Term
Cutaneous or superficial pain
(Origin of pain) |
|
Definition
Arises in the skin or the subcutaneous tissue.
(Hot object or paper cut) |
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Term
Visceral pain
(Origin of pain) |
|
Definition
Caused by the stimulation of deep internal pain receptors.
Most often experienced in the abdominal cavity, cranium, or thorax.
Local, achy discomfort to more widespread, intermittent, and crampy pain.
(Menstrual cramps, labor pain, GI infections, bowel disorders, and organ cancers) |
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Term
Deep somatic pain
(Origin of pain) |
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Definition
Originates in the ligaments, tendons, nerves, blood vessels, and bones.
More diffuse than cutaneous pain, tends to last longer.
(Fracture, sprain, arthritis, and bone cancer) |
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Term
Radiating pain
(Origin of pain) |
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Definition
Starts at the origin but extends to other locations.
(sore throat extends to ears and head, heartburn) |
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Term
Referred pain
(Origin of pain) |
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Definition
Occurs in an area that is distant from the original site.
(Pain of heart attack may be felt down the left arm)
Most common sites: liver, appendix, colon, ureters, kidneys, heart, esophagus, stomach, kidneys. |
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Term
Phantom pain
(Origin of pain) |
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Definition
| Pain that is perceived to originate from an area that has been surgically removed. |
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Term
Psychogenic pain
(Origin of pain) |
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Definition
| Pain that is believed to arise from the mind. |
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Term
| Physical pain is either ________________ or _______________. |
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Definition
| Nociceptive or neuropathic |
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Term
Nociceptive pain
(Cause of pain) |
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Definition
Most common type of pain.
Occurs when pain receptors, nociceptors, respond to stimuli that are potentially damaging.
Most commonly described as aching.
Two types-visceral (pain from internal organs) and somatic pain (pain from skin, muscles, bones, or connective tissue)) |
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Term
Neuropathic pain
(Cause of pain) |
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Definition
Complex and often chronic pain that arises when injury to one or more nerves results in repeated transmission of pain signals even in the absence of painful stimuli.
Described as burning, numbness, itching, and "pins and needles" prickling pain. (no current tissue injury). |
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Term
| Acute pain (Duration of Pain) |
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Definition
Short duration and is generally rapid in onset.
Most often associated with injury or surgery.
Protective in that it indicates potential or actual tissue damage.
< 6 months |
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Term
| Chronic pain (Duration of Pain) |
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Definition
Pain that has lasted 6 months or longer and often interferes with daily activities.
Patients may experience periods of remission and exacerbation.
Is often viewed as insignificant and may lead to withdrawal, depression, anger, frustration, and dependence.
> 6 months |
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Term
| Intractable pain (Duration of Pain) |
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Definition
Is both chronic and highly resistant to relief.
Should be approached with multiple methods of pain relief. |
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Term
| Words to describe pain quality |
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Definition
| Sharp, dull, aching, throbbing, stabbing, burning, ripping, searing, or tingling. |
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Term
| Words to describe pain's periodicity |
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Definition
| Episodic, intermittent, or constant |
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Term
| Words to describe intensity of pain |
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Definition
| Mild, distracting, moderate, severe, or intolerable. |
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Term
| When should you evaluate pain in a patient? |
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Definition
1. On admission
2. Before and after each potentially painful procedure or treatment.
3. When the patient is at rest, as well as when involved in a nursing activity.
4. Before you implement a pain management intervention, such as administering an analgesic drug, and 30 minutes after the intervention.
5. With each check of vital signs, if the pain is an actual or potential problem.
6. When the patient complains of pain. |
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Term
| Most commonly reported types of pain are? |
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Definition
| Severe headaches, and lower back, neck, and facial ache or pain. |
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Term
|
Definition
An unpleasant sensory or emotional experience associated with actual or potential tissue damage.
Pain is also protective, warning us of potential injury to the body.
