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Pain
- an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
- **it is whatever the experiencing person says it is, existing when he says it does
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Pain occurs when .....
nociceptors are stimulated by direct damage to the cell or local release of biochemicals following cell injury
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What are the four physiological processess
- *Transduction
- *Transmission
- *Perception
- *Modulation
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Transduction
- conversion of thermal chemical or mechanical stimulus to electrical energy
- ****Transduction begins in the periphery when a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential
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Transmission
Transport of nerve impulse from the site of injury to the brain via the spinal cord
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Perception
The point at which a person is aware of pain
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Modulation
release of inhibitory neurotransmitters (ex-endorphins) to hinder transmission of pain
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Causative factory :
Microorganisms
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Causative Factor:
Inflammation
Arthritis
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Causative factor:
Impaired blood flow
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Causative factor:
Stretching/straining
- Example:
- Sprained ligament
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Causative factor:
Fractures
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Causative Factor:
Obstruction
Gallstone
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Causative factor:
Chemicals
Skin Rash
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Physiological Responses
- *Sympathetic stimulation (tachycardia, increased BP, sweating, pallor etc)
- Most persons reach a period of adaptation where vitals return back to normal
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Behavioral responses
- Crying, moaning
- *untreated pain reduced QOL
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Types of Pain
- *Acute/Transient
- *Chronic/Persistent
- *Chronic/ Episodic
- *Cancer pain
- *Idiopathic pain
- *Nociceptive vs Neuropathic
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Acute Pain
- Identifiable cause
- *Rapid onset, varies in intensity, and lasts briefly
- *Warns people of impending injury or disease
- *Complication
- -can prolong hospitalization, delay rehabitalization
- *Can progress to chronic pain
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Chronic Pain
- *Prolonged, varies in intensity, and usually lasts longer than is typically expected or predicted
- *Intractrable pain
- *Often no identifiable cause
- *Ongoing and often does not respond to treatment
- *Endorphins either cease to function or are reduced
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Nociceptive Pain
- *Nociceptors
- *Somatic
- *Visceral
- *Responds well to opioids and/ or non-opiods
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Nociceptors
- Nerves that sense and responds to parts of the body which suffer damage.
- *Signal tissue irritation, impending injury, or actual injury
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Somatic
- Sprains, bone fractures, burns, bumps, bruises, inflammation
- *Aching or throbbing and well localized
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Visceral
Arises from visceral organs
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Neuropathic Pain
- *Results from damage to nerves caused by infection or disease
- *Central
- *Peripheral
- *Often chronic
- *May not respond well to opioids and may respond better to anti-seizure and antidepressant medications
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Central (Neuropathic Pain)
From brain or spinal cord (ex. phantom limb pain)
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Peripheral (Neuropathic pain)
- *From peripheral nervous system
- *Described as burning, tingling, pins and needles
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Factors that influence Pain
- *Physiological Factors (age, fatigue, genes,)
- *Social (Attention, previous experience, family/social support)
- *Spiritual
- *Psychological (Anxiety, coping style)
- *Cultural (meaning or pain, ethnicity)
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Barriers to pain relief
- *Healthcare professionals
- *Healthcare system
- *Patients
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Healthcare professionals (Barriers to pain relief)
inadequate/inaccurate information about pain management
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Healthcare system (Barriers to pain relief)
- *Low priority given to pain treatment
- *Restrictive regulation of controlled substances
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Patients (Barriers to pain relief)
- *Reluctance to report pain or take meds- fear of becoming dependent
- *Fear that pain means disease process is progressing
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Assessment of Pain
- *Patients' pain needs to be assessed on a regular bases (6th vital sign)
- *Patients expression of pain
- - most reliable indicator of existence and intensity
- *ABCDE
- *COLDSPA
- *PQRST
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Methods of pain assessment
- *Pain history
- -tolerance, influence on ADLs
- *Pain characteristics
- - Onset, duration, quality, intensity, pattern, non-verbal/behavioral effects
- *Client expectations
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Dilation of bronchial tubes and increased respiratory rate
- Sympathetic Stimulation
- ***Provides increased oxygen intake
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Increased heart rate
- Sympathetic Stimulation
- ***Provides increased oxygen transport
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Peripheral vasoconstriction (pallor, elevation in blood pressure)
- Sympathetic Stimulation
- ****Elevates blood pressure with shift of blood supply from periphery and viscera to skeletal muscles and brain
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Increased blood glucose level
- Sympathetic Stimulaton
- ***Provides additional energy
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Diaphoresis
- Sympathetic Stimulation
- ****Controls body temperature during stress
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Increased muscle tension
- Sympathetic Stimulation
- ***Prepares muscles for action
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Dilation of pupils
- Sympathetic Stimulation
- ****Affords better vision
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Decreased gastrointestinal motility
- Sympathetic Stimulation
- ***Frees energy for more immediate activity
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Pallor
- Parasympathetic Stimulation
- ***Causes blood supply to shift away from periphery
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Muscle tension
- Parasympathetic Stimulation
- ***Results from fatigue
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Decreased heart rate and blood pressure
- Parasympathetic Stimulation
- ***Results from vagal stimulation
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Rapid, irregular breathing
- Parasympathetic Stimulation
- ***Causes body defenses to fail under prolonged stress of pain
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Parasympathetic Stimulation
Severe or deep pain.
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Sympathetic Stimulation
Pain of low to moderate intensity and superficial pain.
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