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what is the most common reason why patients seek health care?
nearly what percentage of Americans annually have ACUTE pain?
~ 15% to 20% of nearly 270 million Americans
managing pain is whose responsibility ?
it's a nursing responsibility
what is subjective pain?
it is whatever the person is experiencing the pain SAYS it is
what is the objective definition of pain?
unpleasant sensory and emotional experience associated with actual or potential tissue damage
pain experience depends on both ____ and ____
both sensory and perception
etiologies [causes] of pain?
- - inflammation
- - infection
- - ischemia
- - stretching of tissue
- - chemicals
- - burns
- - usually, damage
what are Nociceptors?
nociceptors are pain receptors that are free sensory nerve ending present in most tissues
to sense and transmit pain signals
- pain receptors activated in response to actual or impending tissue injury, including
- - somatic pain
- - visceral pain
somatic pain can be located where
skin and muscles etc.
visceral pain can be located where
abdomen [guts] area, organs
nociceptors can be stimulated by what three means?
- - thermal means
- - chemical means
- - physical means
what are the 4 major neural mechanisms
- - transduction
- - transmission
- - perception
- - modulation
transduction occurs at what level?
occurs at the level of peripheral nerves, where nociceptors are located
what does transduction represent?
the conversion of the pain stimuli into a neural action potential
give an example of transduction
tissue injury leads to relsease of inflammatory mediators (bradykinin, serotonin, histamine, substance P) which sensitize the afferent fibers to send a signal to the dorsal horn of the spinal cord
what is [pain] transmission?
neural action potential must be transmitted to and through the CNS for pain to be preceived
[pain] transmission ends up where in the body?
ends up in the dorsal horn in the spinal cord
describe a [pain] transmission scenario
release of neurotransmitters (substance P[increases pain], serotonin [modify the response], prostaglandins [modify the response]) which may activate nearby cells which can facilitate or inhibit transmission of pain
name the types of nerve fibers that transmit somatosensory information
is a nerve fiber that conveys sharp, well-localized pain and has a very rapid conduction rate [meylinted] [fast pain ]
- one of the older nerve fibers the convey a dull, aching, burning pain and has the slowest rate of conduction [unmyelinated][slow-wave pain][can't tell exact spot of pain]
- - found in belly area
- - in the brain, nociceptive input in perceived as pain
- - perception is modified in the brain, related to previous experience, other information, etc.
what is [pain] modulation
- process of inhibiting or chaning/increasing pain inpulses
- - neurons that originate in the brain stem descend to the odrsal horn and change the neuro transmission
- - release substances such as serotonin and endorphins [morphine like substance] which inhibit transmission of pain
explain the gate control theory
- you have pain coming from a certain location and you touch the touch receptors
- in that area the to different transmissions [the pain transmission and the
- touch transmission] are going through the same pathway to the brain. The touch
- transmission is slowing or reducing the pain transmission to the brain
2 physiological reactions to pain
- - sympathetic stimulation [fight/flight]
- - parasympathetic [rest/digest]
sympathetic physiological reaction to pain are
- - increase in respiratory rate
- - increase in heart rate
- - peripheral vasoconstriction [person looks pale]
- - increase in blood glucose
- - diaphoresis
- - increased muscle tension
parasympathetic physiological reaction to pain are
- - pallor [peripheral vasoconstiction]
- - muscle tension
- - nausea and vomiting
- - weakness
- - rapid irregular breathing
which physiological reaction to pain do we tend to see first? sym or parasym?
name the types of pain
- - cutaneous
- - deep somatic
what is cutaneous pain
on the outside of the body, localized, protect the body from outside foreign substances
what is deep somatic pain?
deep within the muscle etc.
what is the most common pain produces by disease
which type of pain has the tendency to refer to other locations
what are the pain classifications
what is acute pain?
- - lasting less than 6 months
- - associated with anxiety, and reflex musculoskeletal spasms [associated with situation requiring immediate response]
what is chronic pain?
- - lasting 6 months or longer
- - associated with loss of appetite, sleep disturbances, and depression [associated with more generalized symptoms. not sleeping well, being depressed, not eating well, etc.]
what is neuropathic pain
abnormal processing of sensory input by the peripheral or central nervous system
centrally generated neuropathic pain can cause what to occur?
can cause "phantom pain" to occur
peripherally generated neuropathic pain can cause what?
- - painful polyneuropathis [diabetic neuropathy]
- - painful mononeuropathies [nerve entrapment]
what is neuralgia
- damage to a specific nerve
neuralgia can cause what to occur?
- - trigeminal-facial tics with stabbing paroxsmal attacks of pain
- - pstherpetic: injury to the peripheral nerves and altered CNS processing [herpes zoster]