6501 Week 3 discussion : Pathophysiology of Pain
Pathophysiology of Pain
Pain is described by Huether and McCance (2017) as a complex experience, one that includes physical, cognitive, spiritual, emotional, and environmental factors, which may be a signal of tissue damage, lasting from seconds to as long as three months, or chronic lasting greater than three to six months and have no purpose (p.340-341). Pain is an unpleasant sensation that can only be described by the person who feels it. The sensation of pain is transmitted by the central nervous system, which processes potentially harmful stimuli by way of nociceptors, which are pain receptors. (Huether & McCance, 2017) 6501 Week 3 discussion : Pathophysiology of Pain. Nociceptors are distributed throughout the body, which transmits the sensation of pain, and responds to the stimuli in different ways (Huether & McCance, 2017). Different types of stimuli cause different types of pain sensations, such as mechanical, thermal and chemical. Some chemical receptors that are associated with the sensation of pain include bradykinin, histamine, leukotrienes and prostaglandins. (Huether & McCance, 2017). Pain has been recognized in the past as the fifth vital sign, making it an important part of the assessment process. Pain can be characterized in many different ways, such as acute, chronic, or referred, which are dependent on the different criteria that identify each.
Acute Pain
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Acute pain is a sensation that last only seconds to day, but may be present for up to three months. Acute pain is a mechanism of the body that warns of immediate danger that can cause harm, which causes the person to immediately respond to remove the cause of the pain. Acute pain is normally self-limiting, resolving within days or weeks, but may continue longer as healing occurs (Anwar, 2016). Acute pain results in autonomic nervous stimulation, which results in increase in heart rate, hypertension, diaphoresis and dilated pupils (Huether & McCance, 2017, p. 340). Acute pain is further divided into classifications, which include somatic, visceral or referred, which help to diagnose and treat the pain more effectively (Huether & McCance, 2017). Somatic pain is pain that is felt as sharp and well localized, or dull, aching, throbbing, which can be poorly localized (Huether & McCance, 2017). Acute pain is commonly the type of pain that patients experience after surgery, traumatic injuries, tissue damage and the inflammatory process (Anwar, 2016).
Chronic Pain
Chronic pain is pain that has been present for longer than three to six months and beyond the natural healing time (Huether & McCance, 2017). Although it may accompany any type of injury, chronic pain serves no purpose and causes suffering of the individual (Huether & McCance, 2017). Chronic pain often leads to negative impact on quality of life, well-being and a person’s long term ability of function (Anwar, 2016). Huether and McCance (2017) explain that with chronic pain, there have been actual changes to the peripheral and central nervous systems that cause a dysregulation of nociception and the pain modulation process (p. 340). Over time, people who suffer with chronic pain have adaptations that lead to normalization of heart rate and blood pressure, which can lead to the misconception that these patients are not actually in pain. Chronic pain that is not controlled leads to problems such as depression, poor eating and sleeping habits, preoccupation with pain and avoidance of any stimuli that causes the pain (Huether & McCance, 2017). Patients who experience chronic pain also are commonly faced with the fact that their pain may never be completely resolved, which is normally achieved with acute pain.
Referred Pain
Referred pain is pain that is felt in a different area that where the pain originates from. An example is symptoms of MI, such as pain in the jaw or shoulder. Referred pain can be from an acute problem or it can be chronic, such as pain felt from sciatic with a chronic back injury. Huether and McCance (2017) explain that the reason behind pain being referred to other areas in the body is because the brain cannot distinguish the origin due to the many impulses that are being received from cutaneous and visceral neurons that converge at the same ascending neurons.
Gender and Age
Shea and McDonald (2010) explain that women and their descriptions of pain had been shown to be dependent on social interactions, and that women who suffered chronic pain seemed to have difficulty with self-esteem, and dignity as patients. Age has an impact on the way pain may be reported, or even assessed due to cognitive function. As a hospice nurse, I have learned that the elderly, cognitively impaired patients often act out when in pain, similar to young children, which leads to undertreatment of pain. I have worked with physicians in the past who did not believe in treating pain with infants, for instance, when circumcising newborns, he refused to order any type of topical pain control. As a nurse, I have worked on both ends of the spectrum, and I have seen pain that was poorly controlled at both ends. I had also done research to support my teaching of patients and families about pain control and the safety of morphine use at the end of life, which has led me many times to learn that patients with dementia are very undertreated for pain, partly because they can’t verbalize, and partly because physicians and nurses are afraid of overdosing them, which leads to poorly controlled pain. Shea and McDonald (2010) explained that it is imperative that healthcare providers have a keen awareness of hour to accurately assess for pain in patients of all ages, so that it can be treated effectively.
Anwar, K. (2016). Pathophysiology of pain.
Disease-a-Month, 62
(9), 324-329. Retrieved
From
https://doi.org/10.1016/j.disamonth.2016.05.015
.
Huether, S.E. & McCance, K.L. (2017) Understanding pathophysiology (6th ed.). St. Louis,
MO: Mosby.
