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Pain (Dimensions of Pain (Affective - (Emotional response; anger, fear,…
Pain
Dimensions of Pain
Affective -
Emotional response; anger, fear, depression and anxiety
Cognitive -
Beliefs, attitudes, memories and meaning attributed to pain influence the response.
Physiological -
Genetic, anatomical and physical determinants of pain influence how painful stimuli are processed, recognised and described.
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Sociocultural -
Age and gender influences on nociceptive processes and responses to opioids. Cultural affects on pain expression.
Pain Mechanisms - Nociception is the physiological process by which information about tissue damage is communicated to the CNS
Transduction - Phase 1
Phase 1 involves the conversion of a noxious mechiacl, thermal or chemical stimulus into an electrical signal called an action potential. Noxious cause a release of chemicals into the damaged tissues. These chemicals include; hydrogen ions, substance P and adenosine triphosphate. Mast cells release alternative chemicals of which activate nociceptors causing an action potential. This sends a signal to the spinal cord via myelinated A-delta fibres and unmyelinated C fibres.
Transmission - Phase 2
Phase 2 is the process of relaying nociceptive signals from the periphery to the spinal cord and then to the brain. Nociceptive signals are carried along primary afferent fibres. The primary afferent fibres terminate in the dorsal horn of the spinal cord causing activity and modulation of pain. From the dorsal horn the signal is transmitted to the thalamus and the cerebral cortex
Perception - Phase 3
Phase 3 is the point at which a person is consciously aware of pain. This mechanism is poorly understood
Modulation - Phase 4
The final phase involves the activation of descending pathways that exhibit inhibitory or facilitatory effects on the transmission of pain.
Classifications of Pain
Neuropathic Pain - (pathophysiological) pain sustained by injury or dysfunction of the peripheral or CNS. Described as numbing, hot, burning shooting, stabbing, sharp or electric shock-like
Acute and Chronic Pain - differ in their cause, course, symptoms and treatment.
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Nociceptive Pain - also referred to as physiological pain sustained by ongoing activation of the sensory system that subserves the perception of noxious stimuli.
Somatic Pain - superficial or deep. Described as deep, aching or throbbing.
Superficial Pain - Skin, mucous membrane and subcutaneous tissues. Described as sharp, burning or prickly.
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Pain Treatment
Pharmacological
Also referred to as drug therapy, this category is divided into three drug types; non-opioids, opioids and adjuvant drugs.
Non-Opioids analgesics include paracetamol, aspirin, and other salicylate and NSAIDs
Opioids; these analgesic agents bind to receptors in the CNS making them an extremely effective form of pain relief. Forms of opioids; morphine, fentanyl, oxycodone, codeine, methadone, hydromorphone and tramadol.
Adjuvant drugs are medication used commonly in conjunction with non-opioids and opioids. Commonly used adjuvant drugs include; corticosteroids, antidepressants, anti seizure drugs and topical agents.
Non-Pharmacological
Non-pharmacolgical strategies include; massage, exercise, transcutaneous electrical nerve stimulation, acupuncture, heat therapy, cold therapy and cognitive therapies.
Analgesic Ladder; 1)Non-pharmacological approaches and/or paracetamol. 2)NSAID and/or oral opioids. 3)Increased dose of oral opioids or IV/SC opioids.
Pain Assessment
A pain assessment is a simple tool the determines the patients pain. This assessment involves asking the patient about the pain, accept what they are saying and intervening to relieve their pain according to the pain management goals. This is done in a full circle as a RN is always to assess, intervene and reassess.
Goals for a nursing pain assessment consist of; describing the patient's pain experience to identify and implement appropriate pain management techniques. Identify the patients goal for therapy and resources for self-management.
Pain Assessment involves investigating the location, intensity, quality and symptoms. It also involves establishing the management strategies and the impact of pain.
Pain is unpleasant sensory and emotional experience associated with actual or potential tissue damage.