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SCR 110 Pain Lecture Notes
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Lecture and study guide notes for PAIN from Davis Advantage Basic Nursing 3rd Edition.
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- more localized and can be described as achy orPAIN tender.
- fracture, sprain, arthri/s, and bone cancer
• One of the most devasta/ng condi/ons and 3. Visceral - caused by the s/mula/on of deep internal
afflic/ons pain receptors; not well localized and can be described
• Unpleasant sensory/emo/onal experience as *ght, pressure, or crampy pain
• A subjec/ve experience-mul/dimensional - The descrip/on of the quality and extent of the pain
experience
oVen serves as a strong clue to the cause
• pa/ents’ pain will be influenced by your (nurse’s) - Most oVen in abdominal cavity, cranium, or thorax
own values, ideals, personal beliefs about pain, and (e.g. Menstrual cramps, labor pain, gastrointes/nal
life experiences
infec/ons, bowel disorders, and organ cancers all
• The pain experience can significantly interfere with a
produce visceral pain)
person’s quality of life, affec/ng nearly every aspect 4. Radia*ng - starts at the origin but extends to other
of life. loca*ons (the pain of gastroesophageal reflux
• Severe back pain can affect a pa/ent’s ability to (“heartburn”) may radiate outward from the sternum
perform ac4vi4es of daily living, sleep and rest,
to involve the en/re upper thorax; pain of a severe
ability to exercise, sexual in4macy, job
sore throat may extend to the ears and head
performance, engagement in social ac4vi4es. 5. Referred - occurs in an area that is distant from the
• Can have destruc/ve effects (nega*ve)
original site. E.g, the pain from a heart a]ack may be
- Pain can cause sleep loss, irritability, cogni/ve
experienced down the leV arm, through the back, or
impairment, func/onal impairment, and immobility,
into the jaw
and thus it can be destruc/ve to the pa/ent and
5. Phantom - Pa/ents with amputated limbs may s/ll
family.
perceive that the limb exists and experience burning,
• Can warn of poten/al injury (posi*ve)
- Posi/ve aspect-> pain can be protec/ve, warning us itching, and deep pain in that area
6. Psychogenic pain refers to pain that is believed to
of poten/al injury to the body. Pain can also prompt
arise from the mind-> Pt perceives the pain despite
us to change our ac/ons
the fact that no physical cause can be iden/fied.
Classifica*on of Pain
Cause of Pain
ORIGIN CAUSE DURATION DESCRIPTION • Nocicep*ve (pain receptors respond to s*muli ->
most common type of pain)
Cutaneous/
Nocicep/ve Acute Quality - Occurs when pain receptors, which are called
Superficial
nociceptors, respond to s/muli that are poten/ally
Deep damaging; for example, as a result of noxious
Neuropathic Chronic Periodicity
soma/c
thermal, chemical, or mechanical s/muli.
Radia/ng/
Intractable Intensity
- may occur as a result of trauma, surgery, or
referred inflamma*on
Psychogenic - Visceral pain (i.e., pain origina/ng from internal
organs)
- Soma*c pain (i.e., pain origina/ng from the skin,
Origin of Pain muscles, bones, or connec/ve /ssue)
1. Cutaneous/Superficial - Arises in the skin or the • Neuropathic (injury to nerves results in repeated
subcutaneous /ssue (burn or abrasion) transmission of pain signals-> burning, numbness,
- If you have ever touched a hot object or received a itching, “pins and needles” prickling pain
paper cut, you have experienced superficial pain. - Is a complex and oKen chronic pain that arises
- Although the injury is superficial, it may cause when injury to one or more nerves results in
significant short-term pain. repeated transmission of pain signals even in the
2. Deep Soma*c Pain - Originates in the ligaments, absence of painful s/muli.
tendons, nerves, blood vessels, and bones.
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, - may originate from any of a variety of condi/ons, • This type of pain is especially frustra/ng for the
such as poorly controlled diabetes, a stroke, a pa/ent and care providers.
tumor, alcoholism, amputa*on, or a viral infec*on • It should be approached with mul/ple methods of
(e.g., shingles or HIV/AIDS) and some medica*ons pain relief. –> pharmacological, non-
(chemotherapeu/c agents). pharmacololgical, chemical pain relief,
radiofrequency and surgery.
By dura*on
1. Acute - a short dura/on with rapid onset (< 6 Quality of Pain
month) 1. Pain quality - sharp or dull, aching, throbbing,
2. Chronic - > 6 months or longer stabbing, burning, ripping, searing, or /ngling.
3. Intractable -both chronic and highly resistant to 2. Pain periodicity - episodic, intermi]ent, or
relief -> It should be treated with mul/ple constant.
methods of pain relief. 3. Pain intensity - mild, distrac/ng, moderate,
severe, or intolerable
Acute Pain
• Has a short dura/on and is generally rapid in onset. Physiology of Pain
• It varies in intensity and may last up to 6 months • Transduc*on: Ac*va*on of nociceptors by s/muli;
• Most frequently associated with injury or surgery sensory nerve cells; release of inflammatory
• It is protec/ve in that it indicates poten*al or actual chemicals; injured area to become red, swollen, and
*ssue damage. hot. Inflamma/on is the most frequent cause of pain
• Although acute pain may absorb a pa/ent’s physical - Mechanical: external forces that result in pressure
and emo/onal energy for a short /me, it is helpful for or fric/on against the body; stretching of /ssue in
the pa/ent to know that it will generally disappear as joints and body cavi/es related to bleeding and
the /ssues heal. swelling and compression of body /ssues caused by
the force of the accident; surgical incisions, fric/on,
Chronic Pain or skin shearing (e.g., sliding down in bed, pressure
• Has lasted 3-6 months or longer and oKen from a mechanical device, such as a cast or brace)
interferes with daily ac*vi*es. - Thermal: exposure to heat or cold. If you have ever
• May experience periods of remission and touched a hot object and rapidly pulled away or
exacerba*on. suffered an earache when outdoors on a cold day
• Persistent pain is oVen related to a chronic illness - Chemical: internal or external. Sharp, sudden pain
(e.g., neuralgia related to diabetes), cancer, or caused when lemon juice or any acidic substance
musculoskeletal issues (e.g., osteoarthri/s, comes in contact with an open area in the skin is an
trauma/c injury, torn car/lage) fall more oVen, have example of external chemical s/muli. In contrast,
sleep disturbances and poor appe/te, and have the chest pain experienced during a myocardial
other impairments in ac/vi/es of daily living (ADLs). infarc/on (heart a]ack) is caused by internal
It may lead to emo/onal distress, withdrawal, chemical s/muli, specifically the chemical changes
depression, anger, frustra/on, dependence, fa/gue, that result from /ssue ischemia
and catastrophizing
• fall more oVen, have sleep disturbances and poor • Transmission: Conduc*on of pain message to spinal
appe/te, and have other impairments in ac/vi/es of cord along either of A-delta fibers (large-diameter
daily living (ADLs). myelinated fiber-transmit fast pain impulses) or C
• Unlike acute pain, chronic pain is oVen viewed as fibers (smaller unmyelinated fibers - slow pain
insignificant and may lead to withdrawal, impulses)
depression, anger, frustra*on, and dependence. • Percep*on: Recognizing and defining pain in the
frontal cortex.
Intractable Pain - Pain threshold - the point at which a person feels
• Both chronic and highly resistant to relief. pain
- Pain tolerance - dura/on or intensity of pain that a
person can endure
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