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PAIN - Coggle Diagram

- - - - Pallor
        Cause or Effect
        Causes blood supply to shift away from
        periphery
      - Muscle tension
        Cause & Effect
        Results from fatigue
      - Decreased heart rate and blood
        pressure
        Cause or Effect
        Results from vagal stimulation
      - Rapid, Irregular breathing
        
        Cause or Effect
        Causes body defenses to fail under
        prolonged stress of pain
      - Weakness or Exhaustion
        
        Cause or Effect
        Results from expenditure of physical
        energy
    - - Dilation of bronchial tubes and
        increased respiratory rate
        Cause or Effect
        Provides increased oxygen intake
      - Increased heart rate
        Cause or Effect
        Provides increased oxygen transport
      - Peripheral Vasoconstriction
        (pallor, elevation in blood pressure)
        Cause or Effect
        Elevates blood pressure with a shift of blood supply from periphery and viscera to skeletal muscles and brain
      - Increases blood glucose level
        Cause or Effect
        Provides additional energy
      - Diaphoresis
        Cause or Effect
        Controls body temperature during stress
      - Increased muscle tension
        Cause or Effect
        Prepares muscles for action
      - Dilation of pupils
        Cause or Effect
        Affords better vision
      - Decreased gastrointestinal motility
        (Vomiting, nausea)
        Cause or Effect
        Frees energy for more immediate
        activity
  - - - CT Scans
      - Bone Scans
      - X-Ray Scan
    - - Myelogram
      - Discography
    - - Nerve Blocks
      - NCV (Nerve Conduction Velocity)
    - - EMG (Electromyogram)
    - - Ultrasound Imaging
    - - MRI Scans
    - - Vitamin Deficiencies
        
        Blood Test
      - Diabetes
        
        Blood Test
      - Immunity Abnormalities
        
        Blood Test
  - - - Pain is localized and of short
        duration
    - - Pain is diffuse and may radiate
        in several directions.
    - - Pain is felt in a part of the body separate from the source of pain and may assume any characteristic
    - - Pain feels as though it travels
        down or along the body part
    - - Pain usually described as burning, shooting, numbing or electric-like
- - - - Step 2 Drugs
        
        Used for mild to moderate pain (pain of 4-6 on a scale from 0-10)
        
        an opioid for mild to moderate pain
        
        ± nonopioid
        
        ± adjuvant
      - Step 3 Drugs
        
        Used for moderate to severe pain (pain of 6-10 on a scale of 0-10), or when effective pain relief is not caused by step 2 drugs
        
        an opioid for moderate to severe pain
        
        ± nonopioid
        
        ± adjuvant
      - Step 1 Drugs
        
        Used for mild pain (pain of 1-3 on a scale from 0-10)
        
        a nonopioid
        
        ± adjuvant
    - - Opioid analgesics
        
        Opioids for severe pain
        
        Morphine
        
        Morphine-like agonists
        
        hydromorphone
        
        oxycodone
        
        methadone
        
        fentanyl
        
        meperidine
        
        Mixed agonists-antagonists
        
        butorphanol
        
        Opioids for mild to moderate pain
        
        Morphine-like agonists
        
        codeine
        
        tramadol
        
        Mixed agonists-antagonists
        
        pentazocine
        
        butorphanol
      - Non-opiod analgesics
        
        Salicylates
        
        Acetaminophen
        
        Nonsteroidal anti-inflammatory drugs (NSAIDs)
      - Adjuvant analgesic therapy
        
        medications used with opioids and nonopioids
        
        Types of adjuvants
        
        Antidepressants
        
        Bupropion
        
        Maprotiline
        
        Corticosteroids
        
        Dexamethasone
        
        methylprednisone
        
        Antiseizure Drugs
        
        gabapentin
        
        Local anasthetics
        
        can be oral, parenteral, topical
        
        Capsaicin
        
        Mechanisms of Adjuvants
        
        adjuvants work in one of 3 ways to enhance pain therapy
        
        Adjuvants may have their own analgesic effects
        
        Adjuvants may counteract the side effects of other analgesics
        
        Adjuvants may enhance the effects of opioids and nonopioids
      - Multimodal Analgesia
        
        a combination of analgesics are used
        
        may have synergistic or additive effects
      - Patient controlled Analgesia (PCA)
        
        Allows patients to safely administer pain medications through a pump
        
        Can be given through IV administration, subcutaneous, epidural, intrathecal, and transdermal routes
  - - - Destroying nerves - interrupts the transmission of pain
        
        surgical resection
        
        thermocoagulation
        
        Neurectomies
        
        Cordotomies
    - - The spinal cord and the brain are electrically stimulated
  - - - Exercise
        
        Exercise is especially useful in persistent musculoskeletal pain
        
        strengthening exercises
        
        stretching
        
        mild to moderate aerobic exercises
        
        Exercise programs to treat pain should be supervised by other interprofessional team members:
        
        physiotherapist
        
        physiatrist
        
        physiologist
      - Acupuncture
      - Cutaneous stimulation
        
        Percutaneous Electrical Nerve Stimulation (PENS)
        
        Massage
        
        Application of heat and/or cold
        
        Transcutaneous Electrical Nerve Stimulation (TENS)
      - Biofeedback
        
        Can help treat:
        
        regional pain syndrome
        
        muscle tension
        
        migraine headaches
        
        Continuous monitoring equipment is used to provide feedback that allows the patient to adjust physiological states and create relaxation
      - Diet
        
        Diet can help with pain management by being used to treat other underlying diseases and conditions that cause pain
        
        Mediterranean diet
        
        useful for managing osteoporosis
        
        A dietician is an interprofessional team member that may help form a meal plan for the patient based on the patient's medical conditions
    - - Relaxation Strategies and Guided imagery
      - Hypnosis
      - Distraction
      - Self Management
        
        sleep promotion
        
        communication skills
        
        energy conservation
  - - - Drugs administration should be tapered to avoid withdrawal syndrome
    - - Addiction behaviors
        
        cravings for drug
        
        lack of control over drug use
        
        compulsive use of drug
        
        continuing to use drug despite harm from use
    - - a higher dose of the drug will be needed to produce the same pain relieving effect
      - If tolerance develops, the drug used to treat pain should be rotated
  - - - Believing that pain is an aspect of aging that is inevitable
      - Fear of using opioids
      - Patients using alternative words to describe pain (such as "aching" or feeling "sore")
    - - Drugs are metabolized slower
      - Taking NSAIDs increases the risk of GI bleeding
      - The use of some pain medications can cause exacerbation of cognitive impairment and ataxia
      - Higher risk for adverse effects occurring
      - Possible interactions between multiple drugs the patient is taking
- - - - peripherally generated pain
        
        Painful peripheral neuropathies
        
        Painful mononeuropathies
      - Centrally generated pain
        
        Sympathetically maintained
        
        Deafferentation
    - - Somatic pain
      - Visceral pain
- - - - Perception: Conscious experience of pain
        
        Modulation: Activation of descending pathways that exert inhibitory/faciliatory effects on the transmission of pain