Name: Saundra Streets E.R. Chronic pain
Uploaded: 2024-12-01
Duration: 4 min 32 s
Description: Hello My name is Saundra Streets and today we will be reviewing client ER with a diagnosis of chronic pain.

[Audio] Hello My name is Saundra Streets and today we will be reviewing client ER with a diagnosis of chronic pain. 

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[Audio] The pathophysiology of chronic pain is complex and multifactorial. Some causes of chronic pain are from tissue injuries, nervous system damage, inflammation or psychological factors.. 

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Complex and Multifactorial
 Tissue Injury Nervous System damage Inflammation Psychological factors

[Audio] Inflammation is the most observed sign of chronic pain. When inflammation is present the body releases certain chemicals from different cells. These chemicals attach to special locks on the surface of pain sensing nerves in the body, when they bind it causes the nerve to become more sensitive which can result in chronic pain.. 

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Inflammation manifests the releasing of inflammatory mediators from various types of cells; these inflammatory mediators, including proinflammatory cytokines, chemokines, HMGB1, and ATP, which can bind with their respective receptors on the nociceptive neurons in the peripheral, modulate their sensitivity and excitability, and then lead to chronic pain.

Many research suggests that microglia play a vital role in pain generation. When microglia are activated, pro-inflammatory and anti-inflammatory factors are produced in an imbalance.

[Audio] E.R.'s objective assessment findings were swollen joints, mainly in the thumbs. Decreased Range of motion to upper extremities. Facial Grimacing, decreased grip and dermatitis to lower legs. Subjective findings included fatigue, poor sleep patterns, depression and reports of brain fog.. 

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Swollen Joints in hands (bilateral thumbs) Decreased ROM in upper extremities Facial Grimacing upon certain movements Decreased grip Dermatitis to lower legs

Fatigue Sleep disturbances Depression Brain fog

[Audio] Culturally, E.R. prioritizes family needs over her own; her Puerto Rican family, as well as her religion, has stigmas around mental health. Genetic factors can be Mutations in SCN9a gene cause insensitivity to pain, grandmother and sister have autoimmune disease.. 

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Cultural & Genetic Considerations and Challenges

Cultural Puerto Rican- prioritizes family needs over personal wellbeing Stigmas around mental health Fear of being labeled a complainer Religion: Seventh-Day Adventists prefer to minimize pharmaceuticals and have a stigma about mental health.

Genetic Pain sensitivity genes Female gender is a risk factor for developing chronic regional pain syndrome Immune system irregularities have been shown to increase the risk of chronic pain

[Audio] Nursing plan of care to include evaluation of pain using a standardized scale. Evaluating anxiety and depression, non-pharmacological methods such as Cognitive brain therapy. CBT reframes negative thoughts encourage P.T. as it enhances and strengthens ROM, medications NSAIDs for mild pain, Antidepressants for neuropathic pain, opioids for severe pain and education on the risk of dependency. 

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Use a standardized pain scale to evaluate pain Use HADS (hospital anxiety & depression tool) Non-Pharmacological Strategies- CBT(cognitive behavior therapy) Encourage PT Heat & cold therapy Administer medications as appropriate Educate patient on pain meds and side effects

[Audio] The literature on healthcare teams reveals that the role of a dedicated manager to direct and coordinate patient care is associated with improved outcomes, specifically a nurse care manager. The nurse care manager can then coordinate care with PCPs, P.T., and behavioral medicine. If chronic pain isn't managed the client may be referred to pain management for either medication adjustments or RF ablation therapy. Since E.R. doesn't use narcotics, pain management isn't something she is interested in.. 

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Nurse Care Manager PCP Physical Therapy Behavioral medicine

[Audio] The first step to involve the client as a part of the care team is develop a Therapeutic relationship with communication, empathy and support. Create Individualized care plans, and setting realistic and meaningful goals using SMART goals, specific, measurable, achievable, relevant, and time bounding-Self management techniques to promote independence, relaxation . activity pacing and CBT . pain diaries allow client to discover patterns . Active participation in Plan Of Care improves strategies that are not working.. 

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Establish a Therapeutic Relationship Involvement in individualized care plans (SMART) Self Management strategies Pain Diaries Active participant in adjustments to Plan of care

[Audio] Although I work in the operating room, I can help other co-workers who face similar issues such as E.R. If E.R. is having an increased amount of pain, she would be better suited in a circulator role versus a scrub role, due to her pain is mostly in joints of the hands and knees, standing and passing instruments all day would not be ideal for her. Keeping a positive culture at work will help reduce E.R.s anxiety and depression associated with her disease and assist her when she is showing signs of fatigue or pain.. 

