Nursing Management of Pain

Pain Mechanisms o Nociception: physiologic process that communicates tissue damage to the CNS o Involves four processes: o Transduction: conversion of a noxious (tissue damaging), mechanical (surgical incision), thermal (sunburn), or chemical (toxic substances) stimulus into a neuronal action potential ▪ Noxious stimuli cause release of a “biologic soup” of chemicals into the damaged tissues. ▪ Inflammation lowers nociceptor threshold ▪ Therapies that alter local environment or sensitivity of peripheral nociceptors • Prevent transduction and initiation of an action potential o NSAIDS – Corticosteroids ▪ Inhibit production of the nerve impulse ▪ Local anesthetics – lidocaine - Antiseizure o Transmission: process by which pain signals are relayed from the periphery to the spinal cord and then to the brain; three segments 1. Transmission along the peripheral nerve fibers to the spinal cord 2. Dorsal horn processing 3. Transmission to the thalamus and the cerebral cortex ▪ Exogenous and endogenous opioids bind to opioid receptors, blocking the release of neurotransmitters ▪ Produce analgesic effect similar to morphine ▪ **Central sensitization occurs through increased sensitivity and excitability in spinal neurons – acute unrelieved pain leads to chronic pain by this process