Pain is whatever the person says it is, and existing whenever the person says it does. |
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Term
|
Definition
| By origin of pain, cause, duration, and quality of pain. |
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Term
|
Definition
| Nociceptors become activated by the perception of potentially damaging mechanical, thermal, and chemical stimuli. |
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Term
|
Definition
Are external forces that result in pressure or friction against the body.
Ex - surgical incisions, friction or skin shearing that occurs from sliding down in bed, or pressure from a mechanical devise, such as a cast or brace. |
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Term
|
Definition
| Result from exposure to extreme heat or cold. |
|
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Term
|
Definition
Can be internal or external.
Lemon juice burns - external chemical stimuli
Chest pain during MI - internal chemical stimuli
Lead poisoning is another example. |
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Term
| Tissue damage prompts the release of what? |
|
Definition
Substances such as bradykinin, histamine, and prostaglandins, which activate nociceptors in the surrounding tissues.
Bradykinin is also a powerful vasodilator that triggers a release of inflammatory chemicals that cause the injured area to become red, swollen, and tender.
Inflammation is the most frequent cause of pain. |
|
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Term
| Process known as transmission |
|
Definition
Peripheral nerves carry the pain message to the dorsal horn of the spinal cord.
Pain messages are conducted to the spinal cord along either of two types of fibers:
1. A-delta fibers
2. C fibers |
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Term
|
Definition
Are large-diameter myelinated fibers that transmit impulses at 6 to 30 meters per second.
These fibers transmit fast pain impulses from acute, focused mechanical and thermal stimuli.
Ex - when you bump your knee.
Pleasurable stimuli to skin receptors, such as from massage, also stimulate A-delta fibers.
At the dorsal horn, A-delta fibers synapse with long fiber neurons that cross the spinal cord and transmit the message directly to the brain. |
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Term
|
Definition
Are smaller unmyelinated fibers that transmit slow pain impulses, that is, dull, diffuse pain impulses that travel at a slow rate.
C fibers conduct pain from mechanical, thermal, and chemical stimuli.
If you bump your knee, the lingering ache in the tissue will be carried by C fibers.
C fiber impulses synapse with shorter fiber neurons that pass through several synapses before reaching the brain.
Communication of pain impulses across any of these synapses requires chemicals, called neurotransmitters, one of the most important of which is substance P. |
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Term
| Most pain impulses are transmitted where? |
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Definition
| To the thalamus of the brain. Some pain messages enter the reticular formation of the brain stem. |
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Term
|
Definition
An integrating center, the thalamus directs the impulses to three regions of the brain.
1. Somatosensory cortex perceives and interprets physical sensations.
2. The limbic system is involved in emotional reactions to stimuli.
3. The frontal cortex is involved in thought and reason. The person now perceives pain. |
|
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Term
|
Definition
| Involved the recognition and definition of pain in the frontal cortex. |
|
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Term
|
Definition
The point at which the brain recognizes and defines a stimulus as pain.
Repeated experience with pain can reduce a patient's threshold. |
|
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Term
|
Definition
| Is the duration or intensity of pain that a person is willing to endure. |
|
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Term
|
Definition
| Extreme sensitivity to pain. |
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Term
|
Definition
The process called modulation changes the perception of pain by either facilitating or inhibiting pain signals.
Two mechanisms allow for modulation of pain:
1. The endogenous analgesia system
2. The gate-control mechanism |
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Term
| The endogenous analgesia system |
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Definition
| Neurons in the brain stem activate descending nerve fibers that conduct impulses back to the spinal cord. These impulses trigger the release of endogenous opioids and other substances to block the continuing pain impulses and provide pain relief. |
|
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Term
| What are endogenous opioids? |
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Definition
| Naturally occurring analgesic neurotransmitters that inhibit the transmission of pain impulses and the release of substance P. |
|
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Term
| Nonpharmacological measures that can prompt the release of endogenous opioids |
|
Definition
| Exercise, meditation, visualization, and music therapy. |
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Term
|
Definition
As slow-pain impulses travel along C (small) fibers from the periphery to the brain, they encounter a "gate" that either allows or blocks the transmission of pain sensation to the brain.
