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Flashcards in BEH Pain Deck (32)
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1
Q

Define Pain.

A

an unpleasant and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

2
Q

What can influence pain management?

A

Pain management is influenced by beliefs, attitudes, education and environment

3
Q

What are some cardiovascular effects of undertreated severe acute pain?

A

Cardiovascular:
• Tachycardia
• Hypertension
• Increased peripheral vascular resistance
• Increased myocardial oxygen consumption
• Myocardial ischaemia
• Altered regional blood flow
• Deep-vein thrombosis
• Pulmonary embolism

4
Q

What are some respiratory effects of undertreated severe acute pain?

A

Respiratory
• Reduced lung volumes (tidal volume)
• Atelectasis
• Decreased cough
• Sputum retention
• Infection
• Hypoxaemia

5
Q

What are some gastrointrstinal and genitourinary effects of undertreated severe acute pain?

A

Gastrointestinal
• Decreased gastric and bowel motility
• Increased risk of bacterial transgression of bowel wall

Genitourinary
• Urinary retention

6
Q

What are some neuroendocrine effects of undertreated severe acute pain?

A

Neuroendocrine
• Increased catabolic hormones
○ Glucagon
○ Growth metabolic hormone
○ Vasopressin (ADH)
○ Aldosterone
○ Renin
○ Angiotensin
• Reduced anabolic hormones
○ Insulin
○ Testosterone
• This catabolic state leads to
○ Hyperglycaemia
○ Increased protein breakdown
○ Negative nitrogen balance
○ Leading to impaired would healing and muscle wasting

7
Q

What are some psychological effects of undertreated severe acute pain?

A

Psychological
• Anxiety
• Fear
• Helplessness
• Sleep deprivation
• Leading to increased pain

8
Q

What are some musculoskeletal and central nervous system effects of undertreated severe acute pain?

A

Musculoskeletal
• Muscle spasm
• Immobility (increased risk of deep-vein thrombosis)
• Muscle wasting leading to prolonged recovery of function

Central nervous system
• Chronic (persistent) pain due to central sensitisation

9
Q

What is the difference between Pain Tolerance and Pain Threshold?

A

Pain Tolerance: the point which pain becomes unbearable and varies widely among individuals and in a single person under different circumstances

  • will vary between individuals

Pain Threshold: people have a relatively constant pain threshold under normal circumstances

  • same in almost everyone
  • e.g. heat applied to skin at an intensity of 45-48C will initiate the sensation of pain in almost everyone
10
Q

What is involved in the perception of Pain?

A
  • sensory system
    • location, duration and intenisty of the pain
  • a motivational-affective component
    • designeed to avoid or escape from the cause of the pain
  • a cognitive-evaluative component
    • information about the current pain and past experiences in order to evaluate the pain
11
Q

What are Nociceptors?

A

respond to potentially damaging stimuli that result in pain. e.g. searing heat, extreme cold, excessive pressure and inflammatory chemicals are all interpreted as painful.

12
Q

What part of the brain is responsible for the perception of pain?

A

Thalamus

13
Q

Where are Nociceptors located?

A

Are widely dispersed throughout the body and can be identified in skin, periosteum, joints, muscle and viscera

14
Q

What are the two main types of Nociceptors?

A
  • A-delta fibres
    • Myelinated fibres
    • Stimulated by heat and noxious mechanical injury
    • Action potentials 2-20 m/s
      • Travel towards the dorsal horn of the spinal cord
      • Synapse with second-order neurons to send message to brain
    • Stimulation leaves to initial sharp pain that follows injury
  • C-fibres
    • Unmyelinated fibres
    • Stimulated by heat and noxious chemical and mechanical injury
    • Action potentials <2 m/s
    • Throbbing, slow building, burning pain, following initial injury
    • Subclass → C-fibre polymodal receptor
      • Responds to heat, cold, pressure and chemical stimuli
15
Q

What are the excitatory and inhibitory neurotransmitters released in response to pain?

