PMC NOTES

• Pain


  Unpleasant sensations due to the activation of the nervous system
• Pain is NOT NORMAL with aging. People seek medical care because of this.
• Pain


  • Subjective
  • 6th Vital sign
  • Defense (Purpose)
• Pain in older people

  • They experience this due to changes with age
  • Atypical presentation
  • Pain or pain treatments may have increased negative effects
  • May have painful misconceptions
• 37% at home and 41% in institutions live with chronic pain
• Path of Pain - "Nociception"

  1. Detection of pain stimuli

  2. It can help us find interventions or identify differences between individuals

  
• Transduction - [FIRST PHASE]

  1. Injury and response initiation

  2. Pain nerve fiber recognizes the signal of tissue or cell damage

  3. Nociceptors react to noxious stimuli
• Transmission - [SECOND PHASE]

  1. Pain moves from PNS to CNS

  2. Via nerve fibers > dorsal horn > spinothalamic tract
• PNS: Types of Fibers

  • A-delta fibers - myelinated, sharp, well localized, and short in duration
  • C fibers - unmyelinated, dull, slow, and long duration
• Perception - [THIRD PHASE]

  Conscious awareness of pain and interpretation
• Modulation - [FOURTH PHASE]

  1. Altered signals and response

  2. Pain increases or pain decreases
• Mobility


  • ROM (Range of Motion)
  • Passive: does not have physical health and ability. Assisting the clients.
  • Active: independent
  • Proprioception - awareness of body position and parts. The ability to walk without watching our feet.
  • Balance - Controlled in cerebellum and inner ear
• Skeletal System (206 bones)


  • Supports the body (feet bones)
  • Facilitates movement (arms and legs)
  • Protection of internal organs (ribs and sternum)
  • Storage of minerals and fat (femur)
  • Hematopoiesis (in red marrow) (hip bones)
• Characterization with shape


  • Long (femur)
  • Short (carpals)
  • Flat (sternum)
  • Irregular (vertebrae)
• Support: Joints


  • Fibrous joint - connected by fibrous connective tissue
  • Cartilaginous joint - connected by hyaline cartilage or fibrocartilage
  • Synovial joint - not directly connected. Comes into contact within a joint cavity filled with lubricating fluid.
  • Synarthrotic: bone to bone
• Support: Ligaments, Tendons and Cartilage


  • Ligament: flexible bands of fibrous tissue. They connect bones and cartilage; or bone to bone
  • Tendons: fibrous bands of tissue that connect bone to muscle
  • Cartilage: supporting connective tissue, used for shock absorption
• Muscles


  • Made from fibers that contract when stimulated by impulses that travel from one nerve to the muscle across the neuromuscular junction.
  • FUNCTION: moving, stabilizing, posture, heat, circulation, organ protection
• 2 types of contractions

  • Isotonic- muscles contraction and change in length example- weight lifting
  • Isometric- muscles being tightened/ tense without moving body parts example- yoga
• Alignment, Postures and Balance

  • Together these reduce risk of injury and facilitate proper function of other organs.
  • Body alignment is the relationship from one body part to another e.g. distal, mid, proximal.
  • Body balance (equilibrium) happens when your center of gravity is balanced over a stable base.
• Acute Pain


  • Sudden and typically resolves
  • Less than 3 months
• Chronic Pain


  • Lasts over 3 months and often not resolved.
  • From cancer treatment, RA, PA, fibromyalgia
• Types of Pain


  • Nociceptive: normal processing of stimuli; usually responsive to nonopioids, opioids or both
  • Neuropathic: abnormal processing of sensory input by the PNS or CNS. Treatment usually includes adjuvant analgesics and is not responsible for opioids. May be described as burning, shooting, electrical, or prickling
• Nociceptive Pain


  • Somatic: bones, joints, muscles, skin. Usually throbbing, and is well localized.
  • Visceral: organs - heart, liver, gut. Tracts. Not localized. More vague
• Neuropathic Pain


  • Centrally generated pain:
  • Deafferentation pain - loss of sensory input into CNS or other types of lesions of peripheral nerves or due to pathology of the central nervous system
  • Sympathetically maintained pain - associated with dysregulation of ANS.
  • Peripherally generated pain: peripheral nerves are damages
• Types of Pain


  • Somatic: Superficial burn, Tibia Fracture, Arthritis
  • Visceral: Menstrual Cramps, Myocardial Infarction (MI), Appendicitis
  • Deafferentation: Spinal Cord Injury, Shingles, Phantom Limb Pain
  • Sympathetic: Complex Neuropathic Pain, CRPS, Trigeminal Neuralgia
  • Peripheral: Diabetic Neuropathy
• Spinal tumor - both nociceptive and neuropathic (?)

  Raynaud's Disease - idk :(
• Pharmacological Pain-Relief Interventions


  • Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) - work by inhibiting enzymes (COX). Used for mild to moderate pain, which relieves pain and inflammation in arthritis, musculoskeletal injuries, and mild to moderate pain.
  • Opioids - bind with opiate receptors (du, delta and kappa) to modify perception of pain. Used for moderate to severe pain, such as post-surgical pain, cancer-related pain, and several pains.
  • Co-analgesics - not originally intended for pain. May be used with other pain medication to enhance pain relief or manage a special type of pain. May include antidepressants, anticonvulsants, muscle relaxants, and local anesthetics.
• Aspirin should be avoided in all children less than 18 years of age due to its association with Reye's syndrome.
• Topical analgesics may benefit older adults, especially with slowed/decreased GI function
• Effects of Pain and Pain Management

  • Physiological- nausea, fatigue
  • Psychological- depression, ineffective coping, anxiety, disturbed sleep, guilt, spiritual distress
  • Psychosocial- impaired social interactions, sexual dysfunction
  • Fear- addiction, impact of pain
• Increase hospital stay and delay healing lead to chronic pain
• Addiction


  Disease with genetic, psychological, and environmental factors. complex, chronic, and relapsing condition characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain
• Tolerance


  • Exposure decreases the effect of pain medication.
  • Opioid use > Stimulation of opioid stimulation > Upregulation of opioid receptors > Receptors demand more opioids.
• Dependance


  Class-specific drug withdrawal syndrome.
• Osteoporosis


  • A chronic disease that is primarily age associated and can be exacerbated by gender (female), other health conditions and medications. Can have a major impact on mobility and safety and increases risks of fracture
• Risk Factors for Osteoporosis

  • Gender
  • Heavy caffeine use (Ca++)
  • Ca &/or Vit D deficiency
  • Low BMI
  • Certain medications/diseases
  • Too much/little exercise
  • Smoking, age, etoh
• Diagnosis of Osteoporosis


  • Assessment. Look for: Shortened height, decreased weight, fractures
  • Dual-energy x-ray (bone density)
  • Lab tests (Ca, CBC, Cr. Etc.)
• Treatment of Osteoporosis


  • Exercise/falls prevention
  • Physiotherapy
  • Dietician
  • Vitamins & minerals
  • Medications
• Osteoarthritis


  • A chronic disease that commonly affects the knees and hips requiring surgery. Causes a lot of pain and affects mobility. Often referred to as "wear and tear" of the joint
• Risk Factors for Osteoarthritis


  • Obesity (increased BMI)
  • Trauma
  • Genetics
  • Overuse
  • Gender (F>M)
  • Smoking, age, etoh