Pharmacology · chapter 14 · Pain Response Drugs
Introduction to 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 6 practice questions with the reasoning.
Key points
Pain is what the client says
Pain is, by nature, a subjective experience that the client describes to the health care provider, so many health care professionals practically define pain as “whatever the client says it is.”
Acute pain
Acute pain is typically sudden in onset and will usually have a duration of less than a month. Acute pain is commonly caused by events such as trauma, injury, or certain medical treatments such as surgery.
Chronic pain and its complications
Because of the chronic nature of this type of pain, affected individuals are more likely to develop long-term complications such as depression, anxiety, substance use disorders, and chronic disability.
Somatic pain
Somatic pain typically occurs in parts of the body such as the skin, bones, and muscles. It tends to be easily pinpointed, may be described as sharp, and is localized to the injured tissue.
Visceral pain
Visceral pain affects internal organs such as the stomach and liver. It may be described as deep, dull, aching sensations that can be more difficult to localize.
Causes of neuropathic pain
Neuropathic pain can result from various neurologic conditions, such as diabetic neuropathies, stroke, multiple sclerosis, herpes zoster (shingles), and phantom limb pain related to an amputation.
How neuropathic pain feels
Neuropathic pain is often described as burning, tingling, or shooting pains that radiate from one location to another.
When number scales fail
These types of scales may not be appropriate when clients do not understand the question or cannot communicate their pain. In cases such as these, other tools are available.
Physical signs of pain
Health care professionals also assess clients for physical signs of pain, which can be indicated by facial expressions, muscle tension, and body movements.
Function as evidence of relief
Generally, when a client’s pain status improves, they should be able to do more of the things they wish to do. This provides more objective evidence than relying solely on client self-reporting.
Stoic clients
Some people may live with a great deal of chronic pain but are stoic and do not exhibit outward signs of it.
When to use the FACES scale
It is especially useful when the client is too young to understand a pain-scale question or when a language barrier exists.
Five steps of nociception
Nociception is a complex process that involves five steps: transduction, conduction, transmission, modulation, and perception.
Bias leads to undertreatment
Researchers have found that health care providers often carry implicit biases that may cause them to underestimate pain in clients due to false perceptions of physiologic differences between people of different ethnicities.
Terms to know
- Chronic pain
- Chronic pain typically lasts longer than 3 months.
- Nociceptive pain
- Nociceptive pain is pain that arises from injury to bodily tissue, such as pain related to traumatic injury, surgery, or infection.
- neuropathic pain
- In contrast to nociceptive pain, neuropathic pain is pain that arises from the nerves of the peripheral and central nervous systems.
- referred pain
- In some cases, deep visceral pain may cause pain elsewhere in the body, which is known as referred pain (e.g., pancreatic injury causing back pain, myocardial infarction causing jaw and shoulder pain; see Figure 14.2).
- Nociception
- Pathophysiology of Pain Nociception is the term used to describe the processing of noxious stimuli by both the peripheral and central nervous systems.
- pain threshold
- Pain Threshold The pain threshold is the point at which someone perceives a stimulus to be painful.
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
A client rates his pain 8 out of 10 but is lying quietly and chatting with visitors. How should the nurse interpret this?
- Pain is subjective; some people are stoic and do not show outward signs.
- The rating should be lowered to match his behavior.
- The client is exaggerating because he looks comfortable.
- Pain medication should be withheld until he looks uncomfortable.
Answer: Pain is subjective; some people are stoic and do not show outward signs.
Pain is a subjective experience, practically defined as whatever the client says it is, and some people live with a great deal of pain but are stoic and show no outward signs. Doubting, changing the rating, or withholding medication ignores the client's report.
A 4-year-old cannot answer when asked to rate pain from 0 to 10. Which approach should the nurse use?
- Assess pain only by checking the blood pressure.
- Ask the child to point to the face drawing that best matches how they feel.
- Record the pain as 0.
- Wait until the child is older to assess pain.
Answer: Ask the child to point to the face drawing that best matches how they feel.
Numeric scales may not be appropriate when a client does not understand the question; the nurse can show drawings of faces and ask the child to point to the one that matches. Recording zero, waiting, or relying on blood pressure alone does not assess the child's pain.
A client with long-standing diabetes describes burning and tingling in both feet that shoots up the legs. Which type of pain is this most likely?
- Somatic pain
- Referred pain
- Visceral pain
- Neuropathic pain
Answer: Neuropathic pain
Neuropathic pain arises from the nerves, can result from diabetic neuropathies, and is often described as burning, tingling or shooting pain that radiates. Somatic pain is sharp and localized, visceral pain is deep and aching in organs, and referred pain comes from an internal organ.
A nurse is assessing pain in a client who cannot communicate verbally. Which findings can indicate pain? Select all that apply.
- Muscle tension
- Facial expressions
- Body movements
- Changes in what the client is able to do
- Eye color
Answer: Muscle tension, Facial expressions, Body movements, Changes in what the client is able to do
Physical signs of pain include facial expressions, muscle tension and body movements, and observing functional impairment is another important way to assess pain. Eye color is not a sign of pain.
Which statements about chronic pain are accurate? Select all that apply.
- It increases the risk of depression and substance use disorders.
- It always has a sudden onset after surgery.
- It typically lasts longer than 3 months.
- Its cause can be entirely unknown.
- It usually resolves in less than a month.
Answer: It increases the risk of depression and substance use disorders., It typically lasts longer than 3 months., Its cause can be entirely unknown.
Chronic pain typically lasts longer than 3 months, can be idiopathic, and raises the risk of long-term complications such as depression, anxiety, substance use disorders and disability. Sudden onset and duration under a month describe acute pain.
A nurse wants objective evidence that a client's pain treatment is working. Which finding is most useful?
- The client asks fewer questions.
- The client's skin color is unchanged.
- The client sleeps during visiting hours.
- The client is now able to walk to the garden and play with his children.
Answer: The client is now able to walk to the garden and play with his children.
When pain improves, the client should be able to do more of the things they wish to do, which gives more objective evidence than self-report alone. Fewer questions, skin color and sleeping during visits are not described as measures of pain relief.
Where every quote comes from
Section 14.1 Introduction to Pain of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, 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.