this is Professor Hoffman in topic seven we're going to be looking at pain management medications it's going to be a three-part uh video series in this part we're want to do the introductory or background information so as we move forward then as you look at your um study guide we're going to be talking about the first three objectives so we want to talk about the physiologic so some of the a& P about pain going be able to compare and contrast acute and chronic pain and we want to look at the use of pain assessment tools so that's where we'll be going in this uh video then we'll move on to uh some specific uh classifications so in the anatomy and physiology of pain it's important to remember from those classes that we're looking at a neurological phenomenon uh we have receptors at the end of specialized nerves that are specific to pain receptors so they are going to be activated by any kind of a noxious stimuli in their area so this can be from uh physical uh causes heat uh pressure um that type of thing it can be caused from chemical um stimuli anything that activates those pain receptors they're called Nas acceptor uh no o c i c e p t o RS so those are the nerve endings um that are responsive specifically to painful stimuli uh so they're going to respond to direct injury but they're also going to respond to injury in the surrounding area and that's going to be influenced by the chemicals that are released by the cells and the tissue that have been injured part of that process is the inflammatory process and in that process we released some chemical mediators uh the one we're going to specifically look at as we talk about pain management medications is going to be prostaglandins uh they are chemical mediators released during the uh INF inflammatory process that are going to lower the thresold for pain for these NS acceptors they going to make them more sensitive to pain so it's going to increase the amount of pain that we're sensing that area because there is a presence of injury or inflammation so again the mediators are going to be primarily prostate glands we'll look at there as we look at that transmission from the site of injury or the site of stimulation uh that signal is sent up through those peripheral nerves to the spinal cord uh quite often they're going to cross over to another nerve that's going to travel up the spinal cord into the brain and there may be another transfer at that point before the signal finally gets to the air of the brain that interprets that signal then as a as pain please keep in mind that pain is not a bad thing it's an essential thing for us to have if we didn't have pain we wouldn't know when we're injured it's a very important safety mode however when it becomes um disabling for us uh then we will look at possibly using medications or other approaches to decrease our awareness of the pain uh so it's going to be an aid to just our normal activities of daily living to decrease pain and that's what we're going to be looking at these medications for with that pathway going from the side of injury um to the spinal cord and up to the brain there's a number of locations throughout the body uh where there are specific receptor sites at those Junction areas uh they're called opioid receptor sites and the ones we are specifically concerned about with pain are the MU mu receptors um they're again they're located in that nerve Channel system that takes that pain stimulus up to the brain to be interpreted as pain at these receptor sites these mu receptors um opioid type chemicals uh so when we think of our narcotic drugs when they are in our system when they get to these receptors they will attach to them and they will block the signal from passing past that receptor site so again we get a decreased level of pain because this pain signal does not make it to the brain so when we talk about our narcotics uh classification of drugs that's how they're going to be working so we'll look at that a little bit more when we get to that discussion in um the third video for this series it's important to keep in mind that we also produce a opioid type chemical in our bodies um as a precaution as a safety mechanism and when that opioid chemical reaches the MU receptor sites it to is going to block them and decrease our awareness of pain uh this is the type of thing called the runner's high we have this um sort of bathing of the system of this U internal opioid you you'll hear it referred to as endorphins those endorphins act like a narcotic drug they're going to block those mu receptors are going to block the signal going to the brain and decrease our level of pain so with things like the the runner's high or if someone is acting in crisis mode U at the sight of an accident or uh for our military individuals when they're in combat it's very possible that they may re um receive an injury but they are not aware of that injury until the situation quiets down because these endorphins these internal opioid chemical chemicals are released and they're blocking those M receptors so so again that's our internal analgesia it's going to be a safety uh outlet for us um a safety response for our body well you normally talk about pain as one of two types U we're going to talk about acute or chronic acute pain uh from as the name indicates it's usually starts Suddenly It's usually fairly short lived and you normally lasting more than 3 months quite often is much less than that and generally has a known cause something we can point to and say this is why I'm having uh this specific pain so the slide gives some examples of acute pain chronic pain then is pain that last 6 months or more and normally it's going to be caused as a result of a disease or a condition injury treatment inflammation chronic inflammation uh and sometimes it is uh we don't know the cause of it so chronic PL pain it may be harder to diagnose uh an ideology uh it's going to be long lasting it's going to be again more than 6 months it is going to be more of a lifestyle um issue for the individual that's experiencing it the next thing we want to look at is the importance of assessing pain as part of our nursing process um so we're familiar uh with the pain scales in this case the Wong uh Baker faces pain rating scales there where for someone who's non-verbal or with a child uh someone who doesn't speak English possibly or some sort of a language barrier it may be helpful to use uh the pictures for them to identify what is their level of pain below the pictures are the corresponding numbers of a 0 to 10 scale um so again if the person can um give us a description of pain based on that 010 scale that's what we'll ask them the W Baker becomes another tool that we can use in certain situations so again that is part of our normal assessment process we want to know what that level is but what's important at that point is taking that information of pain exist and getting more information so on this slide there are some pneumonics uh that give us a way of helping us remember what do we need to identify about the pain so like on the old carts we want to know when did it start where's it at how long is it been lasting uh is it um what does it feel like those types of things so each one of the pneumonics they're gives a different way of um developing a routine on how you're going to assess the pain once the person gives you a number or points at one of the diagrams on the Wong Baker uh scale cuz we need to know more information about that so this part of the pain assessment is really our critical thinking phase of the nursing process related to pain we want to know the why want to know how how bad is it but then through these pneumonics start identifying what are the possible sources of the pain and then we're going to implement um steps to help alleviate the pain if we can so that becomes a clinical reasoning clinical judgment part of the nursing process process we're going to take that information from the assessment and then make a determination of which medication or which class of medication best meets um the quality of pain that this patient's having so in this case it's a three tier those do do not correspond to the 0 to 10 scale directly so just keep that in mind uh but we start at the lowest level and so that is going to be a pain a pain of zero or one we're probably not going to do anything for uh if we get into a pain of 3 to five somewhere in that area um we're going to be looking at using a nonopioid so when we talk about the nids um here in the the next video that would be the case or we might be able to handle the pain by just doing nonpharmacological responses having the patient relax having them Focus um their attention elsewhere um just a number of things create a quiet environment there are things we can do that are are going to help um desensitize them possibly to a mild pain when we get in that area of moderate to severe pain or the moderate areas so the four to six 4 to 7 then we're going to be looking at adding possibly some light opioids so just adding some narcotics along with the nonopioids in this class and even when we get to the top one there is a class of nids that we'll talk about that can be used in place or in along with the opioids so at that second level where we're looking again from four to seven type we're going to have a number of drugs that we can look at or classifications and doing a combination when it's severe pain or moderate to severe so that third step here so we're looking at a pain of seven and greater then we're going to be looking most likely at opioids or something similar to the opioids as well as um some other approaches to help ease the pain so again that becomes our clinical reasoning clinical judgment we start out with a critical thinking phase of gathering information of how severe is your pain subjectively from the patient find out some of those um descriptors then based on that we are going to determine what pain medication is available that best matches that pain and if we don't have a medication that best matches it then that will be our trigger to contact the provider for an order that will um help us meet the patient needs so those are the background things as far as introduction so again just remember our anatomy and physiology is a neurological process does have a chemical component and we'll look at prostate glands and specifically with that um in the neurological component there's times we're going to be blocking neurological activities as part of our pain management so we'll look at each of those features as we go through and that is the conclusion for this video again we'll start talking about nonopioid um pain management classifications in the next video