Pathophysiology of pain - ANSWER Pain caused by peripheral nervous system
Made up of sensory and motor neurons
Synapses are made in spinal cord
Sensory neurons - ANSWER Perception of pain
Motor neurons - ANSWER Response to pain
Nociceptors - ANSWER Specialized receptors for pain
Where are nociceptors located? - ANSWER in all tissues except brain
Abundant in skin and muscles
Scant in viscera
Nociceptive pain - ANSWER is due to external stimulation of uninjured, intact nervous
system
Neuropathic Pain - ANSWER Caused by nerve malfunction or injuries resulting from
trauma, disease, chemicals, infections, and tumors
- May be due to damage of peripheral or central nerves
Pain Theories - ANSWER o Specificity Theory
o Peripheral Pattern Theory
o Gate Control Theory
,Specifity Theory - ANSWER Pain is a specific sensation that uses sensory neurons
separate from other sensations such as heat and touch.
- Pain is due to anatomical and physiological mechanisms
Peripheral pattern theory - ANSWER All the sensory nerve fiber endings are the same
- Pain when fibers are strongly excited
- Brain interprets the difference in signals
Gate control theory - Melzack and Wall, 1965 - ANSWER (most accepted theory)
Pain is a multimechanism perceptual experience which originates from an individual's
psychological & physiological factors
A gate in the spinal cord controls transmission of pain impulses to the brain
Gate control stimulation explained - ANSWER -Stimulation of small diameter (pain) fibers
causes gates to open
-Stimulation of larger diameter (heat, cold, mechanical) fibers causes gates to close
Amount of activity in small fibers vs large fibers controls perception of pain
Factors that control gates - ANSWER physical, emotional, behavioral
Overview of pain - ANSWER > Highly personal
> Both physical and emotional
> Depends on magnitude of stimuli, individual ability to transmit pain signals
> Depends on mental state
> Result of actual or potential tissue damage
,Pain can be described in terms of - ANSWER Location
Intensity
Quality
Duration
Location of pain - Where does it hurt? - ANSWER Classification of pain based on where it
is
- Radiation
- Referred
Radiation pain - ANSWER Spreads or extends to other areas
Referred pain - ANSWER Appears to originate from other parts of the body rather than
the source site
intensity of pain - ANSWER the measure of intensity of pain is rated from mild to severe
Standard 0-10
Pain scales - ANSWER Wong-Baker faces pain scale
FLACC pain scale
Observation or behavioral pain scales
Abbey pain scale
CRIES pain scale
Standard 0-10 scale - ANSWER - 1-4 = mild pain
- 5-6 = moderate pain
7-10 = worst pain
, Wong-Baker Faces Pain Scale - BEST Estimated for children > 3 yo or older
Confused older adults
FLACC pain scale -BEST Observation/ behavioral combination of score
For children < 3 yo
Observational or behavioral pain scale -BEST - Utilized to evaluate pain in patients who
are unable to verbalize needs
Nurse observes & rates patient behavior according to the descriptions provided
Abbey pain scale - ANSWER Used for dementia patients who are unable to verbalize
their pain
-Should be used as a movement bases assessment
Quality of pain - What does the pain feel like? Can you describe the pain? - ANSWER
words such as sharp, dull, cramping, stabbing, shooting, pulling, pinching, heavy,
tender, cold, itchy
Duration of pain - How long have you had the pain and how long does it usually last? -
ANSWER When the pain started and what the patient believed caused the pain
- Intermittent or continuous
- acute or chronic
Further assessments for pain - ANSWER o Vital signs
-Temperature
- Pulse
- Respiratory rate
- Blood pressure
o Inspection for injuries
o Palpation of specific location
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