pain management

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What is nociception?

series of complex electro-chemical events that occur between the site of inflammation/damage and the perception of pain
Name the four process involved in nociception
- 1. Transduction
- 2. Transmission
- 3. Modulation
- 4. Perception of pain
Describe transduction

electrical activity is generated at the ends of nerve fibres by activation of nociceptors
Describe transmission of pain
- from the nociceptors
- - to the dorsal horn of the spinal cord via afferent fibres (a delta and c)
- - ascending fibres of the spinothalamic tract to the thalamus
- - distributed through out the brain
Is there are pain centre in the brain?

no
Which fibres transmit well localized sharp pain?
- a delta
- c fibres

a delta
Which fibres transmite poorly localized dull, aching or burning pain
- a delta
- c fibres

c fibres
Where can pain be modulated?
- descending (efferent) pain control pathways throughout the CNS.
- - midbrain medulla and dorsal horn are most NB
- - neurotransmitters that signal release of substances like endorphins, serotonin, norepinephring, gaba
What part of the brain perceives pain

midbrain and postcentral gyrus
What part of the brain localizes pain

cortex
What part of the brain is responsible for the emotional/anxiety responses to pain

reticular formation, pons and limbic system.
What type of pain is relatively brief and subsides with healing?

acute pain
What kind of pain involves an abnormal processing of stimuli by the peripheral or central nervous system

neuropathic pain
What is the site of somatic pain

skin bone muscle connective tissue
What is the character of somatic pain

throbbing, aching, sharp, gnawing, constant
What is the site of visceral pain

organs
What is the character of visceral pain

dull, cramping, squeezing, deep aching
Which type of pain is often poorly localized

visceral
What type of pain often produces referred pain?
- somatic
- visceral

- visceral
What is the site of neuropathic pain?

follows dermatomes or peripheral nerves
What is the character of neuropathic pain

burning, shooting, tingling, electric, shock-like
Which type of pain is often accompanied by ANS activity such as sweating, nausea etc
- cutaneous pain
- visceral pain
- somatic pain

visceral pain
Describe some effects of pain on the
cardiovascular system
- -tachycardia
- -hypertension
- -increased cardiac O2 consumption
- - myocardial ischemia
- -hypercoagulation
- -DVTs
Describe some effects of pain on the
respiratory system
- -decreased lung volume
- -atelectasis
- -hypoxemia
Describe some effects of pain on the
GI system

decreased motility
Describe some effects of pain on the
GU system

urinary retention
Describe some effects of pain on the
metabolic system
- - increased catabolic hormones
- - decreased anabolic hormones
- - catabolic - cortisol, glucagon, renin, angiotensin etc
- - anabolic - insulin, testosterone
Describe some effects of pain on the
musculoskeletal system

muscle spasm, immobility, fatigue
Describe some effects of pain on the
psychological system

- anxiety, fear, sleeplessness
List some objective signs of pain

tachycardis, hypertension, tachypnea, dialted pupils, increased muscle tension
Kolcaba defines comfort as:

immediate state of being strengthened through having the human needs for relief, ease and transcendence met in 4 contents of experience - physical, psychospiritual, sociocultural and environmental.
state of having a severe discomfort alleviated is:
a. relief
b. ease
c.transcendence

relief
Absence of specific discomforts is:
a. relief
b. ease
c.transcendence

ease
the need for inspiration, strengthening and motivation is encompassed in:
a. relief
b. ease
c.transcendence

transcendence
What is the goal of pain management

- pain level is acceptable to the patient and sedation score below 2
What is the best early clinical indicator of respiratory depression?

increasing sedation
What indicates respiratory depression?

resps less than 8/min
What does narcan reverse?

respiratory depression and analgesia
Dose of narcan?

.05-.4 mg IV
Duration of narcan?

30-60 minutes
A significant decrease in BP following opioid administration indicates what?

hypovolemia
Which opioid is limited to mild pain?

codeine
Codeine is converted by the liver to what form?

morphine
What 3 things should be assessed with each bolus of opioid?
- - pain scale
- - respiratory status
- - sedation scale
Opioids are metabolized and secreted how?

metabolized by liver, and excreted by kidney
A continuous infusion PCA has better pain relief than an intermittent? T or F?

false
What kinds of patients should PCA be used only with caution?
- - COPD
- - sleep apnea
- - liver/renal disease
- - CHF
- - age extremes
How do NSAIDS work?

Inhibit the enzymes COX1 AND COX2 - components of prostaglandins. This decreases inflammation.
Do NSAIDS work peripherally or centrally?

both
NSAIDS block the beneficial actions of prostaglandins. T or F

true
What are some effects of decreased prostaglandins (nsaids) in
-GI
- Renal
- Platelets
- respiratory
-other
- GI- gastric irritation, ulcer
- renal - decreases renal flow - causes renal failure is susceptible patients eg hypovolemia; copd, cirrhosis, renal failure
- Platelets - decreased clotting
- Respiratory - bronchospasm in asthmatics
- other - headache, anxiety dizzyness
What blood work should be checked and normal prior to NSAIDS?
-lytes
- - creatinine
- - GFR
Four contraindications to using NSAIDS
- - blood disorders
- - GI bleed/ulcer
- - renal failure
- - ASA allergy
How does acetaminophen work?

inhibits prostaglandin synthesis CENTRALLY not peripherally.
Name one NMDA - receptor antagonist?

Ketamine - good for neuropathic pain, and opioid tolerant
Name an alpha-2-adrenergic agonist?

clonidine

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meowzart

50800

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pain management

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info re: pain management in parr

Updated

2010-11-21T00:27:25Z

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