acute pain
short term, self limiting, often predictable trajectory; stops after injury heals
breakthrough pain
pain restarts or escalates b4 next scheduled analgesic dose
chronic (persistent) pain
pain continues for 6 months or longer after initial injury
cutaneous pain
pain originating from skin surface or subcutaneous structures
incident pain
occurs predictably after specific movements
modulation
pain message is inhibited during this last phase of nociception
neuropathic pain
abnormal processing of pain message; burning, shooting in nature
nociception
process whereby noxious stimuli are perceived as pain; central and peripheral nervous systems are intact
nociceptors
specialized nerve endings that detect painful sensations
pain
unpleasant sensory and emotional experience associated w/ actual or potential tissue damage, or described in terms of such damage. Pain is always subjective
perception
conscious awareness of painful sensation
referred pain
pain felt at a particular site but originates from another location
somatic pain
originating from muscle, bone, joints, tendons, or blood vessels
transduction
first phase of nociception whereby the painful stimulus is changed into an action potential
transmission
second phase of nociception whereby the pain impulse moves from the spinal cord to brain
visceral pain
originating from interior organs such as the gallbladder or stomach
Nociceptive pain develops when
nerve fibers in the peripheral and central nervous systems are functioning and intact. It starts outside the nervous system and results from actual or potential tissue damage. Nociception occurs in four phases: transduction, transmission, perception, and
Neuropathic pain does not adhere to typical and predictable phases.
It implies an abnormal processing of the pain message due to an injury of the nerve fibers. It is sustained on a neurochemical level that can only be identified by electromyography and nerve-conduction studies.
pain can be classified by its source
visceral pain, deep somatic pain, cutaneous pain, referred pain
pain can also be classified by its duration
acute pain and persistent (or chronic pain)
neuropathic pain
burning, shooting, and tingling
nociceptive pain is described as
aching if localized and cramping if poorly localized; from somatic sites it is described as throbbing/aching
identify the most reliable indicator of a persons pain
subjective report
recall questions for an initial pain assessment
o Do you have pain, discomfort, or soreness?
o Where is your pain?
o When did it start?
o What does your pain feel like?
o How much pain do you have right now?
o What makes you pain better or worse?
o How does pain limit your function or activities?
o How
Use an overall pain assessment tool, such as the Initial Pain Assessment or the Brief Pain Inventory, to
assess chronic pain or problematic acute pain.
use a pain rating scale to
evaluate pain severity
numeric scale is used for
adults and older children.
Pediatric scales, such as the Oucher Scale and the Faces Pain Rating Scale
are used for young children
Older adults may respond best to
a Descriptor Scale.
initial pain assessment
-clinician ask patient to answer 8 questions concerning location, duration, quality, intensity, and aggravating/relieving factors
-further questions are asked about the manner of expressing pain and the effect of pain that impair ones quality of life
brief pain inventory
ask patients to rate the pain within the past 24 hours using 0-10 scale with respect to its impact on areas such as mood, walking, ability, and sleep
short form McGill pain questionnaire
ask patient to rank a list of descriptions in terms of their intensity and to give an overall intensity rating to their pain
numeric rating scales
ask patient to choose a # that rates level of pain for each painful site, w/ 0 being no pain and highest anchor 10 meaning worst pain ever experienced
descriptor scale
list words that describe different levels of pain intensity, such as no pain, mild pain, moderate pain, and severe pain
child re 2 yrs of age
can report pain and point to its location
rating scales can be introduced
4-5 yrs of age
faces pain scale revised
6 drawing of faces that show pain intensity, from no pain on left (score of 0) to very much pain on right (score of 10)
The physical examination can reveal objective data that support subjective data.
o Assess the patient's joints, muscles, skin, and abdomen to detect injuries or other signs of painful disorders.
o When a person cannot verbally communicate the pain, look for nonverbal behaviors of pain, such as guarding, grimacing, moaning, agitation,