Pain Mgmt RN flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Nociceptive pain

Pain caused by activation of peripheral nociceptors from mechanical, thermal, or chemical stimuli; typically described as aching, throbbing, or pressure-like and often responds to nonopioid or opioid analgesics.

Neuropathic pain

Pain caused by a lesion or disease of the somatosensory nervous system; commonly burning, shooting, electric-shock, or pins-and-needles and often treated with gabapentinoids, SNRIs, or tricyclics.

Allodynia

Pain evoked by a normally nonpainful stimulus, such as light touch or gentle brushing, reflecting central or peripheral sensitization in neuropathic pain states.

FLACC scale

Behavioral pain scale for children aged 2 months to 7 years or unable to self-report; scores Face, Legs, Activity, Cry, and Consolability from 0 to 2 each for a total of 0 to 10.

Acetaminophen ceiling dose

For most adults, maximum 4,000 mg per day; limit to 3,000 mg or less with hepatic impairment, chronic alcohol use, low body weight, or prolonged use, and count all combination products.

Opioid equianalgesic morphine

Morphine 10 mg parenteral is approximately equal to 30 mg oral morphine; use equianalgesic tables when switching opioids and reduce the new opioid by 25-50 percent for incomplete cross-tolerance.

Naloxone for respiratory depression

Give 0.04-0.4 mg IV titrated every 2-3 minutes to restore adequate breathing, not full alertness; intranasal 4 mg is used for community opioid overdose.

Serotonin syndrome risk

Combining tramadol, meperidine, or fentanyl with serotonergic drugs such as SSRIs, SNRIs, or MAOIs can cause hyperthermia, rigidity, clonus, and autonomic instability.

LAST treatment

For local anesthetic systemic toxicity, stop injection, secure airway, give 100% oxygen, and administer 20% lipid emulsion 1.5 mL/kg bolus followed by infusion per protocol.

Lidocaine maximum dose

Without epinephrine, maximum lidocaine is 4.5 mg/kg; with epinephrine it is 7 mg/kg; avoid intravascular injection and monitor for toxicity.

Epidural steroid injection risks

Risks include bleeding, infection, dural puncture headache, nerve injury, and transient increased pain; anticoagulants and antiplatelets must be held according to procedural guidelines.

Spinal cord stimulator trial

A temporary trial electrode is placed before permanent implantation to confirm meaningful pain relief; paresthesia-based and high-frequency systems differ in programming and MRI compatibility.

Gate control theory

Nonpainful sensory input such as massage, heat, or TENS activates large-diameter fibers that inhibit pain transmission in the dorsal horn, reducing perceived pain.

TENS contraindications

Avoid TENS over the carotid sinus, pregnant abdomen, pacemaker or implanted electronic device site, and areas of impaired sensation or active malignancy unless specifically approved.

Cognitive behavioral therapy

Structured psychotherapy that identifies and changes maladaptive thoughts and behaviors related to pain, reducing catastrophizing and improving function and coping in chronic pain.

Acupuncture mechanism

Fine needle insertion at defined points modulates endogenous opioid release, descending inhibitory pathways, and local blood flow; evidence supports use for chronic low back and neck pain.

Multimodal analgesia

Combining analgesics with different mechanisms, such as scheduled acetaminophen, an NSAID, and opioid only as needed, improves postoperative pain control and reduces opioid requirements and adverse effects.

PCA safety rule

Only the patient should press the patient-controlled analgesia button; family or nurse activation can cause overdose; monitor sedation, respiratory rate, and pain response regularly.

Preemptive analgesia

Analgesia given before a painful stimulus or incision to reduce central sensitization and subsequent postoperative pain; examples include regional blocks and preincisional nonopioids.

Postoperative sedation warning

Increasing sedation is an early warning sign of opioid-induced respiratory depression and precedes respiratory rate decline; use sedation scales and capnography when available.

Central sensitization

Increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold input, producing hyperalgesia and allodynia and contributing to chronic pain.

Opioid tolerance

A state in which a given opioid dose produces less effect over time, requiring higher doses for the same analgesia; it is distinct from addiction and from physical dependence.

Fibromyalgia treatment

First-line therapies include graded exercise, cognitive behavioral therapy, duloxetine, pregabalin, and amitriptyline; opioids are generally ineffective and not recommended for fibromyalgia.

Low back pain red flags

Urgent evaluation is needed for saddle anesthesia, bowel or bladder dysfunction, fever, unexplained weight loss, cancer history, major trauma, or progressive neurologic deficit suggesting serious pathology.

Codeine in children

Codeine and tramadol are contraindicated in children younger than 12 years and after tonsillectomy or adenoidectomy in those younger than 18 because of CYP2D6 ultrarapid metabolism and respiratory depression risk.

Beers criteria opioids

In older adults, avoid meperidine and use opioids cautiously because of falls, delirium, and respiratory depression; NSAIDs are also avoided in chronic use due to GI and renal risk.

PAINAD scale

Observational tool for advanced dementia scoring breathing, negative vocalization, facial expression, body language, and consolability from 0 to 2 each, total 0 to 10.

Double effect

Ethical principle that an action with a good intended effect, such as relieving pain, may be permissible even if a foreseeable but unintended harmful effect, such as respiratory depression, occurs.

PDMP check

Prescription drug monitoring program query before initiating or changing opioid therapy and at intervals; it identifies multiple prescribers, overlapping controlled substances, and high-risk combinations.

Informed consent elements

Disclosure of diagnosis, proposed treatment, risks, benefits, alternatives, and consequences of refusal, followed by voluntary patient authorization before an invasive procedure.

Teach-back method

Ask the patient to explain pain management instructions in their own words; it identifies misunderstandings and confirms comprehension of medications, warning signs, and follow-up.

Controlled substance wasting

Two licensed clinicians should witness and document disposal of unused controlled substances according to policy; discrepancies must be reported immediately and investigated.