C
OMFORT
I. P
AIN
E
XPERIENCE
- pain is an elusive and complex phenomenon- one of the human body’s defense mechanisms that indicates the personis experiencing a problem- pain is whatever the experiencing person says it is, existing wheneverhe/she says it does
A. O
RIGINS
OF
P
AIN
1.nociceptive
– pain that is usually acute and transmitted after normalprocessing of noxious stimuli- may be categorized as cutaneous, deep somatic, or visceral innature
a.cutaneous (or superficial) pain
– involves the skin orsubcutaneous tissueex. paper cut that produces sharp pain with a burningsensation
b.deep somatic
– diffuse or scattered and originates in tendons,ligaments, bones, bloodvessels, and nervesex. strong pressure on a bone or damage to tissue thatoccurs with a sprain
c.visceral
– poorly localized and originates in body organs in thethorax, cranium, and abdomen- occurs as organs stretch abnormally and become distended,ischemic or inflamed
2.neuropathic pain
– results from injury to or abnormal functioning of peripheral nerves or the CNS- exact cause is unknown- can occur in many forms- can be of short duration or lingering- often described as burning or stabbing
a.allodynia
– pain that occurs after a normally weak or nonpainfulstimuli, such as a light touchor cold drink
3.psychogenic pain
– physical cause for pain cannot be identified- pain that results from a mental event can be just as intense aspain that results from aphysical event
4.referred pain
– pain that is perceived in an area distant from its point of origin
- transmitted to a cutaneous (skin) site different from where itoriginated- can travel to other areas of body innervated by affected nerverootex. pain associated with MI is frequently referred to the neck,shoulders, or arms (often theleft)
B. P
AIN
S
YNDROMES
- capable of causing severe pain- treatment is often delayed as a result of misdiagnosis
1. Complex regional pain syndrome (causalgia)
– occurs in area of partially injured peripheral nerve(brachial plexus or median or sciatic nerve)- described as burning, severe, diffuse, and persistent- elicited by minimal movement or touch of affected area
2. Postherpetic neuralgia
– follows acute CNS infection- severity may be mild to severe- intractable pain may persist for months to years
3. Phantom limb pain
– may occur in person who has had a body partamputated either surgically ortraumatically- pain varies and may be severe, burning, fiery sensation; crushing;cramping; sense that limbis edematous; sensation that limb is being twisted anddistorted- may be triggered by sensation of touching the stump, occurrenceof another illness, fatigue,atmospheric changes, and emotional stress
4. Trigeminal neuralgia
– paroxysms of lightening-like stabs of intensepain in distribution of one ormore divisions of the trigeminal nerve (5
th
cranial)- experienced in the mouth, gums, lips, nose, cheek, chin, andsurface of the head- may be triggered by everyday activities like talking, eating,shaving, or brushing one’s teeth
5. Diabetic neuropathy
– metabolic and vascular changes result indamage to peripheral and autonomicnerves- sensory loss can result and eventually leads to injury progressingto infection and gangrene- symptoms include sensations of numbness, prickling, or tingling(paresthesias)
C. T
RANSMISSION
OF
P
AIN
S
TIMULI
- no specific pain organs or cells exist in the body- interlacing network of undifferentiated free nerve endings receivepainful stimuli- include afferent (fibers carrying impulses from pain receptorstoward the brain) fast-conducting A-delta-fibers and the slow-conducting C-fibers- A-delta-fibers transmit acute, well-localized pain- C-fibers convey diffuse, visceral pain often described asburning and aching- stimulation of sensory receptors and intactness of nerve supply areneither necessary nor sufficientconditions for pain- receptor for pain and nerve route that eventually carries impulseto brain are necessary (butnot always)
phantom pain
– without demonstrated physiologic or pathologicsubstance- sensory misrepresentation from missing limb may still remain inbrain causing this pain
1. Gate Control Theory
– describes transmission of painful stimuli andrecognizes relation between painand emotions- certain nerve fibers (small diameter) conduct excitatory painstimuli toward the brain, butnerve fibers of large diameter appear to inhibit transmissionof pain impulses fromspinal cord to the brain- exciting and inhibiting signals at the gate in spinal cord determineimpulses that eventuallyreach the brain- appears to be influenced by amount of activity in large and smallafferent fibers in addition tonerve impulses that descent from the brain
D. P
ERCEPTION
OF
P
AIN
- involves sensory process that occurs when stimulus for pain is present- includes person’s interpretation of pain
pain threshold
– lowest intensity of stimulus that causes subject to recognizepain- can be changed within a certain rangeex. adaptation can be demonstrated when a person’s hand isimmersed in warm water - -sensation of pain eventually occurs as water is heated;however, the person can
of 00
Comfort
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| Upload Date: | 03/18/2009 |
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