N2 notes for Pain Lec

SLIDE 28
Neurotransmitters inhibit or modulate transmission of pain along the descending pathways. These are produced in the neural synapses, which are located in the brain and along descending pathways.The neurotransmitters we are talking about are endogenous opiods.Endogenous opioids are the body’s own morphine. They increase when you have feeling of well-being, like when you are in love, receiving a massage, feeling no need to worry. Eating fruits and vegetables and exercising causes endorphin production and release by the intestines. Beta endorphin is the most morphine like substance, which is stored in the hypothalamus and the midbrain, and is released during acupressure and massage, and in stress states such as stress, fear, restraint, hypertension, or hypoglycemia. It is also well documented to be released during labor and delivery. It also accounts for person’s performing superhuman feats, such as the mom who lifts the car off her child. It is also referred to as STRESS ANALGESIA.The enkephalains are located primarily in the limbic system and hypothalamus. Many nerve endings secrete enkephalins, which block transmission via the A and C fibers through the presence of Serotonin, the most prominent enkephalin. Serotonin also inhibits norepinephrine, sympathetic repsonses, and inhibits nociception.The final substance is the dynorphins, found in minute quantities throughout the nervous system, but especially in grey matter and the spinal cord itself. They are 200 times as potent as Morphine sulfate.
SLIDE 29
Cutaneous considered superficial, begins with injury to skin, tissue trauma activates histamine, bradykinin, potassium, and hydrogen ion release from extracellular fluids.Cell wall injury causes the release of serotonin from platelets, prostaglandins, and substance P. This pain is often not discretely located—and leads to touch, pressure, and stretch of skin being interpreted as noxious stimuli.
SLIDE 30
Somatic pain originates in subcutaneous tissue, joints, tendons, muscles, and fascia. Associated with muscle ischemia and spasm. Bradykini and histamine release, and C fibers are responsible for transmission. May be difficult for patient to identify, and can be dull, aching, or diffuse. Deep somatic pain stimulates the autonomic nervous system and is associated with nausea, vomiting, and cold, clammy skin.
SLIDE 31
In general the viscera have only sensory receptors for pain. Localized stimulation of pain receptors in the viscera can cause minimal discomfort, but widespread stimulation can cause extreme pain. Visceral pain is the result of compression, distention, or stretching of the viscera in the thoracic or abdominal cavity. Myocardial ischemia or infarct pain is visceral. Visceral pain is generally described as pressure, deep, and squeezing, and may be referred pain. Visceral pain fibers travel to the spianl cord with the fibers of the sympathetic nervous system, which accounts for the association of sympathetic nervous system responses and cardiac problems.
SLIDE 32
Deafferentation pain is considered neuropathic pain rather than nociceptive pain. This is the severe pain associated with cancer.Pain is initiated when damage to the central or peripheral nervous system occurs from the progression of tissue damage associated with the invasion of tumors, thermal damage, or chemical injuries from radiation.Neuralgias and phantom pains are other types of deafferentation pains, as well as lesions from Cerebral spinal accidents.
SLIDE 33
0 is pain free, 10 is the worst you have ever experienced. This is generally effective for adult persons, regardless of language spoken.
SLIDE 35
Remember that lack of physiologic assessment of a response to pain does not mean the pain does not exist. Document exactly what the patient says.Types commonly include stabbing, burning, tingling, numbness, dull, constant vs. only when I laugh. Anything that increases or decreases the sensation.
SLIDE 43
Verbal abilities include the ability to speak the same language, and the inability to speak at all related to dysphasia or intubation.Persons experiencing delirium, dementia, or altered mentation related to psychoactive drugs present a barrier to pain assessment. Coma patients cause us to rely on physical symptomsPublic understanding of pain control interferes. Just say no to drugs, fear of addiction cause patients to attempt to tough it out, and families to argue about too much pain medication.Cultural values and beliefs influence response to pain, but each person is an individual and will respond to pain in their own way.Some cultures see pain as being associated with an imbalance of life, and they wish to manipulate the environment to alleviate the pain.Medical personel may believe an addicted person is just seeking medication. They may believe the person deserves to feel the pain.Health care personnel are concerned about respiratory depression, but this rarely occurs if the patient is complaining of pain. It is unrealistic to tell a person that they cannot have pain relief because of time frame, respiratory rates, and the like. Remember the BRN charge to alleviate pain before it becomes severe. It is your job to discuss pain relief with the physician when the client consistently requests medication before it is due.
SLIDE 47
Morphine provides analgesia, antianxiety, and opioid agonistHydropmorphone—opioid agonists. Shorter duration than morphineFentanyl—IV moderate dose analgesia, epidural provides anesthesia It is 80 times as effective as morphineMeperidine, opioid agonist. One seventh as strong as morphine, it was created to help avoid respiratory depression.
SLIDE 48
Talwin, mixed agonist-antagonist, blocks some and activates other receptorsStadol has agonist-antagonist responses
SLIDE 49
Reduce pain at the site by decreasing inflammation, the causes of pain. Toradol is an injectable NSAID. These work by preventing prostaglandin formation, thus preventing inflammation
SLIDE 50
Antidepressants block the reuptake of serotonin which reduces pain transmission.Anticonvulsants slow transmission of all responses throughout the nervous systemSedative Hypnotics potentiate the action of narcotics
SLIDE 51
Blocks both peripheral and central pathways. Currently, this is the most popular, most abused narcotic pain medication in the world. PO med, relatively inexpensive.
SLIDE 52
Oral—medication must resist stomach acids and be absorbed through the GI tract. Minimal time elapse is 20 minutesTopicals, such as capsaicin, prevent release and depletion of substance PIntramuscular are dependent on absorbtion, so the patient needs to be off the injection site.