1. Acute/transient pain
    Protective, identifiable, short duration
  2. Chronic/persistent
    Is not productive and has no purpose or may not have identifiable cause

    Chronic pain lasts longer than anticipated pain and can be cancerous or noncancerous. Chronic noncancerous pain may include arthritis, headache, low back pain, or peripheral neuropathy. This type of pain is non–life threatening.
  3. Chronic episodic
    Occurs sporadically over an extended duration
  4. Cancer
    Can be acute or chronic
  5. Inferred Physiological
    Musculoskeletal, visceral, or neuropathic
  6. Idiopathic
    Chronic pain without an identifiable physical or psychological cause (like fibromyalgia)
  7. How is pain categorized?
    Pain can be categorized by duration (chronic or acute) or pathology (cancer or neuropathic).
  8. Who might not be able to express pain?
    Aphasic, cognitively impaired, intubated, mentally impaired, or pediatric clients.
  9. How do you assess pain?
  10. Opioids
    • Treat moderate to severe pain
    • Associated with respiratory depression and adverse effects of nausea, vomiting, constipation, itching, urinary retention, and altered mental processes
  11. PCA
    PCA allows clients to help manage their pain. However, the client must be able to participate in this type of intervention.

    The most common types of drugs used in PCA are morphine, hydromorphone, and fentanyl.
  12. Adjuvants/coanalgesics
    drugs used to treat other conditions but they also have analgesic qualities (tricyclic antidepressants and anticonvulsants).s/coanalgesics
  13. Local/regional anesthesia
    Local and regional anesthesia are used in a variety of conditions including labor and delivery, chronic cancer pain, and selected postoperative procedures.
  14. How is chronic pain managed?
    • Clients with chronic pain need to be given medications on a regular basis. The WHO recommends a three-step approach to the management of cancer pain.
    • Treatment begins with NSAIDs and/or adjuvants and progresses to opioids.
  15. Fentanyl
    Transdermal fentanyl is 100 times more potent than morphine and provides analgesia for 48 to 72 hours. This route is used when clients are unable to take oral medications.

    Transmucosal fentanyl exists for breakthrough pain. The fentanyl is swabbed into the mouth.
  16. When should you evaulate effectiveness/appropriateness of pain medications?
    15 to 30 minutes after administration.
  17. Physical Dependence
    A state of adaptation that is manifested by a drug class specific wihtdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or adinistration of an antagonist.
  18. Drug Tolerance
    A state of adaptation in which exposure to a durg induces changeds that result in a diminution of one or more of the drug's effects over time.
  19. Addiction
    A primary, chonic, neurbiologic disease, with genetic, psychosocial, and environmental factors influencing its devleopment nad manifestations. Addictive behaviors include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
  20. Pseudoaddiction
    Client behaviors (drug seeking) that occur when pain is undertreated.
  21. Pseudotolerance
    Need to increase opioid dose for reasons other than opioid tolerance: progression of disease, onset of new disorder, increased physical adtivity, lack of adherence, change in opioid formulation, drug-drug interaction, drug-food interaction.
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