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McCaffery�s definition of pain
Pain is whatever the person experiencing it says it is and exists whenever he says it does
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Nociceptors
receptors that activate the afferent pathways; unable to adapt to repeated stimuli so they continue to fire until the stimuli are removed
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What can inhibit pain?
Endorphins and enkephalins that can have an opioid effect by blocking or diminishing pain perception
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What can decrease endorphin levels?
Prolonged stress and pain, prolonged use of morphine and alcohol
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What can increase endorphin levels?
Brief stress and pain, laughing, exercise, sex, acupuncture, TENS, massive trauma
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Factors that cause the gate to open include
tissue damage, monotonous environment, and fear of pain
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What can close the gate?
Stimulation of large-diameter fibers through massage, position change, and heat or cold applications; distraction, guided imagery, preparatory information
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What physical factors affect pain?
Pain threshold, pain tolerance, age, physical activity, surgery and anesthesia
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Pain threshold
Point at which stimulus causes sensation of pain
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What lowers pain threshold?
Anger, fatigue, anxiety, insomnia, depression and uncontrolled pain
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Pain tolerance
Intensity of pain that a person will endure
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What is the most painful surgery?
Upper Abdomen
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What psychological factors affect pain?
Culture, religion, past experiences, anxiety, situational factors
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Because the brain interprets pain as a stressor, it activates the
sympathetic NS
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What are predictable responses to acute pain?
Increased heart rate, respiratory rate, and BP
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Cause of acute pain is
known, treatable, and temporary
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Acute pain
follows the normal pathway for pain from nociceptor activation to the brain
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Chronic pain
persistent, recurs for > 6 months; neuropathic because it follows an abnormal pathway
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Unusual sensations of chronic pain
burning, shooting pain and abnormal sensations that occur when there is no pain stimulus present; cause may be unknown
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What purposes do pain serve?
Chronic-no useful purpose; acute warns of tissue damage and trauma
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Sympathetic nervous system adapts
so HR, BP and R may be normal; nurse may underestimate severity and undermedicate
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Most chronic pain is
neurogenic
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When should pain be assessed?
On admission and on a regular basis
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Six steps of pain
Accept pt report, determine status of pain, describe pain, examine site of pain, identify coping methods, document findings and evaluate interventions
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How should pain be described?
Location, quality, intensity, aggravating and alleviating factors
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Physical interventions
physical comfort measures, environmental control, stimulation techniques
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Psychological interventions
anxiety reduction, distraction, relaxation and imageryn
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Nonpharmacological interventions
increase tolerance and threshold
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Hot and cold
heat< 30 minutes and don�t put on abdominal pain or malignancy; cold<15 minutes and don�t put on people taking vasoconstriction and heart disease
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Nonopioid analgesics affect
PNS, have ceiling effect on analgesia
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Opioid analgesics affect
CNS
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Examples of opioid agonists
codeine, methadone, dilaudid, Demerol, morphine, fentanyl
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Examples of opioid agonist antagonists
nubain, puprenex, stadol, talwin
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Side effects of opioids
constipation, sedation, nausea, respiratory depression, confusion, hypotension, dizziness, urinary retention
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