Term
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Definition
| "Unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"
"Pain is whatever the experiencing person says it is existing whenever the experiencing person says it does" |
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Term
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Definition
| Point at which a stimulus evokes pain |
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Term
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Definition
| duration or intensity of pain a person is willing to endure |
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Term
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Definition
| after repeated administration of the medication, a given dose begins to lose its effectiveness |
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Term
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Definition
| Involuntary behavior in which abrupt discontinuance of a drug leads to withdrawal symptoms. |
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Term
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Definition
| A primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over medication use, compulsive use, continued use despite harm, and craving |
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Term
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Definition
| Usually temporary, well-defined onset - serves as a warning signal, commonly declines over a short time, < 3 months or as long as it takes for normal healing to occur
Physiological responses - stress response
Behavioral responses - Focuses on pain, cries and moans, frowns, grimaces |
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Term
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Definition
| Usually greater than 6 months in duration - may start as acute injury or event but continues past the normal recovery time poorly defined onset, no useful purpose
Physiological responses – Adaptation
Behavioral responses - No report of pain unless questioned, quiet, rests, inactive, immobile, blank or normal facial expression; can be disabling and is often accompanied by anxiety and depression |
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Term
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Definition
| Normal processing of stimuli that damages normal tissue or has the potential to do so if prolonged
Usually responsive to nonopioids and/or opioids
Types of nociceptive pain: somatic pain and visceral pain |
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Term
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Definition
| Arises from bone, joint, muscle, skin or connective tissue
Usually aching or throbbing in quality and is well localized |
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Term
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Definition
| Arises from viscera, such as the GI tract and pancreas
May be due to tumor involvement of the organ capsule that causes aching and fairly well-localized pain
May be due to obstruction of hollow viscus, which causes intermittent cramping and poorly localized pain |
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Term
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Definition
| Abnormal processing of sensory input by the peripheral or central nervous system
Treatment usually includes adjuvant drugs
A physical cause for reports of excruciating pain may not be evident on examination |
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Term
| Examples Neuropathic Pain: |
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Definition
| Phantom limb pain – may reflect injury to the peripheral nervous system
Diabetic neuropathy |
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Term
| Harmful Effects of Unrelieved Pain (Table 10-1, page 126) |
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Definition
| Unnecessary suffering
Physical and psychosocial dysfunction
Impaired recovery from acute illness and surgery
Immunosuppression
Sleep disturbances |
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Term
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Definition
| Specificity Theory – hypothesis that pain is related to specific anatomic structures and physiologic functions
Pattern Theory – accounted for abnormal pain states not explained by specificity theory
Specificity Theory – hypothesis that pain is related to specific anatomic structures and physiologic functions
Pattern Theory – accounted for abnormal pain states not explained by specificity theory |
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Term
| Theories Related to Pain (cont.) |
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Definition
| Psychosocial Theory – views pain as an emotion or as the manifestation of an emotional state
Gate Control Theory - hypothetical gating mechanism in the spinal cord that allows nerve fibers to receive pain sensations. |
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Term
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Definition
| Location
Quality
Intensity
Onset/Duration
Precipitating, relieving and aggravating factors |
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Term
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Definition
| Ask the patient to mark the location(s) on a figure drawing
Ask the patient to point on his or her body the location of pain(s)
Does it radiate to any other part of his body? |
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Term
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Definition
| "What is the pain like?"
"Can you describe how it feels?"
“What would you do to me for me to feel the same pain?” |
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Term
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Definition
| Ask the patient to rate it on a scale of 0 to 10 (with 10 being the worst pain).
An intensity rating scale can also be used to evaluate therapy. |
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Term
| Set Goals for Comfort and Function/Recovery |
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Definition
| Pain ratings of 4 or greater interfere with a patient’s activity
Pain ratings of 6 and 7 interfere with enjoyment of life |
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Term
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Definition
| "How long does the pain last?"
Constant or intermittent (come and go)? |
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Term
| Precipitating and Aggravating Factors |
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Definition
| What, if anything, brought on the pain?
"Is there anything that makes the pain worse?". |
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Term
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Definition
| Approximately half the people who suffer moderate to severe pain will continue to suffer primarily because clinicians fail to assess pain. |
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Term
| Pharmacological Measures: Nursing Responsibilities |
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Definition
| Assessing pain
Determining when to administer analgesics
Selecting the appropriate analgesic (titrating opioids)
Evaluating effectiveness of the analgesics |
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Term
| Pharmacological Measures: Nursing Responsibilities |
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Definition
| Monitoring and managing medication side effects
Suggesting changes
Consider the needs of special populations (cognitively impaired, patients with substance abuse problems) |
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Term
| Patients with Impaired Communication |
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Definition
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Term
| Cognitively Impaired Elders |
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Definition
| Even patients with substantial cognitive impairment may be able to use a pain rating scale.
Allow sufficient time for the patient to process the information and then respond.
Usually a 0 to 5 scale is preferable to a 0 to 10 scale for these patients. |
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Term
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Definition
| Acetaminophen
NSAIDs
Aspirin
Ibuprofen
Ketorolac
Naproxen |
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Term
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Definition
| Inflammatory conditions
Mild to moderate acute or chronic pain of peripheral origin
Co-analgesic for severe pain
Desire by patient to avoid opioids
Conditions associated with excessive prostaglandin at site of injury or pain
Postoperative pain |
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Term
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Definition
| Analgesic ceiling
Gastrointestinal upset
Prolonged bleeding time
Fluid retention |
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Term
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Definition
| Codeine
Meperidine
Hydrocodone
Methadone
Hydromorphone
Morphine
Oxycodone |
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Term
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Definition
| Not appropriate for first-line opioid for management of any type of pain (AHCPR 1992)
Active metabolite (normeperidine)
Normeperidine is a CNS stimulant – can produce irritability, tremors, muscle jerking, agitation, and seizure
Normeperidine – half-life of 15-20 hours
More likely to cause delirium in postoperative patients of all ages |
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Term
| Opioid Agonist-Antagonist |
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Definition
| Buprenorphine (Buprenex)
Butorphanol (Stadol)
Nalbuphine (Nubain)
Pentazocine (Talwin)
Dezocine (Dalgan) |
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Term
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Definition
| ATC – indicated when pain is predicted to be present for 12 or more hours out of 24 hours
PRN – requires patients to request analgesia, appropriate for intermittent pain |
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Term
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Definition
| Use published tables when converting to another drug or another route |
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Term
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Definition
| Sedation
Nausea and vomiting
Respiratory depression
Constipation |
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Term
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Definition
| Promethazine (Phenergan) does not potentiate the analgesia of narcotics. It actually increases the perceived intensity of pain. Phenergan does potentiate narcotic-related sedation, hypotension, and respiratory depression. |
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Term
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Definition
Antidepressants
Antiseizure agents
Corticosteroids
Local anesthetics |
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Term
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Definition
| Oral
Intramuscular
Intravenous
Rectal
Sublingual/buccal
Subcutaneous
Spinal
Topical
Transdermal
Intranasal |
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Term
| Non-Invasive Non-Pharmacological Methods of Pain Relief |
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Definition
| Repositioning
Heat
Cold
TENS
Acupressure
Massage
Therapeutic touch |
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Term
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Definition
| Acupuncture
Neuroaugmentation
Nerve blocks |
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Term
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Definition
| – hypothesis that pain is related to specific anatomic structures and physiologic functions |
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