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Pathophysiology of Pain and Pain Assessment

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Psychological or 'Idiopathic' Pain 'We all have pain, yet not everyone suffers' The patient's psychological state contributes significantly to pain and ... – PowerPoint PPT presentation

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Title: Pathophysiology of Pain and Pain Assessment


1
Pathophysiology of Pain and Pain Assessment
2
Pain is.
  • Sensory
  • Emotional
  • Cognitive

3
. . . . 3 Hierarchical Levels
  • Sensory-discriminatory component (location,
    intensity, quality)
  • Motivational-affective component ( depression,
    anxiety)
  • Cognitive-evaluative component (thoughts of
    cause, significance of the pain)

4
Who Has Pain?
  • 90 of adults more than one day a month
  • 42 report pain everyday
  • 9 of adults suffer moderate -severe chronic
    non-cancer pain (75 million Americans)

5
Pathophysiology
  • Nociceptive Pain Mechanisms
  • Neuropathic Pain Mechanisms
  • Psychological or Idiopathic Pain Mechanisms

6
Nociceptive
  • Receptor stimulation (by process causing tissue
    injury)
  • Normal activation (of nociceptive system)
  • Afferents A-delta and C-fibers, to dorsal horn,
    ascending neural pathways, thalamic,other brain
    structures
  • Acute and/or chronic inflammation
  • Sensory/discriminatory, motivational/affective,
    cognitive/evaluative

7
Nociceptive Pain Modulation
  • Endorphinergic endogenous opioid compounds
    acting at mu, delta, kappa receptors
  • Opioid associated systems that regulate
    homeostasis, response to stress, and pain
  • Serotonin, norepinephrine and other
    neurotransmitters also involved

8
Types of Nociceptive Pain
  • Acute and Chronic
  • Somatic localized,described as aching,
    throbbing, stabbing (i.e. arthritis, bone mets)
  • Visceral generalized, described as cramping,
    gnawing, varying intensity, often referred ( I.e.
    bowel obstruction)

9
Neuropathic Pain Mechanisms
  • Pathophysiologic changes in the peripheral or
    central nervous system
  • Changes become independent of the initial injury
    or damage, and can sustain a chronic pain state
  • Often described as burning, lancinating,
    electrical

10
Neuropathic Pain Altered Pain Responses
  • Allodynia pain induced by light touch
  • Hyperalgesia increased response to noxious
    stimuli
  • Hyperpathia exaggerated responses to painful
    stimuli, with continued sensation of pain after
    the stimulation has ceased

11
Psychological or Idiopathic Pain
  • We all have pain, yet not everyone suffers
  • The patients psychological state contributes
    significantly to pain and suffering pain is
    objective and subjective
  • Affective and psychological disorders should be
    assessed and treated
  • psychogenic pain

12
Initial Pain Assessment
  • History and Physical Exam
  • Psychosocial Assessment
  • Diagnostic work-up, or review of previous
    diagnostic studies and consultations
  • Assessment should be ongoing, individualized, and
    documented
  • The patient self-report is the gold standard in
    assessment

13
Most Experts Believe
  • That repeated evaluation of the
  • same painful site in a patient with
  • long-standing chronic pain rarely
  • yields useful results and may divert
  • attention from symptom control and
  • functional restoration.

14
Assessing Pain Character and Intensity
  • Select a method, incorporate it
  • Unidimensional Pain Scales
  • Verbal Rating Scale (none, mild)
  • Numeric Rating Scale (010)
  • Visual Analog Scale (10cm line)
  • Faces, Color, other scales
  • Multidimensional Pain Scales
  • McGill Pain Questionnaire
  • Memorial Pain Assessment Card
  • Brief Pain Inventory

15
Post-Test
16
Which of the following are components of the pain
experience?
  • a. Sensory-discriminatory
  • b. Motivational-affective
  • c. Cognitive-evaluative
  • 1. a only
  • 2. a and b
  • 3. a and c
  • 4. All of the above

17
True or False?
  • 1. Nociceptive pain involves normal activation by
    noxious stimuli
  • 2. Neuropathic pain involves injury to
    peripheral, central nervous system
  • 3. Nociception with chronic inflammation and
    persistent tissue injury can cause chronic pain
  • 4. Pain that appear idiopathic need not be fully
    investigated, as there is no physical cause

18
Which are components of initial pain assessment?
  • a. Detailed history, including pain
    characteristics and intensity
  • b. Physical exam, with emphasis on the
    neurological examination
  • c. A psychosocial assessment
  • d. An appropriate diagnostic work-up
  • 1. a only 2. a and b 3. a,b,c 4. all

19
Which is the best indicator of a patients pain?
  • a. Patient self-report
  • b. Caregiver accounts
  • c. Evaluation of facial expressions
  • d. Sympathetic signs and symptoms
  • 1. a 2. a and b 3. a,b,c 4. all

20
Which of these tools does not provide a measure
of pain intensity?
  • a. Faces Pain Scale
  • b. Numeric Rating Scale
  • c. Visual Analog Scale
  • d. Brief Pain Inventory
  • 1. a only 2. d only 3. None 4. all
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