Total Pain Concept
What is "total pain"?
Pain with physical, psychological, social, and spiritual components.
What is the gold standard for pain assessment?
The patient's self-report.
What is the most common opioid side effect?
Constipation.
Who is at higher risk for OIN?
Frail, elderly, dehydrated, or those with renal impairment.
What is the preferred route for pain medication?
Oral, when possible.
Give one example of emotional/psychological pain.
Fear, anxiety, sadness, embarrassment, or worry about decline.
What is somatic pain?
Well-localized pain from muscles, bones, or tissues.
Which opioid side effects usually subside in a few days?
Nausea and sedation.
Which opioids are more likely to cause OIN?
Morphine (hydromorphone is preferred in risk cases).
What is breakthrough pain?
Pain occurring between regular doses, requiring PRN medication.
What does social pain often stem from?
Isolation, loss of connection, role changes, or not seeing loved ones.
What is visceral pain?
Deep, poorly localized pain with nausea, vomiting, and possible referred pain.
What is respiratory depression caused by?
Too-high opioid dose or rapid increases (treated with naloxone).
Name one symptom of OIN.
Hallucinations, delirium, myoclonus, hyperalgesia, allodynia.
Active listening, mindfulness, relaxation, journaling, art/music therapy.
What characterizes spiritual pain?
Loss of meaning, questioning beliefs, regret, fear of afterlife.
What should nurses observe if a patient cannot self-report pain?
Behavioural cues like grimacing, crying, guarding, or yelling.
What is physical dependence?
A normal physiological response to regular opioid use.
What is allodynia?
Pain from normally non-painful stimuli (e.g. sheets, clothing).
Give one social pain intervention.
Encourage connection, involve family, reduce isolation, pet therapy.
What might a patient mean when they say "everything hurts" or "I'm all wrong"?
Physical cues may signal deeper total pain requiring exploration.
What is a "trial treatment" used for in pain assessment?
To see if behaviours improve with analgesics when pain is suspected.
What is opioid tolerance?
Needing higher doses over time for the same effect (normal/expected).
What are two key management strategies for OIN?
Opioid rotation and hydration (plus reassurance and education).
What is a key spiritual intervention for pain?
Providing presence, encouraging expression, connecting to nature/beliefs.