Is the basis for development and use of the transcutaneous electrical nerve stimulation (TENS) as a pain relief measure. |
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Term
|
Definition
| Transduction, transmission, perception, and modulation. |
|
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Term
| Pain is influenced by what? |
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Definition
| Emotions, age, sociocultural factors, and communication and cognitive impairments. |
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Term
| The most common emotions associated with pain are? |
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Definition
| Fear, guilt, anger, helplessness, and loneliness. |
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Term
|
Definition
| When fear remains unresolved, it can prolong or increase the patient's pain. |
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Term
| Anxiety is most often associated with? |
|
Definition
|
|
Term
| Depression is most often associated with? |
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Definition
| Chronic pain, especially intractable pain. |
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Term
| Indicators of pain in neonates |
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Definition
| May be as subtle as skin mottling, grimacing, twitching, crying, poor feeding, increased or decreased activity, averting gaze, temperature fluctuation, elevated BP, and decreased O2 saturation. |
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Term
| Undertreated pain often leads to what? |
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Definition
| Other problems that diminish the QOL, such as social isolation, depression, sleep disturbances, and mobility-related problems. |
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Term
| Common nonverbal cues of pain include? |
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Definition
| Decreased activity, grimacing, frowning, crying, moaning, and irritability. |
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Term
| Physiological cues of pain include? |
|
Definition
| Elevated BP, respiration, and pulse. |
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Term
| The onset of acute pain activates what? |
|
Definition
The sympathetic nervous system.
Fight-or-flight response is protective.
It minimizes blood loss, maintains perfusion to vital organs, prevents and fights infections, and promotes healing. |
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Term
|
Definition
| The parasympathetic nervous system takes over. |
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Term
| Endocrine system effects of unrelieved pain |
|
Definition
Ongoing pain triggers excessive release of hormones, including adrenocorticotropic hormone (ACTH), cortisol, antidiuretic hormone (ADH), growth hormone (GH), catecholamines, and glucagon.
Insulin and testosterone levels decrease.
Hormone shifts activate carbohydrate, protein, and fat catabolism (breakdown), hyperglycemia, and poor glucose use.
The inflammatory process, combined with these endocrine and metabolic changes can result in weight loss, tachycardia, fever, increased respiratory rate, and even death. |
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Term
| Cardiovascular system effects of unrelieved pain |
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Definition
Unrelieved pain leads to hypercoagulation and an increase in HR, BP, cardiac workload, and O2 demand.
The combination of hypercoagulation and increased cardiac workload may lead to unstable angina (chest pain), intracoronary thrombosis (clot formation in the vessels that supply the heart), and myocardial ischemia and infarction (heart attack). |
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Term
| Musculoskeletal system effects of unrelieved pain |
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Definition
| Unrelieved pain causes impaired muscle function, fatigue, and immobility. |
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Term
| Respiratory system effects of unrelieved pain |
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Definition
Patients in pain tend to breathe shallowly, to limit thoracic and abdominal movement in an effort to reduce pain.
This is called splinting. |
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Term
|
Definition
Reduces tidal volume (air exchanged with each breath) and increases inspiratory and expiratory pressures.
These changes can lead to pneumonia and atelectasis as well as underventilation (retained CO2, also called hypercarbia) and respiratory acidosis. |
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Term
| Genitourinary system effects of unrelieved pain |
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Definition
| Unrelieved pain causes release of excessive amounts of catecholamines, aldosterone, ADH, cortisol, angiotensin II, and prostaglandins. These hormones lead to decreased urinary output, urinary retention, fluid overload, hypokalemia, HTN, and increased cardiac output. |
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Term
| Gastrointestinal (GI) system effects of unrelieved pain |
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Definition
Do assessment of GI when giving pain meds.
In response to pain, intestinal secretions and smooth muscle tone increase, and gastric emptying and motility decrease. |
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Term
Common pain responses
Physiological (Involuntary) Responses
Sympathetic Responses (Acute Pain) |
|
Definition
Increased systolic BP
Increased HR and force of contraction
Increased respiratory rate
Dilated blood vessels to the brain, increased alertness
Dilated pupils
Rapid speech |
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|
Term
| Gastrointestinal (GI) system effects of unrelieved pain |
|
Definition
Do assessment of GI when giving pain meds.
