Pain management

• Pain: External; May come on quickly and it's more difficult to ignore
• Ache: Internal; Persistent physical discomfort, typically dull
• Hurt: Accidentally cause pain or injury (can be emotional or physical)
• Pain is a unpleasant sensory and emotional experience associated with actual or potential tissue injury
• Primarily a protective mechanism (acute pain)
• Transduction is the cause of the pain and site of the pain
• Noxious (harmful) stimuli cause release of chemicals due to the tissue injury
• Amount of pain is related to the amount of tissue injury
• Transmission: Movement of pain impulses from the site of transduction to the brain
• A: Large, myelinated, fast rate conduction, produces fast pain, acute pain
• C: Unmyelinated, smallest diameter fiber, slowest rate of conduction, produces slow pain, chronic pain, slow in onset but and longer in duration
• Fast pain: Sharp, localized, large myelinated, cerebral cortex
• Slow pain: Dull, generalized, small unmyelinated, visceral pain
• Cutaneous: Sharp burning pain, origin in skin or subcutaneous tissue
• Deep: More diffuse and throbbing, origin in body structures
• Perception: Is recognized, defined, and responded to nociceptive input is seen as pain in the brain
• Smaller receptive field = Greater discriminative ability
• Large receptor field = Decreased discriminative ability
• Pain threshold: Lowest intensity at which a stimulus is perceived as pain
• Perceptual dominance: Intense pain at one location may increase the threshold in another location
• Modulation: How the body ability to respond and alter to the pain
• Referred pain: Site of pain is different from its point of origin but innervated by the same spinal segment
• Nonopioid analgesics: Isn't addictive (Acetaminophen, Nonselective NSAIDs, COX-2 selective NSAIDs
• Opioid analgesics: Can cause an addiction (Morphine, fentanyl, hydromorphone, and oxycodone)
• Adjuvant analgesics: More advance (Local anesthetics, anticonvulsants, antidepressants)
• Treatment: Targeting any of the three phases (Transmission, perception, modulating)
• Mild pain: 1-3 on a scale of 0-10
• Mild to moderate pain: 4-6 on a scale of 0-10
• Moderate to severe pain: 4-10 on a scale of 0-10