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CH 4 PAIN (TYPES AND CAUSES OF PAIN (Sometimes it is hard to know where…
CH 4 PAIN
TYPES AND CAUSES OF PAIN
Sometimes it is hard to know where the pain is coming from..
Referred pain
Pain may be perceived at site distant from source.
Phantom Pain
Pain after an amputation
Pain, itching, tingling
Chronic Pain
Occurs over extended time; may be recurrent.
Individual may be fatigued, irritable, depressed.
Sleep disturbances common
Acute Pain
Usually sudden and severe, short term
Indicates tissue damage.
Initiates
physiologic stress response.
Increase blood pressure and heart rate; cool, pale, moist skin; increase respiratory rate; increase skeletal muscle tension
Central pain
Caused by dysfunction or damage to the brain or spinal cord
Neuropathic pain
Caused by trauma or disease involving the peripheral nerves
Ischemic pain
Results from a profound, sudden loss of blood flow to an organ or tissue
Cancer-related pain
Caused by advance of the disease; pain associated with treatment; result of coexisting disease
PAIN PATHWAYS
Stimulated by:
Temperature
Extremes of temperature
Chemicals
Examples: acids, bradykinin, histamine, prostaglandin
Physical means
Example: pressure
Due to Nociceptors
Reflex response
(efferent response)
Involuntary muscle contraction away from pain source
Neural
Spinothalamic bundle in the spinal cord
Paleospinothalamic tract
→ slow impulses; chronic, dull pain
Spinothalamic tracts
connect with reticular formation of brain
Neospinothalamic tract
→ fast impulses; acute pain
Somatic sensory area in the cerebral cortex located in the
parietal lobe
Perception and localization of sensation
Hypothalamus and limbic system
Emotional factors
Reticular activating system (RAS)
Reticular formation in the pons and medulla
Awareness of incoming brain stimuli
SIGNS, SYMPTOMS, AND DESCRIPTIONS OF PAIN
Location of pain
Descriptive terms:
Aching, burning, sharp, throbbing, widespread, cramping, constant, periodic, unbearable, moderate
Timing of pain
Physical evidence of pain
Nausea, vomiting, fainting, dizziness, anxiety, fear
Body defense mechanism
Causes:
Inflammation
Infection
Ischemia and tissue necrosis
Stretching of tissue
Stretching of tendons, ligaments, joint capsule
Chemicals
Burns
Muscle spasm
Visceral pain
originates in organs
(due to sympathetic fibers)
Ex. infection/swelling...may be accuse or chronic
Somatic pain
Skin, bone, muscle
(due to sensory fibers)
Ex. broken arm...I feel it at the source
GATE CONTROL THEARPY
Control systems, “gates” built into normal pain pathways
Gates open
: pain transmitted
Gates closed
: no pain or reduced
Pain Control
Ice (closes gates)
Transcutaneous electrical nerve stimulation
(TENS)
Increases sensory stimulation at site, blocking pain transmission.
Opioids
Methods of Managing Pain
Use of analgesic medications
Orally
Parenterally (injection)
Transdermal patch
Classified by ability to relieve
Mild pain
Moderate pain
Severe pain
Young Children
Infants respond physiologically
Ex. tachycardia, increased blood pressure, facial expressions
Table 4.1
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Table 4.2
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ANASTHESIA
TABLE 4.3
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