MEDRADSC 3DH3 Lecture Notes - Lecture 4: Constipation, Hydrocodone, Gabapentin
4 Jun 2018
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What is Pain?
• A upleasat sesor or eotioal eperiee assoiated ith atual or potetial tissue
daage.
• “Pain is whatever the experiencing person says it is, existing whenever the experiencing person
sas it does.
Points to consider about pain:
• Pain is one of the symptoms feared most by patients
• Uncontrolled pain can lead to depression, loss of function, anxiety, family problems
• 1/3 of cancer patients undergoing treatment are in pain
o ~80% with advanced disease live in pain
• 576 million of the ~6 billion people living today will end without adequate analgesia
o WHO article: Preliminary estimates show that, every year, 4.8 million people suffering
from moderate to severe pain caused by cancer do not receive treatment. For moderate
to severe pain experienced during end-stage Acquired Immuno Deficiency Syndrome
(AIDS), an estimated 1.4 million receive no treatment annually. Note that these stats are
fro 2007; hoeer, appear to e osistet he lookig ito todas eh arks.
Last page of WHO article indicates it will take at 15-20yrs to change this.
Process of Pain: Four Phases
• Transduction: Begins when cells are injured
o Cells release chemicals
o Chemicals excite the sensory nerve receptors (norciceptors)
o Chemical information is converted into electrical impulses that move toward the spinal
cord
• Transmission: Stimuli move from pns toward brain
o Fibers carry impulses to cortex of brain
▪ A=carry impulses rapidly, C-fibers carry impulses slower
o Notifies nociceptors that message was received
• Perception: conscious experience of discomfort when pain threshold is reached
• Modulation: Brain interacts with spinal nerves to alter pain experience
o Releases inhibiting neurochemicals
• (Several factors that affect tolerance level and perception of pain)
Causes of Physical Pain
• Tumour pressure: compressing on adjacent structures, nerves nearby
• Procedure related pain: biopsies, uncomfortable position
• Comorbid illness
• Ischemia
• Infection
• Inflammation
find more resources at oneclass.com
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Total Pain
• Refers to the physical, social, spiritual, and psychological suffering commonly experienced by
persons with life-limiting illness and their families
o i.e. involves all domains of suffering
• Term coined by Dame Cicely Saunders
Maslos Hierarh of Hua Needs
•
• Pain can be a result of suffering at any level of the pyramid (or combination of levels)
• Pain can impact optimal functioning at all levels of the pyramid
Causes of Pain: Holistic
• Total pain (holistic):
o Emotional
o Psychosocial
o Spiritual
o Practical
o Underlying symptoms
Barriers to Pain Management
• Health care worker
o Short for time
o Uneducated
o Lack of communication
• Health care system
o Budget
o Access to drugs
• Patient/family
o Anti-drugs (fear of taking them)
o Religion
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find more resources at oneclass.com
• How do we help reduce these barriers?
o Early and aggressive treatment of acute pain can reduce occurrence of long term
chronic pain
o Empowering the patient and family with knowledge can help in the process
o Major focus of palliative and end-of-life care
Types of Pain
• Acute: Sudden onset, usually sharp in quality.
• Chronic: Persists beyond the time of expected healing (>3 mths)
• Neuropathic, nociceptive, somatic, visceral
• Phantom: Perceptions that an individual experiences relating to a limb or organ that is not
physically part of the body.
• Breakthrough flare-up: Episodes of pain that "break through" the control of an otherwise
effective analgesic therapy.
• Cancer pain syndrome: Combination of signs and symptoms as a result of cancer (e.g. SVCO:
SOB, swelling in neck/face, dilatation of veins, chest wall pain)
o SVCO: Superior vena cava obstruction
The Mystery of Chronic Pain
• https://www.ted.com/talks/elliot_krane_the_mystery_of_chronic_pain
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
What is pain? (cid:862)a(cid:374) u(cid:374)pleasa(cid:374)t se(cid:374)sor(cid:455) or e(cid:373)otio(cid:374)al e(cid:454)perie(cid:374)(cid:272)e asso(cid:272)iated (cid:449)ith a(cid:272)tual or pote(cid:374)tial tissue da(cid:373)age. (cid:863) Pain is whatever the experiencing person says it is, existing whenever the experiencing person sa(cid:455)s it does. (cid:863) For moderate to severe pain experienced during end-stage acquired immuno deficiency syndrome (aids), an estimated 1. 4 million receive no treatment annually. Note that these stats are fro(cid:373) 2007; ho(cid:449)e(cid:448)er, appear to (cid:271)e (cid:272)o(cid:374)siste(cid:374)t (cid:449)he(cid:374) looki(cid:374)g i(cid:374)to toda(cid:455)(cid:859)s (cid:271)e(cid:374)(cid:272)h (cid:373)arks. Last page of who article indicates it will take at 15-20yrs to change this. Causes of physical pain: tumour pressure: compressing on adjacent structures, nerves nearby, procedure related pain: biopsies, uncomfortable position, comorbid illness. Total pain: refers to the physical, social, spiritual, and psychological suffering commonly experienced by persons with life-limiting illness and their families i. e. involves all domains of suffering, term coined by dame cicely saunders.
