Final Prep - Chronic Pain Mgmt Flashcards


Chronic Pain

pain lasting >12wks beyond usual recovery period for injury
or illness lasts for months or years d/t chronic
condition can interfere w/ sleep & disrupt daily
life difficult to define onset


Acute Pain

pain associated w/ injury or pathology comes on
quickly, but generally lasts short time, usually <3mo & dec.
over time inc. HR, RR, BP


Pain Effects

hopelessness & depression sleep problems
difficulty performing daily activities, like walking or going to
work


Nociceptive Pain

produced by irritation of nerve endings can be sharp,
dull, or aching, & mild or severe Sx can include: heat,
redness, & swelling at pain site & Hx of injury or known
inflammation


Nociceptive
Pain - Somatic

from the joints, muscles, bones, chest wall, other soft
tissues, well localized common etiologies: fibromyalgia,
arthritis, trauma, bone metastases
Sx: focal, ache/throb/sharp, maybe
edema/swelling/redness, tender, worse w/ movement & better at
rest


Nociceptive
Pain - Visceral

comes from internal organs or blood vessels common
etiologies: chronic pancreatitis, abdominal cancers, IBS,
endometriosis, cystitis
Sx: colicky, vague, constant or cramp, aching,
poorly localized, referred, can be constant w/ liver, spleen, &
pancreas


Neuropathic
Chronic Pain

produced by damage or dysfunction of nervous system
result of disease, trauma, or injury dull, throbbing,
aching, or intense, sharp, & constant common
etiologies: diabetic neuropathy, spinal stenosis or sciatica,
phantom limb pain, drug induced pain


Chronic Pain
Assessment Parameters L - T

general Hx & physical is crucial L - locationof
pain M - manner of expressing pain, meds - what worked well
& what didn't, musculoskeletal system N - number of
pain, neurological system O - origin of pain, own attitude
toward it & Tx P - provoking or precipitating factors,
psychosocial assessment, patterns of coping & resources
Q - quality R - radiation S - severity /
suffering T - timing


Chronic Pain Factors

socioeconomic culture gender
spiritual suffering / meaning of pain psychological
factors - anxiety & depression


Common
Barriers to Good Assessment

biological - comorbidities, mult. allergies, conflicting
therapies behavioral - low motivation, poor adherence,
chemical dependency, poor communication social - language
barrier, cultural, health systems obstacles, lack of social support,
regulatory fears, financial HCP/system - inexperience,
disease focus rather than pt focus, time constraints
insurance - formulatory & coverage restrictions, HCP
reimbursement knowledge deficit - lack of Dx, misinformation
for non-medical sources


Tx Steps to Consider

ID best methods of Tx focus on early Tx
define distinct goals for pt: pain reduction, improve fx,
improve quality of life S.M.A.R.T for goal setting


Chronic Pain NDx

pain, chronic activity intolerance risk for
ineffective coping risk for powerlessness risk for
anxiety risk for disturbed sleep pattern deficient
knowledge risk for fear


Tx Planning

determined by team including pt teamwork &
empathetic listening in developing Tx plan give individual
copy of plan to pt & family (w/ pt consent) 5 major
elements: set personal goals, improve sleep, increase physical
activity, manage stress, decrease pain


Nursing
Interventions Classifications

pain mgmt mood mgmt pt contracting
med mgmt behavior mod coping enhancement


Tx Considerations

1st Tier Pain Therapies: behavior mod, NSAIDS, TENS, OTC pain
meds, rehab therapy, non-opioids 2nd Tier Pain Therapies:
systemic opioids for mild to mod pain, 1st tier therapy &
adjuvant 3rd Tier Pain Therapies: systemic opioids for mod to
severe pain, 1st tier pain therapy & adjuvant advocate
for simplest, least invasive option, IM not recommended


Pain Mgmt - Routes

oral - preferred unless dysphagia rectal
sublingual transdermal SQ IM - not
recommended IV


Non-opiod Meds

for mild to moderate pain:
NSAIDS acetaminophen salicylates (ASA)


Adjuvant Med

analgesics generally used for other medical problems, such as
depression & seizures
anticonvulsants - for brief, sharp pains caused by
peripheral nerve syndromes, relief may not be immediate, Ex:
Neurontin, lyrica, tegretol, klonopin, Dilantin, Depakote, Topamax,
& lamictal
steroid - may be used for bone metastases or
neuropathic pain assoc. w/ tumor compression, or if
inflammation


Opioids

2nd - 3rd tier: morphine sulfate, fentanyl, hydrocodone, &
oxycodone have no ceiling effect, are effective SE:
sedation, constipation, N/V, itching, rash, resp depression
antidote: Narcan


ATC Dosing Schedule

helps prevent the recurrence of pain reduces anxiety
of anticipating pain reduces total dosage required to
manage pain


Breakthrough Pain:

moderate to severe flare-up, occurs even when taking ATC med
incident pain - caused by activity or movement
spontaneous or idiopathic pain - just happens
tolerance


Chronic Pain
Mgmt - NOT Recommended

meperidine nalbuphine butorphanol
pentazocine


Addiction

compulsive, uncontrollable dependence on a substance, habit, or
practice to such a degree that cessation causes severe emotional,
mental, or physiologic reactions


Tolerance

med dose needs to be increased as pt adjusts to effects of med,
requires increase to get same pain relief


Dependence


physical dependence:
a physiological state in which abrupt withdrawal or reduction
of drug causes withdrawal Sx withdrawing leads to
adrenaline response, avoid by decreasing drug 25% a day

psychological dependence:
condition characterized by compulsive craving for excessive
doses of a drug

Physical Dependence Sx

sweating tachycardia tachypnea
cramps diarrhea hypertension


Pseudo-Addiction

physical dependence confused with psychological dependence,
often a result of uncontrolled pain due to inadequate Tx
pain relief seeking, not drug-seeking when right dose
used, pt functions better in life, where opposite is true with a
drug addict agreements b/t pt & physician are often
used


PCA - Pt
Controlled Analgesia

programmable pump, infusion delivery device educate pt
& family about pump effective monitoring &
documentation


Advanced Tx

nerve block - an injection of local anesthetic applied directly
to the nerve in area of pain implantable drug pump - device
that delivers med directly to CSF neurostimulator -
implantable device in the epidural space that uses low level
electrical impulses that interfere with transmission of pain signals
to the brain epidural steroid injection - into the epidural
space to alleviate chronic pain to low back or leg


Evaluation
After Intervention

IM drug therapy - 20-45min after admin IV drug therapy
- 5-20min after admin imm. release analgesic - 45-60min
after admin sustained release or transdermal patch - every
shift unless otherwise stated by manufacturer non-pharm
interventions - 15-20 after intervention initial or change
in PCA dose - 20-30min after change or upon initial start
change in IV drip unexpected change in pt status