In response to pain, intestinal secretions and smooth muscle tone increase, and gastric emptying and motility decrease. |
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Term
| Gastrointestinal (GI) system effects of unrelieved pain |
|
Definition
Do assessment of GI when giving pain meds.
In response to pain, intestinal secretions and smooth muscle tone increase, and gastric emptying and motility decrease. |
|
|
Term
Common Pain Responses
Physiological (Involuntary) Responses
Sympathetic Responses (Acute Pain) |
|
Definition
Increased systolic BP
Increased HR and force of contraction
Increased respiratory rate
Dilated blood vessels to the brain, increased alertness
Dilated pupils
Rapid speech |
|
|
Term
Common Pain Responses
Parasympathetic Responses (Deep or Prolonged Pain) |
|
Definition
Decreased systolic BP, possible syncope
Decreased pulse rate
Changeable breathing patterns
Withdrawal
Constricted pupils
Slow, monotonous speech |
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Term
Common Pain Responses
Behavioral Responses (Voluntary) |
|
Definition
Withdrawing from painful stimuli
Moaning
Facial grimacing
Crying
Agitation
Guarding the painful area |
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|
Term
Common Pain Responses
Psychological (Affective) Responses |
|
Definition
Anxiety
Depression
Anger
Fear
Exhaustion
Hopelessness
Irritability |
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|
Term
|
Definition
Assess for pain as the 5th VS
Ask patients to rate their pain intensity whenever you take full VS.
This will prompt patients to report pain more often. |
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Term
| Pain assessment for dementia patients |
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Definition
Pain Assessment in Advanced Dementia (PAINAD) scale is a five-item, observational tool, specifically geared to older adults with dementia.
Areas for rating include breathing, negative vocalization, facial expression, body language, and consolability.
Lower scores indicate less pain. |
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Term
| Signs of sympathetic nervous system stimulation (pain) |
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Definition
Elevated BP and pulse
Appear ashen
Seen if pain is acute |
|
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Term
| Signs of parasympathetic nervous system stimulation (pain) |
|
Definition
Seen when pain is unresolved or chronic
BP and pulse may be lower than normal
Patient may report feeling faint |
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|
Term
| When writing a pain nursing diagnosis |
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Definition
Specify the location of the pain and any etiological or precipitating factors that you are aware of.
ALso identify any knowledge deficits, fear of addiction, or any other fears or beliefs. |
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Term
Nonpharmacological Pain Relief
Cutaneous Stimulation |
|
Definition
Stimulation of the skin is a method of pain relief based on the gate-control theory of pain.
Skin stimulation sends impulses along the large snesory fibers, which in turn excite inhibitory interneurons in the spinal cord to "close the gate.".
This process diminishes the patient's perception of pain.
Cutaneous stimulation works best on pain that is localized and not diffuse. |
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Term
Nonpharmacological Pain Relief
TENS Units |
|
Definition
Transcutaneous electrical nerve stimulator is a battery-powered device about the size of a pager that is worn externally.
Pads are applied directly to the painful area.
Once activated, the unit stimulates A-delta sensory fibers.
A TENS unit can be worn intermittently or for long periods of time. |
|
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Term
Nonpharmacological Pain Relief
PENS Units |
|
Definition
Percutaneous electrical stimulation combines a TENS unit with percutaneously placed (through the skin) needle probes to stimulate peripheral sensory nerves.
PENS is effective in short-term management of acute and chronic pain.
PENS therapy in some patients promotes physical activity, increases the sense of well-being, reduces the use of nonopioid meds, and improves sleep. |
|
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Term
Nonpharmacological Pain Relief
Spinal Cord Stimulator |
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Definition
| Chronic neurologic pain may be treated by a surgically implanted spinal cord stimulator (SCS). The SCS produces a tingly sensation that interferes with the perception of pain. |
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Term
Nonpharmacological Pain Relief
Acupuncture |
|
Definition
Application of extremely fine needles to specific sites in the body to relieve pain.
