Three types of pain scales

Three types of pain scales

1. simple descriptive

2. numeric intensity (1-10)

3. Wong-Baker faces (good for children)

I. Pain perception - 5^th vital sign interpretation of pain

1. threshold the least amount of stimuli that is needed for a person to identify it as pain

2. tolerance the maximum amount of painful stimuli a person is willing to withstand

without seeking avoidance of the pain (can change with circumstances)

J. Physiology of pain

1. transduction

2. transmission

3. modulation

4. perception

K. Transduction activation of pain receptors

Pain receptors, known as nociceptors, are sensory neurons on skin that travel via peripheral nervous system. These are excited by mechanical, thermal, or chemical stimuli.

*During transduction, stimuli trigger the release of biochemical mediators related to pain that sensitize these receptors.

*Some pain medications are effective during transduction in blocking portions of this process.

L. Transmission from site of injury to brain (afferent impulses)

1. pain impulse travels form the peripheral nerve fibers to the spinal cord

2. then from the spinal cord to the brain,pain control can take place at this step. ie. Opioids

block the release of neurotransmitters and stops the pain at the spinal level

3. A delta fibers are large nerve fibers that conduct organ pain that can be described as

aching or burning. (visceral pain)

4. reflex arc protective reflex response to protect the body from danger, such as touching a

hot iron. *substance "P" - neurotransmitter that enhances transmission in reflex pathway




M. Modulation pg 1374 (41-13)

1. The process where the pain sensation is inhibited or modified

2. regulation probably due to neuromodulators. these are endogenous opioids, morphine-like

substances that bind to opioid receptor sites in the brain. These are endorphins &

enkephalins

3. other neurotransmitters that have a "blocking" effect are" serotonin & norepinephrine




N. Gate Control Theory of Pain

1. describes the transmission of pain and describes a relationship between pain & emotions

2. smaller peripheral nerve fibers conduct pain stimuli to the brain, and large diameter

nerve fibers inhibit the transmission of pain from the spinal cord to the brain.

3. a gating mechanism located in the spinal cord exhibit exciting & inhibiting signals that

affect the impulses are attempting to reach the brain at the same time.

4. past experiences and learned behavior can alter the gating mechanism, thus altering the

responses to pain.

5. attempts to explain why pain is interpreted differently by different people

6. also explains why heat,cold, and pressure are effective for some pain relief

TENS unit gate control theory

O. Responses to pain

1. physiologic involuntary

2. behavioral

3. affective




P. Physiologic responses: pg 1372 box 41-1

1. increase in blood pressure and heart rate as part of the fight or flight response. These

values return to normal after a number of minutes or hours, in spite of the continuation of

the pain

2. reflexive withdrawal away from pain

3. the person may hold their breath or the respirations may become short & shallow or

rapid

4. pallor

5.increase in glucose output and adrenalin also due to the fight or flight response

6. nausea & vomiting

7. fainting

8. alters immune system if last long enough, can increase the risk of infection & disease

9. the pain threshold is lowered if the pain is persistent

10. increases cardiac workload




Q. Behavioral responses

1. crying

2. moaning

3. grimacing

4. restlessness

5. decrease in movement can lead to other complications




R. Affective responses

1. depression

2. anxiety

3. fatigue

4. hopelessness

5. restlessness

6. sleeplessness

7. ↓appetite

8. decreased quality of life




S. Psychogenic Pain

1. a physical reason for pain cannot be identified

2. all other diagnoses should be thoroughly reviewed &n exhausted

3. documentation is the same as physical pain (many times pt has seen multiple Drs.)




T. Cultural considerations

1. influence reaction to & expression of pain

2. there is little variation in pain threshold, but culture influences the amount of pain one

tolerates

3. in some cultures, tolerance of pain signifies strength & endurance

4. family, gender, age, anxiety, past experiences, & religion also affect pain expression

Oriental not display/verbalize pain encourage to take pain meds