Comfort/Pain
Terms
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- Acupressure
- application of pressure or massage, or both, to usual acupuncture sites
- Acupuncture
- technique that used long thin needles to prick specific parts of the body to produce insensitivity to pain
- Acute Pain
- episode of pain that lasts for seconds to less than 6 months
- Afferent
- ingoing: traveling toward a center. sensory neurons which carry messages to the central nervous system (CNS), are afferent
- Analgesic Drug
- pharmaceutical agent used to relieve pain
- Axon
- A neuron's efferent segment; it conducts impulses away from the cell body
- Brief Pain
- pain that passes quickly; synonym for transient pain
- Cutaneous stimulation
- pain relief modalities that utilize stimulation of the skin by massage, application of heat and cold, vibration, and pressure
- Contra lateral stimulation
- stimulation to an area opposite the affected area
- Continuous Pain
- pain that does not stop
- Chronic Pain
- episodes of pain that last 6 months or longer, pain may be continuous or intermittent
- Diffuse Pain
- pain that covers a large area
- Dendrites
- A neuron's fine, free-branching afferent segments; they conduct impulses to the cell body
- Dermatome
- A skin area innervated by sensory neurons that share the same spinal nerve root; each dermatome corresponds to a specific spinal cord level
- Dorsal Horn
- The posterior portion of the spinal cord's gray matter, to which sensory nerve fibers are attached. Also called the posterior horn, the dorsal horn receives sensory impulses from the body and relays them towards the brain
- Dull Pain
- growing discomfort less intense and acute than sharp pain
- Efferent
- Outgoing: traveling away from the center. Motor neurons, which carry messages away from the CNS, are efferent. An axon, which carries impulses away from the cell body, is a neuron's efferent segment
- Nociceptors
- Pain receptors; free nerve endings sensitive to painful mechanical, thermal, electrical, or chemical stimuli
- Pain
- sensation of physical or mental suffering or hurt which usually causes distress or agony to the one experiencing it
- Pain Threshold
- amount of stimulation required before a person experiences the sensation of pain
- Pain Tolerance
- point beyond which a person is no longer willing to endure pain (i.e. pain of greater duration or intensity)
- Phantom Pain
- sensation of pain without demonstrable physiologic or pathologic substance; commonly observed after amputation of a limb
- Placebo
- Latin word meaning "I shall please"; an inactive substance that gives satisfaction to the person using it
- Psychological Pain
- pain for which no physical cause can be identified
- Referred Pain
- pain in an area removed from that in which stimulation has its origin
- Relax
- to become less rigid, to slacken effort and to decrease tension
- Severe Pain
- pain that could be described as being between 8-10 on a scale of 1-10; synonym for excruciating pain
- Sharp Pain
- quick, sticking and intense discomfort
- Shifting Pain
- discomfort that moves from one area to another
- Slight Pain
- pain that could be described as being between 1-3 on a scale of 1-10; synonym for mild pain
- Somatic Pain
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Deep Somatic: Pain resulting from injury to connective tissue, bones & muscles
-generally an aching & well localized pain
-may produce nausea
-frequently associated with diaphoresis & blood pressure changes - Spinothalamic tract
- An ascending spinal cord pathway leading to the reticular formation of the brain stem and frontal lobe. This tract is associated with transmission of dull, aching and burning pain sensations
- Substantia gelantinosa
- Small, densely packed cells within the dorsal horn involved in pain impulse modulation
- Synapse
- The space between neurons (or between a neuron and a muscle or organ) that a nerve impulse must cross for transmission to occur. It's also called the synaptic cleft
- Definition of Pain
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"Pain is an unpleasant sensory & emotional experience that is associated with or described in terms of either potential or actual tissue damage"
Pain is a complex phenomenon
-colored by culture and environment
-the meaning pain has to the client
Two major aspects:
-Pain & the associated suffering
Involvement of social issues
-pain of childbirth vs. appendicitis - The Decade of Pain Control & Research
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Mandated Pain be considered the 5th vital sign in January 2001
Compulsory for health care professionals practicing in an accredited facility to enquire about, measure, and treat pain as they would temperature, blood pressure, pulse and respiratory rate. - How do we define pain?
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-physiologically
-psychologically
-nursing definition - Physiological Definition of Pain
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Medical: Mountcastle defines pain as "that sensory experience evoked by stimuli that injure or threaten to destroy tissue"
The "Anatomy of Ouch". "Any sensation that is amplified to an uncomfortable level..." - Psychological Definition of Pain
- This definition focuses on pain as something that belongs to the client and often does have a protective component
- Nursing's Definition of Pain
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Marco McCaffrey defines pain as "whatever the experiencing person says it is and existing whenever the person says it does"
This definition makes the client the expert on his or her pain
It is subjective but the nurse is responsible for accurately assessing and appropriately responding to the client's pain - Types of Pain & Their Etiology
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1. Nociceptive Pain
-pain caused by damage to somatic or visceral tissue
2. Neuropathic Pain
-pain caused by nervous system damage
3. Psychogenic Pain (Idiopathic Pain)
-pain without organic pathology - Nociception
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Nociception is the activation of the primary afferent nerves with peripheral terminals (free nerve endings) that respond differently to noxious (tissue-damaging) stimuli
Nociceptors function primarily to sense and transmit pain signals
Nociception: may or may not be perceived as pain, depending on a complex interaction within the nociceptive pathways - Classifications of pain - Nociceptive Pain
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Response to tissue damage
1. Somatic:
-deep somatic
-superficial
2. Visceral - Organ
Usually responds well to opiods or nonopiods
Has protective function (to guard incisions - Examples of Deep Somatic Pain
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Ligaments, joints, fascia, tendons, & muscle all vary in the number of nerves serving the area
Muscular pain usually occurs in association with stretching , ischemia, or forceful contractile activity. Injury to muscle causes the release of lactic acid & other chemicals (neurotransmitters) that increase pain - Somatic Pain: Superficial
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Pain resulting from stimulation of the skin
Sharp stinging sensation - Nociceptive Pain - Visceral Pain
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Occurs in any of the large body organs occupying any body cavity
-cranial
-thoracic
-abdominal
-pelvic cavity
Diffuse, poorly localized, vague, dull
-ex: acute appendicitis
Exception: If the cause is a tumor within an organ - pain may be localized - Mechanics Involved in Transmission of Nociceptive Stimuli: Neurotransmitters
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Neurotransmitters
-Affect the speed of impulse
-Substance P (increases)
-Prostaglandin (increases)
-Seratonin (decreases) - Mechanics Involved in Transmission of Nociceptive Stimuli: Neuromodulators
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Neuromodulators
-Affect the intensity of the sensation
-Bradykinin (increases)
-Histamine (increases)
-Endorphins (decrease)
-Norepinephrine (decreases) - Neuropathic Pain
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Caused by nervous system damage
Lesions that cause neuropathic pain can occur at any location in the pain pathway
Damage to peripheral nerves (PNS) as well as lesions of the spinal cord (CNS)
No protective function
Pain disproportionate to degree of damage - Examples of Neuropathic Pain
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Diabetic Neuropathy
Postherpetic neuralgia (shingles): involves scarring & degenerative changes to the spinal cord, ganglia, nerve truncks and skin
Phantom pain: not completely undrstood - noted after amputation of a body part
-can be a sensation or severe pain (itching, tingling, pressure, pins & needles
This does not occur in client who maintain the feeling they can move the phantom limb voluntarily - Idiopathic Pain
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Pain without organic pathology
Clients experiencing psychogenic pain have real pain experience
Newly accepted diagnostic tool
-thermography which measures temperature of surfact tissue to reflect blood flow