It stimulates the endogenous analgesia system.
Dental pain and nausea after chemo. |
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Term
Nonpharmacological Pain Relief
Acupressure |
|
Definition
Similar to acupuncture, stimulates specific sites in the body.
Instead of needles, fingertips provide firm, gentle pressure over the various pressure points.
May have a calming effect through the release of endorphins.
Patients can be taught key points to stimulate so they can self-administer acupressure at any time. |
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Term
Nonpharmacological Pain Relief
Massage |
|
Definition
Effective in reducing pain.
By providing cutaneous stimulation and relaxing the muscle, message helps to reduce pain.
Little effort from the patient and may improve sleep.
Some patients don't like to be touched so obtain permission. |
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Term
|
Definition
The use of slow,long, guiding strokes.
Used for obstetrical patients during labor and as back rubs for postsurgical patients. |
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Term
Nonpharmacological Pain Relief
Application of cold |
|
Definition
Cold causes vasoconstriction and can help prevent swelling and bleeding. Can be effective in reducing the amount of pain that occurs during procedures.
Apply a cold pack to the site before and after a procedure to reduce pain. |
|
|
Term
Nonpharmacological Pain Relief
Application of heat |
|
Definition
| Heat promotes circulation, which speeds healing. |
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Term
Nonpharmacological Pain Relief
Contralateral stimulation |
|
Definition
Stimulating the skin in an area opposite to the painful site.
Stimulation may be in the form of scratching, rubbing, or applying heat or cold.
This is helpful if the affected area is painful to touch, under bandages, or in a cast.
It has provided some relief to patients who have phantom pain after an amputation. |
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Term
| Cognitive-Behavioral Interventions |
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Definition
Attempts to alter patterns of negative thoughts and to encourage more adaptive thoughts, emotions, and actions.
Used to decrease depression and anxiety. |
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Term
Nonpharmacological Pain Relief
Distraction |
|
Definition
A method of drawing the patient's attention away from the pain and focusing on something other than the pain.
Can be visual, tactile (massage), intellectual, or auditory.
Most effective on mile to moderate pain and for brief periods of time. |
|
|
Term
Nonpharmacological Pain Relief
Relaxation Techniques |
|
Definition
Reduce pain in a variety of medical conditions, especially in chronic pain.
In sequential muscle relaxation (SMR), the patient sits comfortably and tenses a group of muscles for 15 seconds and then relaxes the muscle while breathing out.
Start at face and move down to feet. |
|
|
Term
Nonpharmacological Pain Relief
Guided Imagery |
|
Definition
Uses auditory and imaginary processes to affect emotions and help calm and relax.
Most effective on chronic pain. |
|
|
Term
Nonpharmacological Pain Relief
Hypnosis |
|
Definition
Involves the induction of a deeply relaxed state.
Hypnotist may suggest to a patient with arthritis that the pain can be turned down. |
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|
Term
Nonpharmacological Pain Relief
Therapeutic Touch (TT) |
|
Definition
Was developed by nurses and derived from the ancient practice of laying on of hands.
Does not require physical contact.
It focuses on the use of the hands to direct energy fields surrounding the body. |
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Term
Nonpharmacological Pain Relief
Humor |
|
Definition
Humor has positive effects on a patient's physical and emotional health.
Laughter is positive and indicates mental well-being.
Humor may boost the immune system. |
|
|
Term
Nonpharmacological Pain Relief
Expressive Writing |
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Definition
| Writing can help reduce chronic pain. |
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|
Term
Pharmacological Pain Relief Measures
Analgesics are classified into three groups |
|
Definition
1. Nonopioids
2. Opioids
3. Adjuvants
Patients in severe pain should start at third step. |
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|
Term
|
Definition
Administer analgesics at regular times throughout the day.
ATC will keep pain at an acceptable level throughout the day and allow the patient to function at an optimal level. |
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Term
|
Definition
Relieve mild to moderate pain.