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Working in the operating room, I rarely treat pain issues unless it’s a surgical intervention.
 E.R. is a coworker; therefore, understanding her pain  is crucial to knowing which position is better suited for her daily ( as a scrub tech or circulator) Fibromyalgia can affect behavior, and understanding chronic pain can help mitigate E.R.’s thought processes to positive rather than negative. Assisting E.R. when needed will reduce her overuse of joints and strengthen teamwork relationships

References. Puntillo, F., Giglio, M., Paladini, A., Perchiazzi, G., Viswanth, O., Urits, I., Sabba, L., Varrassi, G., & Brienza, N. (2021). Pathophysiology of musculoskeletal pain: a narrative review. Therapeutic Advances in Musculoskeletal Disease., 13(1). https://doi.org/1177/1759720x21995067 Vergen-Salle, P., & Bertin, P. (2021). Chronic pain and neuroinflammation. Joint Bone Spine, 88(6) https://doi.org/10.1016/j.jbspin.2021.105222 Fang, X.-X., Zhai, M.-N., Zhang, Z.-J., He, C., Wang, H., Wang, J., & Zhu, M. (2023). Inflammation in pathogenesis of chronic pain: Foe and friend. Molecular Pain, 19. https://doi.org/10.1177/17448069231178176 Banasik, J. L. (2022). Pathophysiology (7th ed.). Elsevier.
ISBN-13: 9780323761550. 

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Puntillo, F., Giglio, M., Paladini, A., Perchiazzi, G., Viswanth, O., Urits, I., Sabba, L., Varrassi, G.,         	& Brienza, N. (2021). Pathophysiology of musculoskeletal pain: a narrative review. Therapeutic 	Advances in Musculoskeletal Disease., 13(1). https://doi.org/1177/1759720x21995067
 Vergen-Salle, P., & Bertin, P. (2021). Chronic pain and neuroinflammation. Joint Bone Spine, 88(6) 	https://doi.org/10.1016/j.jbspin.2021.105222
 Fang, X.-X., Zhai, M.-N., Zhang, Z.-J., He, C., Wang, H., Wang, J., & Zhu, M. (2023). Inflammation in pathogenesis of chronic pain: Foe and friend. Molecular Pain, 19. https://doi.org/10.1177/17448069231178176
 Banasik, J. L. (2022). Pathophysiology (7th ed.). Elsevier.
ISBN-13: 9780323761550

Saundra Streets 
E.R.
Chronic pain


Hello My name is Saundra Streets and today we will be reviewing client ER with a diagnosis of chronic pain

avatar

The pathophysiology of chronic pain is complex and multifactorial. Some causes of chronic pain are from tissue injuries, nervous system damage, inflammation or psychological factors.

Inflammation is the most observed sign of chronic pain. When inflammation is present the body releases certain chemicals from different cells. These chemicals attach to special locks on the surface of pain sensing nerves in the body, when they bind it causes the nerve to become more sensitive which can result in chronic pain.

E R 's objective assessment findings were swollen joints, mainly in the thumbs. Decreased Range of motion to upper extremities. Facial Grimacing, decreased grip and dermatitis to lower legs. Subjective findings included fatigue, poor sleep patterns, depression and reports of brain fog.

Culturally, E R  prioritizes family needs over her own; her Puerto Rican family, as well as her religion, has stigmas around mental health. Genetic factors can be Mutations in SCN9a gene cause insensitivity to pain, grandmother and sister have autoimmune disease.

Nursing plan of care to include evaluation of pain using a standardized scale. Evaluating anxiety and depression, non pharmacological methods such as Cognitive brain therapy. C-B-T reframes negative thoughts encourage P T  as it   enhances and strengthens R-O-M--, medications NSAIDs for mild pain, Antidepressants for neuropathic pain, opioids for severe pain and education on the risk of dependency

The literature on healthcare teams reveals that the role of a dedicated manager to direct and coordinate patient care is associated with improved outcomes, specifically a nurse care manager. The nurse care manager can then coordinate care with PCPs, P T , and behavioral medicine. If chronic pain isn't managed the client may be referred to pain management for either medication adjustments or RF ablation therapy. Since E R  doesn't use narcotics, pain management isn't something she is interested in.

The first step to involve the client as a part of the care team is develop a Therapeutic relationship  with communication, empathy and support. Create Individualized care plans, and setting realistic and meaningful goals using S-M-A-R-T goals, specific, measurable, achievable, relevant, and time bounding Self management techniques to promote independence,  relaxation . activity pacing and C-B-T . pain diaries allow client  to discover patterns . Active participation  in Plan Of Care improves strategies that are not working.

Although I work in the operating room, I can help other co workers who face similar issues such as E R  If E R  is having an increased amount of pain, she would be better suited in a circulator role versus a scrub role, due to her pain is mostly in joints of the hands and knees, standing and passing instruments all day would not be ideal for her. Keeping a positive culture at work will help reduce E R s anxiety and depression associated with  her disease and assist her when she is showing signs of fatigue or pain.

 Puntillo, F., Giglio, M., Paladini, A., Perchiazzi, G., Viswanth, O., Urits, I., Sabba, L., Varrassi, G.,         	& Brienza, N. (2021). Pathophysiology of musculoskeletal pain: a narrative review. Therapeutic 	Advances in Musculoskeletal Disease., 13(1). https://doi.org/1177/1759720x21995067
 Vergen-Salle, P., & Bertin, P. (2021). Chronic pain and neuroinflammation. Joint Bone Spine, 88(6) 	https://doi.org/10.1016/j.jbspin.2021.105222
 Fang, X.-X., Zhai, M.-N., Zhang, Z.-J., He, C., Wang, H., Wang, J., & Zhu, M. (2023). Inflammation in pathogenesis of chronic pain: Foe and friend. Molecular Pain, 19. https://doi.org/10.1177/17448069231178176
 Banasik, J. L. (2022). Pathophysiology (7th ed.). Elsevier.
ISBN-13: 9780323761550