Shea, M., & McDonald, D. (2010). Factors associated with increased pain communication by
Older adults. Western Journal of Nursing Research, 33(2), 169-206. Retrieved from
http://journals.sagepub.com.ezp.waldenlibrary.org/doi/abs/10.1177/0193945910372775
Week 3
Pain
The neurological system affects all parts and functions of the body through nerve stimulation. Nerves also control the sensation and perception of pain. While pain can be described in a variety of ways, it is essentially labeled according to its duration and source. As an advanced practice nurse evaluating a patient, you need to consider the following questions: Does the pain quickly come and go, or is it persistent and ongoing? Does the pain arise at the source of injury or in another location? In this Discussion, you compare three common types of pain—acute, chronic, and referred.
To prepare:
· Review this week’s media presentation on the neurological system, as well as Chapter 13 in the Huether and McCance text.
· Identify the pathophysiology of acute, chronic, and referred pain. Consider the similarities and differences between these three types of pain.
· Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain.
Post A 1 page paper APA format
1
a description of the pathophysiology of
acute
,
chronic
, and
referred pain
, including similarities and differences between them.
2
Then, explain how the factors you selected might impact the pathophysiology, diagnosis, and prescription of treatment for acute, chronic, and referred pain. 6501 Week 3 discussion : Pathophysiology of Pain.
Course resources
· Huether, S. E., & McCance, K. L. (2012).
Understanding pathophysiology
(Laureate custom ed.). St. Louis, MO: Mosby.
o Chapter 12, “Structure and Function of the Neurologic System”
This chapter begins with an overview of the structure and function of the nervous system. It also explains the importance of the central, peripheral, and autonomic nervous systems.
o Chapter 13, “Pain, Temperature, Sleep, and Sensory Function”
This chapter covers the role of pain, sleep, stress, and the senses on body functions. It also explores alterations involving pain, sleep, stress, and the senses.
o Chapter 14, “Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function”
This chapter explores disorders of cognitive systems, neuromotor function, tone, movement, and motor performance. It also examines factors that impact these disorders as well as clinical manifestations.
o Chapter 15, “Disorders of the Central and Peripheral Nervous Systems and Neuromuscular Junction”
This chapter examines the pathophysiology, clinical manifestations, and evaluation and treatment of central and peripheral nervous system disorders. Tumors of the central nervous system are also covered. 6501 Week 3 discussion : Pathophysiology of Pain.
o Chapter 16, “Alterations of Neurologic Function in Children”
This chapter focuses on the pathophysiology, clinical manifestations, evaluation, and treatment of neurologic disorders and brain tumors in children. Normal growth and development is also examined.
· McPhee, S. J., & Hammer, G. D. (2010).
Pathophysiology of disease: An introduction to clinical medicine
(Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.
o Chapter 7, “Nervous System Disorders”
This chapter begins with an overview of the structure and function of the nervous system to lay a foundation for exploring nervous system disorders. It then examines several nervous system disorders such as Parkinson’s disease, epilepsy, dementia, Alzheimer’s disease, and stroke. 6501 Week 3 discussion: Pathophysiology of Pain.
Chapter 12, “Disorders of the Adrenal Medulla”
This chapter examines disorders relating to alterations of the adrenal medulla. It classifies disorders by the organ or tissue that is most impacted by the disorder. The pathophysiology, clinical manifestations, symptoms, and signs of the disorders are also covered.
Chapter 19, “Disorders of the Hypothalamus & Pituitary Gland”
This chapter covers the structure and function of the hypothalamus and pituitary glands. It also explores disorders of the hypothalamus and pituitary glands.
Chapter 21, “Disorders of the Adrenal Cortex”
This chapter begins by exploring the structure and function of the adrenal cortex. It then explores disorders relating to alterations of the adrenal cortex.
Media
· Laureate Education, Inc. (Executive Producer). (2012f).
The neurological system
. Baltimore, MD: Author.
This media presentation outlines the pathophysiology of the neurological system and associated alterations.
Optional Resources
· Alzheimer’s Association. (2012). Retrieved from
http://www.alz.org/
· National Multiple Sclerosis Society. (2012). Retrieved from
http://www.nationalmssociety.org/index.aspx
· National Parkinson Foundation. (2012). Retrieved from
http://www.parkinson.org/
NURS 6501N-6 Advanced Pathophysiology
Pain
Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”, per the American Pain Society (Huether & McCance, 2012, p.324). Pain descriptions are subjective to the person experiencing it and at times can be very hard to control once started. This week’s discussion will consider types of pain, including acute, chronic and referred pain and their similarities and differences. Also, other factors that affect pain will be discussed and their effects on pathophysiology, diagnosis and treatment. 6501 Week 3 discussion : Pathophysiology of Pain.
Acute Pain
Acute pain begins when the body is attempting to warn of a potentially harmful experience, to relieve it (Huether & McCance, 2012, p.327). It is usually sudden or unexpected, and may linger for minutes to days, depending on location and severity. Acute pain can be further divided into somatic, visceral, or referred. Somatic pain comes from the skin, while visceral pain is pain from internal organs (p.327). Referred pain, however, refers to the air where the pain is felt (p.328) “The polymodal peripheral receptors initiate unpleasant sensations that can be modulated in the dorsal horn and the anterior columns of the spinal cord before reaching the cerebral cortex” (Fink, 2005, p. 277). Although neurological pathways of the body allow for sensation of pain, skin and visceral sensations are different.