Also reduce inflammation and fever.
Acetaminophen (Tylenol), aspirin, and ibuprofen (Advil, Motrin).
Nonopioid analgesics are often compounded with opioids. This allows for a lower dose of opioid to be administered and reduces the incidences of side effects. |
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|
Term
Nonopioid Analgesics
Nonsteroidal Anti-Inflammatory Drugs |
|
Definition
Largest group of nonopioid analgesics.
NSAIDs
Include aspirin and ibuprofen.
NSAIDs act primarily in the peripheral tissues by interfering with the production of prostaglandins.
Common side effect is gastric irritation.
NSAIDs should be used with caution in patients with impaired blood clotting, renal disease, and GI bleeding or ulcers.
Should not combine two NSAIDs because it increases the risks of side effects. |
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Term
|
Definition
| Sensitize pain receptors and are involved with inflammation. |
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|
Term
Nonopioid Analgesics
Aspirin |
|
Definition
Is a unique NSAID.
In addition to reducing inflammation, fever, and pain, it can inhibit platelet aggregation (clumping), the first step in clot formation.
MI, stroke, and thrombophlebitis (a clot in the peripheral veins) are all associated with platelet aggregation.
Low dose aspirin (usually 81 mg) is prescribed to decrease risk of these disorders.
Regular use prolongs clotting time so patients will bruise easily and will bleed more if cut.
Taking a daily dose of aspirin to prevent MI does not seem to increase the side effects for patients taking other NSAIDs. |
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|
Term
Nonopioid Analgesics
Acetaminophen |
|
Definition
Has very little anti-inflammatory effect like most nonopioid analgesics.
It has an analgesic and fever-reducing property.
Hasa fewer side effects and is probably the safest nonopioid.
Does not affect platelet function, rarely causes GI problems, and can be used in patients who are allergic to aspirin or other NSAIDs.
It can cause severe hepatotoxicity (liver toxicity) in patients who consume alcohol and in patients with liver disease.
Should be considered for treatment of persistent pain, particularly musculoskeletal pain. |
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Term
|
Definition
Opioids are natural and synthetic compounds that relieve pain.
Opioids work by finding pain receptor sites to bind with and block the pain impulse.
Opiate receptors include mu, delta, kappa, and sigma receptors. Mu receptors are most effective in relieving pain.
Most effective for certain types of pain (visceral pain, which is more generalized). Pain that is of neurological origin tends to be resistant to opioids. |
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Term
Opioid Analgesics
Mu agonists |
|
Definition
Stimulate mu receptors and are used for acute, chronic, and cancer pain.
Include codeine, morphine, hydromorphine, fentanyl, methadone, and oxycodone.
Excellent medication for breakthrough pain (pain that breaks through" relief provided by analgesics. |
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Term
|
Definition
Pain that "breaks through" relief provided by analgesics.
Breakthrough analgesia refers to a rescue or extra dose.
Drugs used for breakthrough pain should have a rapid onset and short duration. |
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|
Term
Opioid Analgesics
Agonist-antagonist |
|
Definition
Stimulate some opioid receptors but block others.
Include pentazocine (Talwin) and nalbuphine (Nubain), and partial agonists, such as Buprenex.
Appropriate for moderate to severe acute pain.
Should not be used with mu agonists (e.g. morphine) because they may act as antagonists at the mu receptor sites ad reduce or reverse the analgesia from the mu agonist. |
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Term
|
Definition
| A five-question, yes / no self-report designed to predict a patient's tendency for aberrant behaviors when prescribed opioid analgesia. |
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|
Term
| Screener and Opioid Assessment for Patients with Pain (SOAPP) |
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Definition
| Longer, highly reliable tool that may be more appropriate for high-risk populations or when the clinician has time for a thorough assessment. |
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Term
|
Definition
Nausea, vomiting, constipation, and drowsiness, difficulty with urination, dry mouth, sweating, tachycardia, palpitations, bradycardia, rashes, urticaria (hives), or pruritus (itching).
