Pain Processing and Adverse Effects

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Questions and Answers

What influences the perception of pain experience at a certain point in pain processing?

Only neuroendocrine factors

Only cultural conditioning

Social and environmental cues, as well as cultural conditioning and past personal experiences (correct)

Only past personal experiences

What should be restored first in patients with severe hypotension or decompensated shock before administering analgesia?

Circulatory volume (correct)

Immune function

Neuroendocrine response

Pain threshold

Which of the following is a neuroendocrine adverse effect of pain?

Spasms

Anxiety

Impaired muscle mobility

Poor wound healing (correct)

What is a potential consequence of administering analgesia to patients with severe hypotension or decompensated shock?

Blunted stress response Signup and view all the answers

Which of the following is a psychological adverse effect of pain?

Anxiety Signup and view all the answers

What is the primary goal of pre-hospital analgesia?

To hasten the relief of discomfort Signup and view all the answers

What is a challenge in pain management, according to the text?

Lack of appropriate treatment options Signup and view all the answers

Which of the following is a respiratory adverse effect of pain?

↓ lung volumes Signup and view all the answers

What is the primary goal of combining analgesic drugs from different classes in a multimodal approach?

To maximize pain relief at lower analgesic doses Signup and view all the answers

What is the primary function of inflammation in response to tissue damage or injury?

To destroy invading organisms or irritants Signup and view all the answers

Which of the following is a mediator of the pain response involved in increasing the perception of pain?

Prostaglandins Signup and view all the answers

What is the main advantage of using a multimodal approach to pain management?

It reduces the risk of adverse drug effects Signup and view all the answers

Which pathway is involved in the production of prostacyclins?

Cyclo-oxygenase Pathway Signup and view all the answers

What is the primary role of prostaglandins in the body?

To act as local signals to achieve different responses in different tissues Signup and view all the answers

What is the main mechanism by which prostaglandins are inactivated in the body?

They are quickly changed from active to inactive products at the site of use Signup and view all the answers

Which of the following is NOT a mediator of the pain response?

Immobilisation Signup and view all the answers

What is the primary purpose of the Numeric Rating Scale in pain assessment?

To help assess the extent of an individual's pain and improve communication regarding pain with health care providers Signup and view all the answers

What should be done if a patient exhibits evidence of sedation or other serious adverse effects after receiving analgesic medication?

Stop further administration of the medication Signup and view all the answers

According to the latest Clinical Practice Guidelines, what pain scale should be considered for patients over 12 years old?

Self-report scale, such as the Numeric Rating Scale Signup and view all the answers

What is a limitation of the Numeric Rating Scale in pain assessment?

It only evaluates one aspect of pain - intensity Signup and view all the answers

What is an advantage of using the Numeric Rating Scale in pain assessment?

It can be administered verbally and in writing Signup and view all the answers

What is the recommended course of action if a patient is still in significant pain after receiving analgesic medication?

Re-dose the medication at half the initial dose Signup and view all the answers

What type of pain is Penthroxyflurane typically used to treat?

Moderate to severe pain, such as trauma or bone fractures Signup and view all the answers

What is an important consideration when administering analgesic medication?

The timing of dosing in relation to medication half-life and onset of action Signup and view all the answers

Study Notes

Pain Processing

Perception of pain experience is influenced by social and environmental cues, as well as cultural conditioning and past personal experiences.

Adverse Effects of Pain

Neuroendocrine

Activation of stress response
Poor wound healing
Impaired immune function
Hyperglycaemia
Weight loss / muscle wasting

Musculoskeletal

Spasms
Impaired muscle mobility and function
Immobility
Weakness
Fatigue

Psychological

Anxiety
Fear
Sleep deprivation
PTSD

Cardiovascular

↑ heart rate
↑ blood pressure
↑ myocardial oxygen demand
Hypercoagulation
Unstable angina
Myocardial infarction
Deep vein thrombosis
Pulmonary embolism

Respiratory

↓ lung volumes
↓ cough
Splinting
Pneumonia
Hypoxaemia
Atelectasis

Gastrointestinal

↓ bowel motility
↓ gastric emptying
Constipation
Anorexia

Pre-Hospital Analgesia

Hastens the relief of discomfort rather than waiting for pain medication administration in EDs
Historically only entonox and morphine have been available for pre-hospital pain management
Many new additions such as Ketamine

Multimodal Approach

Combines analgesic drugs from different classes and employs analgesic techniques that target different mechanisms of pain
Inclusive of non-pharmacological therapy
Its synergistic effect maximizes pain relief at lower analgesic doses
Reduces the risk of adverse drug effects

Inflammation

Protective function in response to tissue damage/injury
Body uses inflammation to destroy invading organisms or irritants, remove toxins and start the process of tissue repair
Sometimes this inflammation is not appropriate and can become harmful

Prostaglandins

Huge mediator of the pain response
Made by all tissues in very small quantities
Act as local signals to achieve different responses in different tissues
Two pathways to the production of these mediators:
- Cyclo-oxygenase Pathway
- Lipooxygenase Pathway

Pain Assessment

Use an age-appropriate pain scale to assess pain
Latest Clinical Practice Guidelines suggest:
- >12 years: Consider using a self-report scale, such as the Numeric Rating Scale
Numeric Rating Scale:
- Preferred due to ease of use and high compliance
- Designed to help assess the extent of an individual's pain and improve communication regarding pain with health care providers
- Pros:
  - Takes less than a minute to complete
  - Takes less than a minute to administer and score
  - The numeric scale allows it to be used internationally without translation difficulties
  - Deemed valid and reliable for rating pain intensity
  - Can be administered verbally and in writing, making it accessible for more people
- Cons:
  - Only evaluates one aspect of pain - intensity
  - Does not factor in past pain experiences
  - Does not factor in fluctuations in pain
  - Only evaluates pain experienced in the last 24 hours or "an average pain intensity"

Analgesic Agents

Consider the timing of dosing in relation to medication half-life and onset of action
Mild to moderate pain:
- Paracetamol (oral / IV)
- Acetyl salicylic acid
- Diclofenac
- Ibuprofen
Moderate to severe pain:
- Penthroxyflurane (inhaled)
- Fentanyl (IV / IN)
- Morphine (IV)
- Ketamine (IV / IM / IN)

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Description

This quiz covers the psychological and environmental factors influencing pain perception, as well as the negative effects of pain on the body, including neuroendocrine and stress responses.