Chronic Pain
Chronic pain is constant pain lasting a minimum of 3 months (Huether & McCance, 2012). Chronic pain can be sub grouped into neuropathic pain, which results from a neurological lesion dysfunction, or peripheral neuropathic pain, that results from trauma or disease of a peripheral nerve. There is also central neuropathic pain that develops from dysfunction in the brain or spinal cord (p.328). The process of nociception drives chronic pain. When nociceptors are stimulated, an action potential is started along the nerve that it is attached to 6501 Week 3 discussion : Pathophysiology of Pain. The nerves, composed of axons are classified per the nerve innervated. Some axons are myelinated, which help to protect the myelin and produce a faster pain transmission signal. Nerve endings that respond to sensory processes such as heat, cold and touch have different myelination properties and neurotransmitters that they respond to (Rashiq et al., 2008).
Referred Pain
Pain felt in the area other than the point of origin is defined as referred pain (Huether& McCance, 2012). Research has shown that the mechanism of convergence is the explanation for referral pain. When primary afferent fibers from different sites converge on the same second-order neuron in the brainstem nucleus (Hashemipour & Borna, 2014). In a case study on orofacial pain, referred pain was of greatest concern when the pathology became progressive in conditions such as “infections, vascular disorders, and neoplastic disease. Well-known sources of pain referred to the jaws include the pain of ischemic cardiac disease, esophageal pathology, and central lesions that cause increased intracranial pressure or produce compression of one or more of the cranial nerves” (p. 152).
Pain Comparison
Onset between the specific types of pain differ. Acute pain is sudden, whereas, chronic and referred pain occur due to some other etiology. Description of pain also differs. In acute pain, the exact area and reason for the pain is easily identified, whereas, chronic and referred pain usually occur because of some other problem, and may be harder to diagnose. Signs and symptoms of acute pain are usually immediately felt and observed, while chronic and referred pain may show symptoms slowly over time (Huether & McCance, 2012) 6501 Week 3 discussion : Pathophysiology of Pain.
Age and Genetic Factors on Pain
At any age, pain effects the body differently. As an infant and child, the pain threshold, or the lowest toleration of pain is very low due painful experiences (Huether & McCance, 2012). Physiological changes in heartrate and breathing often show signs of pain or discomfort. 6501 Week 3 discussion : Pathophysiology of Pain Behavioral changes in facial muscles, crying, and restlessness, also show an observable change that could be a response to pain. In adults, the pain threshold is subjective and can change within moments. Physiological changes in behavior are like infants and children, but adults can be more specific about what they are feeling (p.330).
Genetic research has shown that a rare disease called congenital insensitivity to pain with anhidrosis (lack of sweating), also known as hereditary sensory and autonomic neuropathy type 4. It is characterized by profound insensitivity to noxious stimuli and absence of sweating, as well as secondary complications such as repeated injuries, self-mutilation, and recurrent febrile episodes. Delayed developmental milestones, hyperactivity, emotional lability, and intellectual disabilities are also observed to varying degrees. Morphologic studies revealed that insensitivity to pain and anhidrosis result from the absence of sensory and sympathetic postganglionic neurons (Wang et al., 2016).
Conclusion
Structures and functions of the neurological system are very complex, yet it continues to regulate the body with little help from us. Pain is regulated by this system, and helps to warn the body of potentially dangerous experiences. Pain treatments vary individually, and can take time to diagnose and maintain. Pain will always be an issue that the human body faces daily. With continued research, the pathophysiology may be better understood and possibly better treatments invented. 6501 Week 3 discussion : Pathophysiology of Pain.
References
Fink, W. A. (2005). The pathophysiology of acute pain.
Emergency Medicine Clinics of North America
,
23
(2), 277-284. doi:10.1016/j.emc.2004.12.001
Hashemipour, M. A., & Borna, R. (2014). Incidence and characteristics of acute referred orofacial pain caused by a posterior single tooth pulpitis in an Iranian population.
Pain Practice
,
14
(2), 151-157. doi:10.1111/papr.12034
Huether, S. E., & McCance, K. L. (2012).
Understanding pathophysiology (Laureate custom ed.)
. St. Louis, MO: Mosby.
Rashiq, S., Schlopflocher, D., Taenzer, P., & Jonsson, E. (2008).
Chronic pain: A health policy perspective
. Weinheim, Germany: Wiley-Blackwell/Wiley-VCH.
Wang, Q., Guo, S., Duan, G., Ying, Y., Huang, P., Liu, J. Y., & Zhang, X. (2016). Phenotypes and genotypes in five children with congenital insensitivity to pain with anhidrosis.
Pediatric Neurology
,
61
, 63-69. doi:10.1016/j.pediatrneurol.2016.04.006 6501 Week 3 discussion : Pathophysiology of Pain