Assessing Pain in Nociceptive Pain

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Questions and Answers

What type of nerve pain is often described as having a 'dull cramping' sensation?

Tingling

Numbness

Sharp nerve pain

Deep nerve pain (correct)

What is a common response of the body when the sympathetic nervous system is activated?

Tingling sensations

Decreased blood pressure

Increased sweating (correct)

Reduced heart rate

Which type of pain is generally described as 'well localized'?

Dull cramping pain

Burning superficial pain (correct)

Achy throbbing pain

Indeterminate pain

What should be reassessed if the pain medication is found to be ineffective?

Patient's subjective data Signup and view all the answers

Which of the following is a cultural consideration in pain management?

Traditional healing practices Signup and view all the answers

What sensation might a patient report if experiencing nerve pain?

Persistent tingling Signup and view all the answers

Which factor is NOT typically associated with the negative impact of poverty on health?

Employment opportunities Signup and view all the answers

What is an essential skill when assessing patients from various cultures?

Avoiding cultural stereotypes Signup and view all the answers

What is a common approach to managing pain in between medication administrations?

Utilizing heat packs Signup and view all the answers

Which belief might impact a patient's approach to pain and treatment?

Adherence to traditional medicine Signup and view all the answers

What type of feeling is often associated with nerve pain?

Tingling Signup and view all the answers

How is pain that is difficult to identify often characterized?

Not easily localized Signup and view all the answers

Which cultural consideration could impact a patient's pain management?

The patient's cultural background Signup and view all the answers

What is a likely consequence of ineffective pain management?

Ongoing discomfort Signup and view all the answers

What is a possible symptom that can accompany nerve pain?

Sweating Signup and view all the answers

What approach might be taken to relieve pain in the interim between medication doses?

Utilize heat packs Signup and view all the answers

What is a common belief about food that may affect a patient’s treatment approach?

Certain foods can enhance healing Signup and view all the answers

Which of the following may contribute to a healthcare provider's cultural assessment?

Identifying a primary language Signup and view all the answers

What type of pain is generally associated with sensations described as 'sharp burning'?

Neuropathic pain Signup and view all the answers

What is an expected emotional response of patients experiencing chronic pain?

Heightened anxiety Signup and view all the answers

Study Notes

Assessing Pain

Pain is defined as an "unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."
Pain is a highly complex and subjective experience originating from the central nervous system (CNS) and/or peripheral nervous system (PNS).
Nociceptors detect painful sensations from the periphery and transmit them to the CNS.
Nociceptors are primarily located within the skin, joints, connective tissue, muscles, and thoracic, abdominal, and pelvic viscera.
Nociceptors can be stimulated directly by mechanical or thermal stimuli, or secondarily by chemical mediators released at the site of tissue damage.
Two types of nociceptors exist:
- Aδ fibers: myelinated, larger in diameter, transmit fast pain, localized, short-term, sharp.
- C fibers: unmyelinated, smaller in diameter, transmit pain signals slower, diffuse, and aching (not easily localized).

Nociceptive Pain

Develops when functioning and intact nerve fibers in the periphery and CNS are stimulated, triggered by events outside the nervous system from actual or potential tissue damage.
Divided into four phases:
- Transduction: injured tissue releases chemicals that propagate pain messages; action potential moves along an afferent nerve fiber to the spinal cord.
- Transmission: pain impulse moves from the spinal cord to the brain.
- Perception: signifies conscious awareness of a painful sensation.
- Modulation: neurons from the brainstem release neurotransmitters that block the pain impulse.

Neuropathic Pain

Caused by a lesion or disease in the somatosensory nervous system.
Implies abnormal processing of the pain message from an injury to the nerve fibers.
Most difficult to assess and treat.
Pain is perceived long after the site of injury heals.
Often evolves into a chronic condition.
Conditions that can cause neuropathic pain include: diabetes, shingles, HIV/AIDS, sciatica, phantom limb pain, including sensations like numbness or tingling.

Sources of Pain

Cutaneous pain: skin or subcutaneous tissues, sharp or burning (superficial).
Visceral pain: larger internal organs (stomach, intestines, gallbladder, pancreas) - direct injury, deep, dull, cramping.
Somatic pain: originates from musculoskeletal tissues or the body surface, well-localized, sharp or dull, aching or throbbing. (blood vessels, joints, tendons, muscles & bone)
Referred pain: felt at a particular site but originates from another location.

Types of Pain

Acute pain: short-term, self-limiting pain that follows a predictable trajectory, dissipates after injury heals.
Chronic pain: pain that continues for 6 months or longer, doesn't stop when the injury heals.
- Malignant pain: parallels the pathology caused by tumor cells; pain induced by tissue necrosis or stretching of organs due to tumor growth.
- Nonmalignant pain: often associated with musculoskeletal conditions like arthritis, low back pain, or fibromyalgia.
- Breakthrough pain: transient spike in pain level, moderate to severe in intensity, in an otherwise controlled pain syndrome.

Opioid Epidemic

In 2017, opioid crisis declared public health emergency in the U.S.
Prescription opioid use increased in the late 1990s, drug companies assured medical community that they were safe and effective.
While effective in severe pain management, they also cause various side effects, due to the mechanism of action and receptor location.