Large doses may lead to respiratory depression and hypotension.
Always assess the patient for level of alertness and respiratory status before you administer the drug. |
|
|
Term
| Side effect - respiratory depression |
|
Definition
Reduce dosage by 25% when you observe signs of oversedation.
Administer antagonist, such as naloxone (Narcan), if patient is unresponsive or minimally responsive. |
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|
Term
Side effects of opioids
Paradoxical reactions |
|
Definition
| May lead to a paradoxical increase in pain despite receiving increasing doses of opioids. |
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|
Term
Side effects of opioids
Sedation |
|
Definition
Most patients experience some degree of sedation at the beginning of opioid therapy or when the dose is increased.
Monitor postoperative patients who receive opioids for sedation and respiratory depression every 1 to 2 hours for the first 12 - 24 hours after surgery. |
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Term
|
Definition
Refers to the approximately equal analgesia that a variety of opioids will provide.
Ex - a parenteral dose of 5 mg of morphine is equivalent to 60 mg of parenteral codeine or 100 mg of oral codeine in terms of analgesic effect it produces. |
|
|
Term
| Routes of administration for opioid analgesics |
|
Definition
| Use the safest and least invasive route to administer opioids. |
|
|
Term
Routes of administration for opioid analgesics
PCA |
|
Definition
PCA pumps are an effective and safe way to deliver opioids by IV, epidural, or subcutaneous routes.
They provide excellent pain relief and give the patient a sense of control over the pain. |
|
|
Term
Routes of administration for opioid analgesics
Oral |
|
Definition
Convenient, safe, and generally produces steady analgesic levels.
Preferred route unless rapid onset is desired.
For mild to severe pain. |
|
|
Term
Routes of administration for opioid analgesics
Nasal |
|
Definition
Rich supply of blood in this area provides the drug easy access to systemic circulation.
May cause burning or stinging. |
|
|
Term
Routes of administration for opioid analgesics
Transdermal |
|
Definition
Delivers a continuous release of drug for up to 72 hours.
Convenient for patient who requires constant opioid treatment for pain.
Patient and family teaching required for storage and proper disposal of patches. |
|
|
Term
Routes of administration for opioid analgesics
Rectal |
|
Definition
Suppositories are an excellent alternative to the oral route, especially in infants and young children.
Effective with vomiting patients, those with GI obstruction, or at risk for aspiration. |
|
|
Term
Routes of administration for opioid analgesics
Subcutaneous |
|
Definition
May be used for intermittent injections and continuous administration of opioids.
Continuous subcutaneous infusion (CSCI) is appropriate for people who cannot tolerate oral opioids or who have dose-limiting side effects from oral administration (nausea),
Hydromorphine and morphine are the drugs most commonly used.
Used for chronic cancer pain and in palliative care. |
|
|
Term
Routes of administration for opioid analgesics
IM |
|
Definition
Are painful, onset is slow, and absorption is unreliable.
Not the preferred route of administration of pain medication.
Mostly used for short-term pain relief postoperatively. |
|
|
Term
Routes of administration for opioid analgesics
IV |
|
Definition
Produces immediate pain relief and is desirable for acute or escalating pain.
Most commonly used for short-term therapy and for hospitalized patients who can be monitored.
Methods of IV delivery include continuous infusions, bolus, and PCA.
Drawbacks include the need for venous access and the need to maintain a patient line.
Less pain and fewer side effects than with oral route. |
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Term
Routes of administration for opioid analgesics
Intra-articular |
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Definition
A pain pump is implanted into a joint during arthroscopic surgery as a measure to control postsurgical pain.
Delivers continuous infusion of local aesthetic directly to the surgical site. |
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Term
Routes of administration for opioid analgesics
Intraspinal and Epidural Analgesics |
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Definition
Requires placement of a catheter in the subarachnoid space or the epidural space by an anesthesiologist or CRNA.
Epidural space is preferred because it poses less risk of complications. |
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Term
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Definition
Reduce the amount of opioid the patient requires.
Used as primary or inconjunction with opioids for moderate to severe pain.
