
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| Non-narcotic analgesics | aspirin, acetaminophen (tylenol), NSAIDS (ibuprofen)
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| Narcotic analgesics | opioid agonists (morphine sulfate, MSO4, codeine, hydrocodone), methadone, meperidine, propoxyphene, fentanyl
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| action of opioid analgesics | bind with opiate receptors in CNS to alter the perception of pain
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| adverse affects of opioid analgesics | constipation, nausea and vomiting, respiratory/circulatory depression, urinary retention
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| action of opioid antagonists | blocks opiate receptors, used to treat overdoses (Narcan)
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| what drug is used to reverse overdoes? | Narcan
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| action of non-opioid analgesics | inhibit prostaglandin synthesis
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| adverse effects of non-opioid analgesics | GI upset, GI bleeding, Tinnitus, liver/kidney toxicity
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| routes of administration | oral, rectal, intramuscular, subcutaneous, intravenous, transdermal/transmucousal, intraspinal, nerve blockers, epidural
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| methods of administration | nurse administered analgesia (scheduled or prn), pt controlled analgesia (PCA), epidural catheters
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| what drug is in an epidural catheter? | duramorph
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| side effects of epidural catheters | resp depression, pruritis, allergic reactions, urinary retention, N/V
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| Sympathectomy | sever pathways of sympathetic division of autonomic nervous system
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| nerve block | novocaine (knee)
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| cordotomy | severs spinothalamic portion of anterolateral tract
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| rhizotomy | sever anterior or posterior nerve root bw ganglion and cord (provides pain relief and/or reduces spasticty)
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| TENS unit | (Transcutaneous electric nerve stimulation) generate electric current to skin and tissues, adjustable voltage, portable
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| Acupuncture | insert fine needles into skin at specific sites (gate control vs. stimulation od endorphin production)
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| Hypnosis | assisting a pt to induce an altered state of conciousness to increase responsivness to suggestion
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| guided imagery | envision something pleasant, music, aromatherapy
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| Considerations of analgesic administration | med allergies, revious responses to analgesics, other meds being taken, body weight, individual pain experience, body system assessment
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| % of cancer patients that experience pain | 75%
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| incidence and severity of cancer pain depends on... | site, stage, presence, location of metastases
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| which drug is the gold standard for cancer pain management? | morphine sulfate
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| Principles of opioid use for cancer patients | individualize the regimen, use the simplest dosing schedule, least invasise, safest route, avoid IM, ATC dosing provides more stable plasma drug levels
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| opioid side effects | confusion, N/V, constipation, sedation, agitation, anxiety, fatigue, headaches
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| adjuvant analgesics | enhance pain relief in combo with narcotics
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| NSAIDS | work at peripheral receptor sites (ibuprofen, SSRI, corticosteroids)
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| antidepressants | alters serotonin levels and block receptors in spinothalamic tract that transmit pain
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| anticonvulsants | used for NEUROPATHIC pain
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| anxiolytics (anti-anxiety) | xanax, can cause physiologic withdrawal
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