Pain Control: An Open Learning Introduction for Healthcare Workers

124 Pages·2018·8.52 MB·English

by  Stalker, Agnes E

PA I N C O N T RO L
An open learning programme
for healthcare workers
Nan Stalker
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
U S I NG T H IS W O R K B O OK
The workbook is divided into 'sessions', covering specific subjects.
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In the introduction to each learning pack there is a learner profile to help you
assess your current knowledge of the subjects covered in each session.
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Each session has clear learning objectives. They indicate what you will be able
to achieve or learn by completing that session.
Each session has a summary to remind you of the key points of the subjects
covered.
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Each session contains text, diagrams and learning activities that relate to the
stated objectives.
T
It is important to complete each activity, making your own notes and writing in
answers in the space provided. Remember this is your own workbook—you are
allowed to write on it.
T
Now try an example activity.
Acrwm
This activity shows you what happens when cells work without oxygen. This
really is a physical activity, so please only try it if you are fully fit.
First, raise one arm straight up in the air above your head, and let the other hand
rest by your side. Clench both fists tightly, and then open out your fingers wide.
Repeat this at the rate of once or twice a second. Try to keep clenching both fists
at the same rate. Keep going for about five minutes, and record what you
observe.
Stop and rest for a minute. Then try again, with the opposite arm raised this time.
Again, record your observations.
T
Suggested timings are given for each activity. These are only a guide. You may
like to note how long it took you to complete this activity, as it may help in
planning the time needed for working through the sessions.
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Time taken on activity
T
Time management is important. While we recognise that people learn at
different speeds, this pack is designed to take 15 study hours (your tutor will
also advise you). You should allocate time during each week for study.
T
Take some time now to identify likely periods that you can set aside for study
during the week.
Mon Tues Wed Thurs Fri Sat Sun
am
pm
eve
•
At the end of the learning pack, there is a learning review to help you assess
whether you have achieved the learning objectives.
A C K N O W L E D G E M E N TS
Writer: Nan Stalker
Reviewer: Gill Young
Director of programmes: Leslie Mapp
Programmes manager: Caroline Pelletier
Production manager: Stephen Moulds, DSM Partnership
The views expressed are those of the team members and do not necessarily reflect those
of The Open Learning Foundation.
The publishers have made all reasonable efforts to contact the holders of copyright
material included in this publication.
© 1999 Open Learning Foundation
Radcliffe Medical Press Ltd
18 Marcham Road, Abingdon, Oxon 0X14 1AA
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system or transmitted in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without the prior permission of the copyright
owner.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
ISBN 1 85775 436 0
Typset by DSM Partnership, London SW18
Printed and bound by TJ International Ltd, Padstow, Cornwall
C O N T E N TS
Introduction 1
Learning Profile 2
Session One: Neurones 7
Session Two: The brain 17
Session Three: The spinal cord 27
Session Four: Voluntary and reflex action and the autonomic nervous system 33
Session Five: The human experience of pain 39
Session Six: Natural analgesic systems 45
Session Seven: The development of chronic pain 51
Session Eight: The pharmacology of pain control 63
Session Nine: The practice of pain management 79
Learning Review 85
Further Reading 89
Useful Web addresses related to pain 91
Resources Section 93
1 Making connections - the synapse 94
2 Action potential 96
3 Pathophysiology of acute pain 98
4 Management of the individual with pain, part 1: physiology and evaluation 101
5 Acupuncture, a brief introduction 104
6 Antidepressants and chronic pain 107
7 How to hit pain before it hurts you 109