Ex anti-convulsants, antidepressants, local anesthetics, topical agents, psychostimulants, muscle relaxants, neuroleptics, corticosterioids, and others.
Often used in managing neuropathic pain. |
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Term
| Nerve blocks and epidural injection |
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Definition
Two types of regional anesthesia.
An anesthetic agent is injected into or around the nerve that supplies sensation to a specific part of the body.
Most nerve blocks affect a network of nerves called a plexus. |
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Term
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Definition
An injection of local anesthetics into body tissues.
Short-acting agents, such as marcaine, may be used.
Local anesthetics are injected into subcutaneous tissue for minor surgical procedures.
May also be injected into joints and muscle for pain relief. |
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Term
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Definition
Involves applying an agent that contains cocaine, lidocaine, or benzocaine directly ot the skin, mucous membranes, wounds, or burns.
Is quickly absorbed and provides pain relief for mild to moderate pain.
Sunburn relief agents, gel products for tooth and gum pain, and first aid sprays are forms of topical anesthetics. |
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Term
| Radiofrequency ablation therapy |
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Definition
Uses electromagnetic waves that travel at the speed of light to target nerves that carry pain impulses.
Used to provide longer term pain relief that that provided by injections of steroids or pain relievers and nerve blocks. |
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Term
| Surgical Interruption of Pain Conduction Pathways |
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Definition
| Surgical interruption of pain conduction pathways results in permanent destruction of nerve pathways and is used as a last resort for intractable pain. |
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Term
Surgical Interruption of Pain Conduction Pathways
Cordotomy |
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Definition
Interrupts pain and temp sensation below the tract that is severed.
Most frequently done for leg and trunk pain. |
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Term
Surgical Interruption of Pain Conduction Pathways
Rhizotomy |
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Definition
Interrupts the anterior or posterior nerve route that is located between the ganglion and the cord.
Anterior interruption is generally used to stop spastic movements that accompany paraplegia, and posterior interruption eliminates pain in the area innervated.
Most often used for head and neck pain produced by cancer. |
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Term
Surgical Interruption of Pain Conduction Pathways
Neurectomy |
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Definition
Used to eliminate intractable localized pain.
The pathways of peripheral or cranial nerves are interrupted to block pain transmission. |
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Term
Surgical Interruption of Pain Conduction Pathways
Sympathectomy |
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Definition
Severs the paths to the sympathetic division of the ANS. The outcomes of this procedure are improvement in vascular blood supply and the elimination of vasospasm.
used to treat the pain from vascular disorders, such as Raynaud's disease. |
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Term
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Definition
| Is the state of psychological dependence in which a person uses a drug compulsively and will engage in self-destructive behavior to obtain the drug. |
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Term
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Definition
Any medication or procedure, including surgery, that produces an effect in a patient because of its implicit or explicit intent, not because of its specific physical or chemical properties.
Not suitable for pain management. |
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Term
| Perception of pain occurs where? |
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Definition
| In the frontal cortex of the brain |
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Term
| Fast pain impulses are carried where? |
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Definition
| On large-diameter A-delta fibers |
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Term
| Slow pain impulses are carried where? |
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Definition
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Term
| What will result from unrelieved pain? |
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Definition
| Serious physiological and well as psychological problems. |
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Term
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Definition
| By the endogenous analgesic system or by the gate-controlled mechanism. |
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Term
| what are the pharmacological measures for pain? |
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Definition
Nonopioid analgesics
opioid analgesics
adjuvant alangesics |
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Term
Physiological (involuntary) responses
Sympathetic Responses (Acute Pain) |
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Definition
Increased systolic BP
Increased RH and force of contraction
Increased respiratory rate
Dilated blood vessels to the brain, increased alertness
Dilated pupils
Rapid speech |
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Term
| Parasympathetic Responses (Deep or Prolonged Pain) |
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Definition
Decreased systolic BP, possible syncope
Decreased pulse rate
Changeable breathing patterns
Withdrawal
Constricted pupils
Slow, monotonous speech |
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