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121 Week 2 Chapter 3 Pain & Its Management Newer
- 1. Pain pain
- 2. Pain and It’s ManagementObjectives Define Pain Assessing Pain Pain Treatment
- 3. Define Pain Sensation of hurting or strong discomfort Subjective, can’t be measured objectively #1 complaint by patients seeking medical care Usually accompanies:inflammationtissue damageinfectiontrauma
- 4. Purpose of Pain Protective function; motivates person to remove cause Each disease produces characteristic patterns which helps with diagnosis
- 5. How Patients Express Pain Perceptions from past experience Pain threshold & tolerance Cultural expression Age Anxiety or stress level Depression Activity level
- 8. Pain Gate Theory Explains why thoughts and emotions affect pain
- 9. www.PainClinic.org Pain Mechanisms –Normal Sensations Sensory Cortex Normal HR, BP, RR, Skin temp Brain Stem Limbic System Feeling Happy CVS / RS Centres Descending Inhibition Closing The Gate Dorsal Horn Skin Stimulation
- 10. www.PainClinic.org What Happens InAcute Pain Sensory Cortex Pain Perception Normal HR, BP, RR, Skin temp Raised HR, BP, RR Cold Skin Brain Stem Brain Stem Limbic System Feeling Happy CVS / RS Centres CVS / RS Centres Limbic System Pain Behaviour Descending Inhibition Closing The Gate Descending Inhibition Helps Close The Gate Dorsal Horn Sensitised Dorsal Horn (Wind Up) Skin Stimulation Tissue Injury
- 11. www.PainClinic.org Recovery After Acute Pain Sensory Cortex Pain Perception Pain Subsides Normal HR, BP, RR, Skin temp Raised HR, BP, RR Cold Skin Normal HR, BP, RR Warm Skin Brain Stem Brain Stem Brain Stem Limbic System Feeling Happy CVS / RS Centres CVS / RS Centres Limbic System Pain Behaviour CVS / RS Centres Limbic System Feeling Happy Descending Inhibition Closing The Gate Descending Inhibition Helps Close The Gate Descending Inhibition Helps Close The Gate Dorsal Horn Sensitised Dorsal Horn (Wind Up) Dorsal Horn Winds Back Down Tissue Injury Tissue Healing
- 12. www.PainClinic.org Why Does Chronic Pain Develop ? Sensory Cortex Pain Perception Chronic Pain Normal HR, BP, RR, Skin temp Raised HR, BP, RR Cold Skin ? Risk of Hypertension + Angina Brain Stem Brain Stem Brain Stem Limbic System Feeling Happy CVS / RS Centres CVS / RS Centres Limbic System Pain Behaviour CVS / RS Centres Limbic System Chronic Pain Pt Chronic Pain Pt Poor Descending Inhibition - Gate Wide Open Setting The Scene Badly Managed Acute Pain Emotionally Sensitive Patient Low IQ and ability to understand Poor Coping Skllls Previous Bad Pain Experiences Pain Goes on For Longer Surgical Complications Descending Inhibition Closing The Gate Descending Inhibition Helps Close The Gate Activated Silent Channels Dorsal Horn Sensitised Dorsal Horn (Wind Up) Permanently Sensitised Dorsal Horn Tissue Injury Continuing Pain Input
- 13. Referred Pain Pain that comes from area other than site where it originates due to shared sensory nerve pathways
- 14. Assessment of Pain P=place A=amount I=interactions N=neutralizes
- 15. Pain Drawings
- 16. Pain Treatment #1 choice for treatment of pain is medication Classifications of medications for pain treatment:opioidnon-opioidanalgesicsanestheticsanti-inflammatoriesPCAplacebo
- 18. Pain Treatment Alternatives bioFeedback
- 21. Yoga
- 24. Aromatherapy
- 25. Massage
- 27. Humor
- 28. Relaxation
Editor's Notes
- The brain commonly blocks out sensations that it knows are not dangerous, such as when the feel of tight-fitting shoes that are put on in the morning has all but vanished by the second cup of coffee. A similar process is at work in processing some moderately painful experiences.1. This case example shows how the experience of pain may change as information is processed in the brain. Applying a clothespin to one’s arm initially produces pain that may be quite intense as the skin and surface muscles are compressed. Peripheral nerve fibers detect this pressure and transmit a pain signal to the spinal cord and on to the brain. At first it is the fast pain signals that get through, and the intensity of the pain experience is fairly proportional to the amount of pressure applied. Everyone would agree that this is acute pain.The slower pain signals are not far behind, however, and a dull ache may soon be noticed. After a short while, the pain coming from the pinched tissue will begin to be decreased by the closing of the spinal nerve gates. This is because the brain begins to view the pain signals as non-harmful. The pressure may be painful initially but it is not injuring the person in any way. As time goes on, the pain message is given less priority by the brain and the person’s awareness of it decreases greatly. The brain knows that the clothespin is not causing any injury. Therefore, the brain gradually “turns the volume down” on the pain message to the point of it being barely noticeable after about thirty minutes. The compression on skin and muscle is still occurring, but it is now perceived as a mild discomfort if it is noticed at all.2. This case example shows how other factors can sometimes play a major role in the experience of pain.The patient reports that she thinks her back pain is due to a spinal tumor. A thorough physical examination and medical history reveals that her spine is normal, except for the onset of the back pain after a recent period of extreme stress. The stress involved the patient’s elderly father, who had just been diagnosed with a spinal tumor. The patient reported that her father’s symptoms had also initially included back pain. Upon questioning, it became quite clear that the patient had an extreme fear that she also was suffering from a spinal tumor. This belief was creating intense suffering, which in turn, made the back pain worse. The patient’s MRI showed no problems with her spine, and the diagnosis of stress related back pain was made. After experiencing tremendous relief that the back pain was not the result of a tumor, the patient’s symptoms began to dissipate rather rapidly and she returned to normal activities