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3. CLASSIFICATION OF PAIN
BY ONSET AND DURATION
Acute pain
Sudden
Chronic pain
Persistent
or recurring
Often difficult to treat
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in onset
Usually subsides once treated
5. CLASSIFICATION OF PAIN BY
SOURCE
Vascular pain
Possibly originates from vascular or
perivascular tissues
Neuropathic pain
Results from injury to peripheral nerve fibers or
damage to the CNS
Superficial pain
Originates from skin or mucous membranes
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6. PAIN TRANSMISSION GATE THEORY
Most common and well-described
Uses the analogy of a gate to describe how
impulses from damaged tissues are sensed in the
brain
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7. PAIN TRANSMISSION
These substances stimulate nerve endings,
starting the pain process.
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Tissue injury causes the release of:
Bradykinin
Histamine
Potassium
Prostaglandins
Serotonin
9. PAIN TRANSMISSION
“C” Fibers
No myelin sheath
Small fiber size
Conduct slowly
Facilitate pain
transmission
Dull and
nonlocalized
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“A” Fibers
Myelin sheath
Large fiber size
Conduct fast
Inhibit pain
transmission
Sharp and
well-localized
10. PAIN TRANSMISSION
Types of pain related to proportion of
“A” to “C” fibers in the damaged areas
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11. PAIN TRANSMISSION
These pain fibers enter the spinal cord
and travel up to the brain.
The point of spinal cord entry is the
DORSAL HORN.
The DORSAL HORN is the location
of the “GATE.”
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12. PAIN TRANSMISSION
This gate regulates the flow of sensory impulses
to the brain.
Closing the gate stops the impulses.
If no impulses are transmitted to higher centers
in the brain, there is NO pain perception.
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13. GATE THEORY OF PAIN
TRANSMISSION
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INSTRUCTORS MAY WANT TO USE
EIC IMAGE #37:
14. PAIN TRANSMISSION
Activation of large “A” fibers CLOSES gate
Inhibits transmission to brain
perception of pain
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Limits
15. PAIN TRANSMISSION
Activation of small “B” fibers OPENS gate
Allows impulse transmission to brain
perception
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Pain
16. PAIN TRANSMISSION
Gate innervated by nerve fibers from brain,
allowing the brain some control over gate
Allows brain to:
identify, and localize the pain
Control the gate before the gate is open
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Evaluate,
18. PAIN TRANSMISSION
Body has endogenous neurotransmitters
Enkephalins
Produced by body to fight pain
Bind to opioid receptors
Inhibit transmission of pain by closing gate
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Endorphins
19. PAIN TRANSMISSION
GATE
closed, recognition of pain REDUCED
Same pathway used by opiates
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Rubbing a painful area with massage or liniment
stimulates large sensory fibers
Result:
20. OPIOID ANALGESICS
Pain relievers that contain opium,
derived from the opium poppy
or
chemically related to opium
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Narcotics: very strong pain relievers
23. OPIOID ANALGESICS: SITE OF
ACTION
Large “A” fibers
Dorsal horn of spinal cord
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24. OPIOID ANALGESICS:
MECHANISM OF ACTION
Bind to receptors on inhibitory fibers,
stimulating them
Prevent stimulation of the GATE
Prevent pain impulse transmission
to the brain
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26. OPIOID ANALGESICS: THERAPEUTIC
USES
Cough
center suppression
Treatment of constipation
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Main use: to alleviate moderate to severe pain
Opioids are also used for:
27. OPIOID ANALGESICS: SIDE
EFFECTS
Euphoria
Nausea and vomiting
Respiratory depression
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
Constipation
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28. OPIATE ANTAGONISTS
Used for complete or partial reversal of
opioid-induced respiratory depression
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naloxone (Narcan)
naltrexone (Revia)
Opiate antagonists
Bind to opiate receptors and prevent a response
29. OPIATES: OPIOID TOLERANCE
A common physiologic result of chronic opioid
treatment
Result:
larger dose of opioids are required
to maintain the same level of
analgesia
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34. OPIATES
Narcotic
withdrawal
Opioid abstinence syndrome
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Physical dependence on opioids is seen when the
opioid is abruptly discontinued or when an opioid
antagonist is administered.
36. OPIOID ANALGESICS:
NURSING IMPLICATIONS
Before beginning therapy, perform a thorough
history regarding allergies, use of other
medications,health history, and medical history.
Obtain baseline vital signs and I & O.
Assess for potential contraindications and drug
interactions.
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37. OPIOID ANALGESICS:
NURSING IMPLICATIONS
Assessment
of pain is now being considered
a “fifth vital sign.”
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Perform a thorough pain assessment, including
nature and type of pain, precipitating and
relieving factors, remedies, and other pain
treatments.
38. OPIOID ANALGESICS:
NURSING IMPLICATIONS
Be sure to medicate patients before the pain
becomes severe as to provide adequate analgesia
and pain control.
Pain management includes pharmacologic and
nonpharmacologic approaches. Be sure to include
other interventions as indicated.
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39. OPIOID ANALGESICS:
NURSING IMPLICATIONS
Oral forms should be taken with food to minimize
gastric upset.
Ensure safety measures, such as keeping side
rails up, to prevent injury.
Withhold dose and contact physician if there is a
decline in the patient’s condition or if VS are
abnormal—especially if respiratory rate is below
12 breaths/minute.
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40. OPIOID ANALGESICS:
NURSING IMPLICATIONS
Follow proper administration guidelines for IM
injections, including site rotation.
Follow proper guidelines for IV administration,
including dilution, rate of administration, and so
forth.
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CHECK DOSAGES CAREFULLY
41. OPIOID ANALGESICS:
NURSING IMPLICATIONS
Constipation
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is a common side effect and
may be prevented with adequate fluid and
fiber intake.
Instruct patients to follow directions for
administration carefully, and to keep a
record of their pain experience and
response to treatments.
Patients should be instructed to change
positions slowly to prevent possible
orthostatic hypotension.
42. OPIOID ANALGESICS:
NURSING IMPLICATIONS
Patients should not take other medications or
OTC preparations without checking with their
physician.
Instruct patients to notify physician for signs of
allergic reaction or adverse effects.
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43. OPIOID ANALGESICS:
NURSING IMPLICATIONS
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Monitor for side effects:
Should VS change, patient’s condition decline,
or pain continue, contact physician immediately.
Respiratory depression may be manifested by
respiratory rate of less than 12/min, dyspnea,
diminished breath sounds, or shallow breathing.