pain management

  1. What is nociception?
    series of complex electro-chemical events that occur between the site of inflammation/damage and the perception of pain
  2. Name the four process involved in nociception
    • 1. Transduction
    • 2. Transmission
    • 3. Modulation
    • 4. Perception of pain
  3. Describe transduction
    electrical activity is generated at the ends of nerve fibres by activation of nociceptors
  4. 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
  5. Is there are pain centre in the brain?
  6. Which fibres transmit well localized sharp pain?
    - a delta
    - c fibres
    a delta
  7. Which fibres transmite poorly localized dull, aching or burning pain
    - a delta
    - c fibres
    c fibres
  8. 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
  9. What part of the brain perceives pain
    midbrain and postcentral gyrus
  10. What part of the brain localizes pain
  11. What part of the brain is responsible for the emotional/anxiety responses to pain
    reticular formation, pons and limbic system.
  12. What type of pain is relatively brief and subsides with healing?
    acute pain
  13. What kind of pain involves an abnormal processing of stimuli by the peripheral or central nervous system
    neuropathic pain
  14. What is the site of somatic pain
    skin bone muscle connective tissue
  15. What is the character of somatic pain
    throbbing, aching, sharp, gnawing, constant
  16. What is the site of visceral pain
  17. What is the character of visceral pain
    dull, cramping, squeezing, deep aching
  18. Which type of pain is often poorly localized
  19. What type of pain often produces referred pain?
    - somatic
    - visceral
    - visceral
  20. What is the site of neuropathic pain?
    follows dermatomes or peripheral nerves
  21. What is the character of neuropathic pain
    burning, shooting, tingling, electric, shock-like
  22. Which type of pain is often accompanied by ANS activity such as sweating, nausea etc
    - cutaneous pain
    - visceral pain
    - somatic pain
    visceral pain
  23. Describe some effects of pain on the
    cardiovascular system
    • -tachycardia
    • -hypertension
    • -increased cardiac O2 consumption
    • - myocardial ischemia
    • -hypercoagulation
    • -DVTs
  24. Describe some effects of pain on the
    respiratory system
    • -decreased lung volume
    • -atelectasis
    • -hypoxemia
  25. Describe some effects of pain on the
    GI system
    decreased motility
  26. Describe some effects of pain on the
    GU system
    urinary retention
  27. Describe some effects of pain on the
    metabolic system
    • - increased catabolic hormones
    • - decreased anabolic hormones
    • - catabolic - cortisol, glucagon, renin, angiotensin etc
    • - anabolic - insulin, testosterone
  28. Describe some effects of pain on the
    musculoskeletal system
    muscle spasm, immobility, fatigue
  29. Describe some effects of pain on the
    psychological system
    - anxiety, fear, sleeplessness
  30. List some objective signs of pain
    tachycardis, hypertension, tachypnea, dialted pupils, increased muscle tension
  31. 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.
  32. state of having a severe discomfort alleviated is:
    a. relief
    b. ease
  33. Absence of specific discomforts is:
    a. relief
    b. ease
  34. the need for inspiration, strengthening and motivation is encompassed in:
    a. relief
    b. ease
  35. What is the goal of pain management
    - pain level is acceptable to the patient and sedation score below 2
  36. What is the best early clinical indicator of respiratory depression?
    increasing sedation
  37. What indicates respiratory depression?
    resps less than 8/min
  38. What does narcan reverse?
    respiratory depression and analgesia
  39. Dose of narcan?
    .05-.4 mg IV
  40. Duration of narcan?
    30-60 minutes
  41. A significant decrease in BP following opioid administration indicates what?
  42. Which opioid is limited to mild pain?
  43. Codeine is converted by the liver to what form?
  44. What 3 things should be assessed with each bolus of opioid?
    • - pain scale
    • - respiratory status
    • - sedation scale
  45. Opioids are metabolized and secreted how?
    metabolized by liver, and excreted by kidney
  46. A continuous infusion PCA has better pain relief than an intermittent? T or F?
  47. What kinds of patients should PCA be used only with caution?
    • - COPD
    • - sleep apnea
    • - liver/renal disease
    • - CHF
    • - age extremes
  48. How do NSAIDS work?
    Inhibit the enzymes COX1 AND COX2 - components of prostaglandins. This decreases inflammation.
  49. Do NSAIDS work peripherally or centrally?
  50. NSAIDS block the beneficial actions of prostaglandins. T or F
  51. What are some effects of decreased prostaglandins (nsaids) in
    - Renal
    - Platelets
    - respiratory
    • 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
  52. What blood work should be checked and normal prior to NSAIDS?
  53. -lytes
    • - creatinine
    • - GFR
  54. Four contraindications to using NSAIDS
    • - blood disorders
    • - GI bleed/ulcer
    • - renal failure
    • - ASA allergy
  55. How does acetaminophen work?
    inhibits prostaglandin synthesis CENTRALLY not peripherally.
  56. Name one NMDA - receptor antagonist?
    Ketamine - good for neuropathic pain, and opioid tolerant
  57. Name an alpha-2-adrenergic agonist?
Card Set
pain management
info re: pain management in parr