Med-Surg · chapter 7 · Pain Assessment and Management
Concepts and Causes of Pain
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Subjective pain experience
Pain is whatever the experiencing person says it is, existing whenever they say it does” (McCaffery, 1968).
Pain classification factors
Pain may be classified according to a variety of factors, such as location, onset, duration, and cause.
Abnormal pain treatment need
On the contrary, abnormal pain moves beyond the expected severity and duration expected from the cause of the pain and may require additional medical treatment.
Acute pain vital signs
Acute pain typically produces a physiological response resulting in vital sign changes, such as increased pulse, respirations, and blood pressure.
Untreated acute pain risk
Do not ignore acute pain. If left untreated, acute pain may turn into chronic pain.
Chronic pain vital signs
Chronic pain does not typically result in vital sign changes because the body has adjusted to the new normal of chronic pain.
Chronic pain assessment
When managing chronic pain, it is important to assess one’s ability to perform activities of daily living, as well as assess for signs of depression and anxiety. Early intervention is key to preserving quality of life and mental well-being.
Breakthrough pain triggers
It may be caused by stress, illness, or activity, by the wearing off of pain medicine, or for no known reason.
Neuropathic pain descriptors
It may be characterized as shooting, stabbing, sharp, or burning pain. Some people may even describe the pain as an electrical shock or say it feels like “pins and needles.”
Neuropathic safety risk
Neuropathic pain may also affect sensitivity: for example, it can interfere with a person’s ability to feel hot and cold sensations, which may result in injury.
Phantom pain reality
Approximately 80 percent of patients who undergo an amputation will experience phantom pain (Cleveland Clinic, 2021). Phantom pain is caused by the brain misinterpreting the pain signals, but the pain is real.
Somatic pain location
The first, somatic pain, is experienced in the muscles, skin, or bone. This pain is focused on a specific area of the body and is typically more intense than visceral pain.
Visceral pain location
The other type of pain, visceral pain, is experienced in the internal organs; the exact location may be difficult to identify.
Referred pain pathways
Due to the shared neural pathways, the individual may feel the pain in a different portion of the dermatome supplied by the same nerve root.
Terms to know
- pain
- Generally, pain is an uncomfortable or unpleasant sensation that typically signifies injury or illness.
- nociceptor
- A nociceptor is a type of sensory receptor that responds to potentially damaging stimuli by sending nerve signals to the spinal cord and brain in a process called nociception.
- acute pain
- When pain is short in duration, typically lasting from minutes up to three to six months (depending upon the reference source), it is considered acute pain.
- chronic pain
- By contrast, chronic pain is longer in duration, typically identified as pain lasting longer than six months.
- breakthrough pain
- A sudden increase in pain that lasts for a short time is called breakthrough pain.
- neuropathic pain
- Damage to nerves or other parts of the nervous system can result in neuropathic pain.
- nociceptive pain
- Pain caused by damage to the body tissue, typically from injury to joints, muscles, skin, tendons, or bones, is called nociceptive pain.
- referred pain
- When the pain in one part of the body is caused by pain in a different location in the body, it is considered referred pain.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
At 1900, a patient with a back injury reports pain for eight months: "It never completely goes away. Some movements make it worse, and others make it less intense." Which description best represents the overall pain pattern in the assessment note?
- Chronic back pain characterized by brief breakthrough episodes.
- Intermittent chronic back pain associated with movement.
- Recurrent acute back pain associated with movement.
- Constant chronic back pain with movement-related changes in intensity.
Answer: Constant chronic back pain with movement-related changes in intensity.
Eight months supports chronic pain, and continuous pain remains constant even when its intensity varies. Intermittent pain comes and goes, rather than remaining present. Recurrent acute pain and brief breakthrough episodes do not accurately describe the ongoing pattern reported here.
At 0900, a patient following limb amputation reports burning pain: "It feels like it is in the foot that was removed, not at the incision." Which statements accurately represent this report in the pain-assessment note? Select all that apply.
- Burning incisional pain localized to the amputation site.
- Referred pain originating in a different, intact body region.
- Neuropathic pain associated with limb amputation.
- Pain perceived in the missing foot, consistent with phantom pain.
- Somatic nociceptive pain arising in the remaining limb's tissues.
Answer: Neuropathic pain associated with limb amputation., Pain perceived in the missing foot, consistent with phantom pain.
The section identifies pain perceived in a missing body part as phantom pain, a type of neuropathic pain. Referred pain would attribute the pain to another location, which this report does not establish. The remaining-tissue and incisional descriptions assign a source or location that the patient did not report.
At 1400, a patient with rheumatoid arthritis reports a sudden, brief increase in otherwise controlled chronic pain. The pain then returns to its previous level. The patient cannot identify a trigger, and the assessment has not established one. Which entry best reflects the available information?
- Brief breakthrough pain episode; no trigger identified.
- Acute pain caused by a new injury rather than breakthrough pain.
- Breakthrough pain caused by the regular pain medication wearing off.
- Stress-related breakthrough pain despite the regular medication regimen.
Answer: Brief breakthrough pain episode; no trigger identified.
A sudden, short-lived increase in pain can be breakthrough pain even when no cause is known. The report does not establish medication wearing off, a new injury, or stress, so the other entries assign unsupported causes.
Where every quote comes from
Section 7.1 Concepts and Causes of Pain of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.