I N T R O D U C T I ON
This unit focuses primarily on the pharmacological aspects of pain and pain control.
In Session One we revise the topic of neurones. We identify different types of neurone
and discuss nerve impulses, neurotransmitters and types of nerve fibre ending.
In Session Two we revise the topic of the structure and function of the brain. We look at
the different parts of the brain, and discuss the membranes which cover the brain - the
meninges - and the cerebrospinal fluid which protects the brain and the spinal cord.
In Session Three we revise the topic of the structure and function of the spinal cord. We
discuss the structure of the spinal cord, and consider peripheral, cranial, spinal and
cervical nerves.
In Session Four we revise the topic of voluntary and reflex action and the autonomic
nervous system. We start by discussing the function of the central nervous system then
discuss voluntary movement and reflex action. We also consider the two parts of the
autonomic nervous system: the sympathetic nervous system and the parasympathetic
nervous system.
In Session Five we discuss the human experience of pain. We review the history of
pain, distinguish between acute and chronic pain, and discuss the modulation of pain.
In Session Six we look at the natural analgesic systems of the human body. We start by
discussing the endogenous opioid systems of the body and their role in controlling pain.
We then go on to consider how acupuncture draws upon these systems to control pain.
We also discuss the issues of referred pain and projected or phantom pain.
In Session Seven we look at the development of chronic pain. We start by looking at
how different types of pain are transmitted: in particular, we look at the role played by
peripheral sensitisation and hyperalgesia in transmitting chronic pain. We then consider
the role of a range of chemical mediators in transmitting pain. Next, we look at drugs
that relieve pain by sensitising the nociceptors. Finally, we consider the issue of central
sensitisation to pain, and the problem of peripheral nerve damage.
In Session Eight we look at the pharmacology of pain control. We start by defining the
most important terms used in the session, then go on to discuss an important group of
drugs - the non-steroidal anti-inflammatory drugs or NSAIDs. We consider the
mechanisms of NSAIDs, their therapeutic uses and some of the side effects which can
be associated with them. Next, we discuss the use of opioids: how they work, their
pharmacological properties, their effects, their therapeutic use and the problems of
tolerance, withdrawal and dependence. Finally, we consider the use of some other drugs
to relieve pain.
In Session Nine we look at the management of pain. We start by considering the World
Health Organisation analgesic ladder of pain management, then look in more detail at
the use of drugs in pain management, and consider the problems of drug dependence
and what is known as 'the pain habit'.
PAIN CONTROL
Learning Profile
Below is a list of learning statements for this unit. You can use it as a way of identifying
your current knowledge and deciding how the unit can develop your learning. It is for
your general guidance only. You will need to check each individual session in more
detail to identify specific areas on which you need to focus.
For each of the outcomes listed below, tick the box on the scale which most closely
corresponds to your starting point. This will give you a profile of your learning in the
areas covered in each session of this unit. The profile is repeated again at the end of this
unit as a learning review, and you will be able to check the progress you have made by
repeating it again then.
Not at Partly Quite Very
all well well
Session One
I can:
• describe a typical neurone Q Q Q Q
• identify different types of neurone
and explain their functions • • • •
• explain the function of nerve endings • • • •
• identify the electrical and chemical
factors essential in the functioning
of nerve tissue. Q Q Q Q
Session Two
I can:
• summarise the functions of the
central nervous system • • • Q
• identify the structure and function of
the five main parts of the brain • • • Q
• explain the function of the ventricles
of the brain • • • •
• explain the role of the meninges and
cerebrospinal fluid. Q Q Q Q
PAIN CONTROL
Not at Partly Quite Very
all well well
Session Three
I can:
• explain the structure and function
of the spinal cord • • • •
• identify the peripheral nerves • • • •
• explain the type, function and
distribution of the twelve cranial nerves • • • •
• explain the function and route of
the spinal nerves. • • • •
Session Four
I can:
• explain the anatomical difference between
a voluntary movement and a reflex action • Q Q •
• explain the roles of the sympathetic and
parasympathetic nervous systems Q Q Q Q
• identify the functions of the autonomic
nervous system. • • • •
Session Five
I can:
discuss the belief that pain is not a
sensation but an emotion Q • • Q
identify the different types of pain and
their physiological background • • Q •
explain the functions of the two main
types of nociceptor • • • •
discuss the value of superficial electrical
stimulus in the control of acute pain • • • •
evaluate the stimulation of the brain and
spinal cord in the control of pain. • • • •