A

Excitatory

  • Glutamate
  • Monoamines
  • Substance P

*in the dorsal horn of spinal cord*

Inhibitory

  • Gamma Amino Butyrix Acid (GABA) and GLycine
  • 5-Hydroxy-Tryptamine (5-HT)
  • Noradrenaline
  • Endogenous Opiods
    • endorphins
    • dynorphins
    • enkephalins
16
Q

How does the body modulate pain?

A

Inhibition of pain is a function of endogenous opioid peptides e.g. endorphins

Endorphins bind to opioid receptors located on the spinal cord and brain and inhobit nociception transmission and pain perception.

17
Q

What is Nociceptive and Neuropathic pain?

A

A basis for classification of Pain.

Nociceptive - somatic and visceral pain

Neuropathic - centrally and peripherally generated pain

18
Q

Describe the location, description and mechanism, as well as give examples of somatic, visceral and neuropathic pain.

A
19
Q

What are some Pharmacological Pain Mx options?

A

Opioids:

  • morphine, fentanyl, codeine, pethidine

Non-Opioids:

  • paracetamol, acetylsalicylic acid, ibuprofen
  • NSAIDs

Inhalational:

  • Methoxyflurane
  • Nitrous Oxide
20
Q

What are some non-pharmacological pain Mx options?

A

Distraction:

  • assist Pt to focus on a stimulus other than pain

Hypnosis, imagery and relaxation:

  • calm voice
  • coach breathing - deep breaths

Cutaneous stimulation:

  • ice pack, heat, acupuncture
21
Q

What are some abnormal signs to look out for?

A
  • swelling/oedema
  • brusing
  • discolouration/skin colour
  • lacerations
  • abrasions
  • avulsions
  • skin tears
  • bleeding
  • discontinuities
  • level of function
  • shortening
  • rotation/abnormal rotation
  • decreased ROM
  • angulation
22
Q

What does PILSDUCT stand for?

A
  • Pain
  • Irregularity
  • Loss of Function/Power
  • Swelling and Muscle Spasm
  • Deformity
  • Unnatural movement/position
  • Crepitus (grating)
  • Tenderness
23
Q

What does a neurovascular assessment examine?

A
  • pain
  • Vascular Integrity
  • Neurological Integrity
24
Q

What are the parameters for peripheral neurovascular assessment?

A
  • colour
  • sensation
  • movement - functionality
  • capillary refill
  • temperature
  • tissue turgor
  • pulses - presence, quality and absence over the full length of extremity
    • Arm: radial, ulnar, brachial
    • Leg: femoral, popliteal, posterior tibialis, pedal
25
Q

What are the 5P’s of distal ischaemia?

A
  • pain
  • pallor
  • paralysis
  • parasthesia (tingling)
  • polar (coolness)
26
Q

What is an analgesia?

A

Is a substance that inhibits the body’s reaction to, or the perception of pain without producing a loss of consciousness

27
Q

What are the contraindications for Methoxyflurance?

(AV CGP’s)

A
  • Pre-existing renal diseases/impairment
  • Concurrent use of tetracycline antibiotics
  • Exceeding total dose of 6ml in 24/24
28
Q

What are some precautions for Methoxyflurane?

A
  • The “Penthrox” inhaler must be hand-held by the Pt so that if unconsciousness occurs it will fall from the Pt’s face. Occasionally the operator may need to assist but must continuously assess the level of consciousness
  • Pre-eclampsia

*try and administer in a well ventilated place, ~20% of methoxyflurance is recovered in the exhaled air*

29
Q

How is Methoxyflurane administered?

A

Self-administrated under supervision using the hand held “Penthrox” Inhaler with oxygen supplementation

30
Q

What are some common side effects of Methoxyflurane?

A
  • Drowsiness
  • Decrease in blood pressure and bradycardia (rare)
  • Exceeding the max. total dose of 6ml in a 24 hr. period may lead to renal toxicity
31
Q

What is the initial dose of Methoxyflurane?

A

Initial dose is 3ml, which will provide 25min of analgesia. A further 3ml dose may be administered once the initial dose is exhausted and if required.

32
Q

How is Methoxyflurane excreted?

A

Excreted mainly by the lungs, but is also excreted by the liver