Acute and Chronic Pain PDF

Acute and Chronic Pain By Angela D. Banks, RN, PhD Pathophysiology of Pain Transduction Pain Transmission Perception Pain threshold—the level of pain stimulation required to be perceived Pain tolerance—degree of pain an individual is willing t...

Acute and Chronic Pain By Angela D. Banks, RN, PhD Pathophysiology of Pain Transduction Pain Transmission Perception Pain threshold—the level of pain stimulation required to be perceived Pain tolerance—degree of pain an individual is willing to bear before seeking relief Pain expression—the way in which the pain experience is communicated to others Definitions of Pain Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is whatever the experiencing person says it is and exists whenever he or she says it does (McCaffery, 1999). Types of Pain Types of pain Acute pain Chronic pain Other Types of Pain Somatic Pain Visceral Pain Neuropathic Pain Three Locations of Pain Localized pain Radiating pain Referred pain Referred Pain  bindswithcalciumthatformskidney Stones Oxilate Feverfrequenturinationfoulodor Distinguishing Back pain from Kidney pain Back pain usually caused by Kidney pain usually caused by heavy lifting or back injury UTI or kidney stones Wide spread pain across the back Lower back (flank area) and buttocks Pain on one side of body that Felt in upper back increases in frequency Pain is usually intermittent Pain is constant until treatment is May be relieved by back rendered stretches May accompany abdominal pain Hematuria may be present bagels high in oxilate Attitudes and Practices Related to Pain Substance Abuse  Addiction, Pseudoaddiction, Tolerance Addiction—a psychological of physical need for a habit forming substance (e.g. alcohol or drugs) despite its harmful effects Pseudoaddiction—describes a phenomena of patients with pain being undertreated Tolerance—state of adaptation in which exposure to a drug results in a decrease in one or more the drug’s effects over time Tolerance Physical Dependence Nursing Management of Pain Precipitating factors Aggravating Factors Localization of the pain Character and quality Duration of pain Pharmacologic Therapy Acetylsalicylic acid (Aspirin) Acetaminophen (Tylenol) NSAIDs Aspirin Motrin GI disturbances COX-2 inhibitors Celebrex  Non-Opioid Analgesics Acetaminophen (Tylenol) Oral and liquid preparations Does not cause GI bleeding Nephrotoxic and Hepatotoxic Intravenous Route Acetaminophen (Ofirmev)  Opioid Analgesics Methadone (Dolophine) Morphine (Roxanol) Oxycodone (Oxycontin) Hydromorphone (Dilaudid) Sublimaze (Fentanyl) Weak Opiate Codeine (Codeine Sulfate) CYP2D6 enzyme needed to convert codeine to the active metabolite morphine which provides an analgesic effect  Heroin Most commonly abused opioid in US Heroin is injected (mainlining or skin popping Heroin can be sniffed (known as snorting) Frequently used in combination with cocaine  Heroin Dependence Methadone Maintenance Program Long half life 12-24 hours One dose daily Goal of program is to reduce dosage gradually  Side Effects of Opioids Nausea and vomiting Constipation Sedation Respiratory depression Euphoria Pain Management in End of Life PCA Infusion Pump Spinal Analgesia Epidural analgesia Intrathecal (subarachnoid) analgesia  Chronic Pain Treatment Opioids not recommended Providers need more education in providing adequate pain control Involves a multidisciplinary approach a. Medication b. Physical Therapy c. Psychological Counseling