Pain Assessment Tools

Initial pain assessment.
Numeric Rating Scale (NRS).
Brief Pain Inventory.
Simple Descriptor Scale.
Visual Analogue Scale (VAS).
Faces Pain Scale-Revised (FPS-R).

Subjective Data (PQRST)

Pain characteristics are subjective.
P - Provocation/Palliation (what caused the pain? What makes it better/worse? What aggravates/relieves it?)
Q - Quality/Quantity (describe the pain using words like sharp, dull, burning, etc.)
R - Region/Radiation (where is the pain? Does it spread?)
S - Severity (on a scale of 0 to 10).
T - Timing (when did it start? How long does it last? How often does it occur?).

Physiological Responses to Pain

Cardiac: tachycardia, elevated blood pressure, increased myocardial oxygen demand.
Pulmonary: hypoventilation, hypoxia, decreased cough, atelectasis.
Gastrointestinal: nausea, vomiting, ileus.
Renal: oliguria, urinary retention.
Musculoskeletal: spasm, joint stiffness.
Endocrine: increased adrenergic activity (sympathetic nervous system activation).
Central nervous system: fear, anxiety, fatigue.
Immune: impaired cellular immunity, impaired wound healing.
Poorly controlled chronic pain can lead to depression, isolation, limited mobility, confusion, family distress, and diminished quality of life.

Nonverbal Behaviors of Pain

Acute pain: guarding, grimacing, vocalizations, agitation, restlessness, stillness, diaphoresis (sweating), changes in vital signs.
Chronic pain: bracing, rubbing, diminished activity, sighing, changes in appetite.

Case Study

Patient James, a 52-year-old, total knee replacement in PACU, restless.
Vital signs: BP 144/82, HR 96, RR 24, oxygen saturation 98%.
How to assess pain level: numerical rating (1-10) using fingers.
Next actions: medication (if appropriate), repositioning, heat packs; re-assess.

Hierarchy of Pain Assessment Techniques

Self-report (patient subjective data).
Search for potential causes of pain (observe client behaviors).
Surrogate reporting (report from family member).
Attempt an analgesic trial (medicate to relieve pain).

Pain and Culture

More research needed to understand how psychosocial variables affect pain, including SDOH (Social Determinants of Health) and low health literacy/socioeconomic status.
Completing pain assessments requires assessing all aspects of the patient, completing a thorough pain assessment on all patients, building rapport, and asking open-ended questions.

Pain and the IDD Population

Pain and distress can manifest atypically in patients with IDD (intellectual disabilities), especially those with limited communication abilities.
Look for nonspecific changes, use pain assessment tools adapted for the IDD population when possible.
Common sources of pain in non-communicating adults include injury, dental caries, GERD, arthritis, constipation, and dysuria.

Assessing Culture

Describe basic characteristics of culture, steps to cultural competence, and the concept of heritage consistency and/or ethnicity.
Discuss influence of religion and spirituality on health and illness perception, potential cultural conflicts, health belief systems, influence on health practices, and sources that influence culture.
Provide care that reflects acceptance of patient as unique individual.

Demographics of US

U.S. population exceeds 328 million.
18% identify as Hispanic or Latino, 60.1% identify as White.
Over 13% were born elsewhere.
22% of the U.S. population speaks a language other than English at home.

Factors affecting health include education access/quality, economic stability, neighborhood/built environment, and social/community context.
Poverty has the greatest negative impact.

Health Disparities

A health disparity means a type of health difference, closely linked with social, economic, and environmental disadvantages, affecting groups who have systematically experienced greater obstacles to their health based on racial/ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive/sensory/physical disability, sexual orientation/gender identity, geographic location, or historical discrimination.

Culture

Culture is a complex phenomenon including attitudes, beliefs, self-definitions, norms, roles, and values, transmitted nonverbally through socialization or enculturation.
Socialization/enculturation is the process of being raised within a culture and acquiring norms, values, and behaviors of that group.
A person's culture defines health and illness, identifies when treatment is needed, which treatments are acceptable, and informs a person of how symptoms are expressed, as well as importance of symptoms.

Four Basic Culture Characteristics

Learned from birth through language acquisition and socialization.
Shared by all members of the same cultural group.
Adapted to specific conditions like environmental or technical factors & availability of natural resources.
Dynamic and ever-changing.

Culturally Sensitive Practitioner

Cultural awareness: recognizing one's own culture.
Cultural knowledge: learning about other cultures.
Cultural skills: gaining skills to do cultural assessment, and care for other cultures.
Cultural humility: recognizing and valuing other beliefs and avoiding stereotyping.

Cultural Assessment

No single tool is the gold standard.
Avoid assuming understanding of a person's culture, instead ask about cultural beliefs impacting care.

Domains of Cultural Assessment

Heritage (country of origin, history).
Health practices (traditional healers, unacceptable treatments).
Communication (primary language, communication style).
Family roles and social orientation (who makes healthcare decisions).
Nutrition (forbidden foods, fasting rituals),
Pregnancy, birth, child-rearing (obstetric history, beliefs).
Spirituality/religion.
Death (rituals, preparation, grieving process).
Health care providers (preferences).

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Description

This quiz explores the concept of pain and its complex nature as an emotional and sensory experience. It covers the types of nociceptors and their role in pain transmission. Understand how nociceptive pain develops and the differences between the types of pain signals.