{"id":475,"date":"2019-12-01T20:17:06","date_gmt":"2019-12-02T01:17:06","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/10-2-pain-and-mobility-concepts\/"},"modified":"2023-08-01T12:15:50","modified_gmt":"2023-08-01T16:15:50","slug":"10-2-pain-and-mobility-concepts","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/10-2-pain-and-mobility-concepts\/","title":{"raw":"10.2 Pain and Mobility Concepts","rendered":"10.2 Pain and Mobility Concepts"},"content":{"raw":"
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Concepts Related to Pain<\/h1>\r\nThis resource provides a basic introduction to the concept of pain as it relates to pharmacology. The concept of [pb_glossary id=\"808\"]pain<\/strong>[\/pb_glossary] is defined as \"an unpleasant sensory and emotional experience associated with actual or potential tissue damage\"[footnote]Jean Giddens, Concepts of Nursing Practice \u2013 2nd edition (Missouri: Elsevier, 2017)[\/footnote].\r\n\r\nThe example concept map in figure 10.2a provides a summary of the key information necessary to understand pain informed by several resources.[footnote] Jean Giddens, Concepts of Nursing Practice \u2013 2nd edition<\/em> (Missouri: Elsevier, 2017)[\/footnote]\r\n\r\nYou are encouraged to revisit this map after you have completed the chapter.<\/a>\r\n\r\n \r\n\r\n[caption id=\"attachment_472\" align=\"aligncenter\" width=\"1152\"]\"this Figure 10.2a Pain Concept Map [Image Description<\/a><\/em>][\/caption]Before addressing the medications that are used to treat analgesic and musculoskeletal conditions in our clients, it is important to review the physiology of pain and the anatomy of the musculoskeletal system.\r\n

Analgesic System<\/h1>\r\n

Physiology of Pain<\/h2>\r\nPain occurs when there is tissue damage in the body. Tissue damage activates pain receptors of peripheral nerves. [pb_glossary id=\"754\"]Nociceptors[\/pb_glossary], the nerve endings that respond to painful stimuli, are located in arterial walls, joint surfaces, muscle fascia, periosteum, skin, and soft tissue. Nociceptors are barely present in most internal organs.[footnote]Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice (11th ed.)<\/em>. (pg. 305, 310, 952-953, 959-960). Wolters Kluwer.[\/footnote]\r\n\r\nThe cause of tissue damage may be physical (e.g., heat, cold, pressure, stretch, spasm, and ischemia) or chemical (pain-producing substances are released into the extracellular fluid surrounding the nerve fibers that carry the pain signal). These pain-producing substances activate pain receptors, increase the sensitivity of pain receptors, or stimulate the release of inflammatory substances (e.g., [pb_glossary id=\"755\"]prostaglandins[\/pb_glossary]).[footnote]Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice (11th ed.)<\/em>. (pg. 305, 310, 952-953, 959-960). Wolters Kluwer.[\/footnote] Pain can also activate the physiological stress response.[footnote]Finnerty, C., Mabvuure, N., Ali, A., Kozar, R., & Herndon, D. (2014). The Surgically Induced Stress Response. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3920901\/[\/footnote]\r\n\r\nFor a person to feel pain, the signal from the nociceptors in peripheral tissues must be transmitted to the spinal cord and then to the hypothalamus and cerebral cortex of the brain. The signal is transmitted to the brain by two types of nerve cells (A-delta and C fibers). The dorsal horn of the spinal cord is the relay station for information from these fibers. In the brain, the thalamus is the relay station for incoming sensory stimuli, including pain. From the thalamus, the pain messages are relayed to the cerebral cortex where they are perceived.[footnote]Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice (11th ed.)<\/em>. (pg. 305, 310, 952-953, 959-960). Wolters Kluwer.[\/footnote] See Figure 10.2b for an illustration of how the pain signal is transmitted from peripheral tissues to the spinal cord and then to the brain.[footnote]\"Sketch colored final.png<\/a>\" by Bettina Guebeli<\/a> is licensed under CC BY-SA 4.0<\/a>[\/footnote]\r\n\r\n[caption id=\"attachment_472\" align=\"aligncenter\" width=\"876\"]\"Illustration, Figure 10.2b The Transmission of Pain from Peripheral Tissues to the Brain[\/caption]\r\n

Endogenous Analgesia<\/h2>\r\nThe CNS has its own endogenous analgesia system for relieving pain. The CNS suppresses pain signals from peripheral nerves. Opioid peptides interact with opioid receptors to inhibit the perception and transmission of pain signals. These opioid peptides are endorphins, enkephalins, and dynorphins.[footnote]. Frandsen, G. & Pennington, S. (2018). Abrams\u2019 clinical drug: Rationales for nursing practice (11th ed.)<\/em>. (pg. 305, 310, 952-953, 959-960). Wolters Kluwer.[\/footnote]\r\n\r\nSee the video below for more information about how pain relievers work.\r\n
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How Do Pain Relievers Work? by George Zaidan<\/strong>[footnote]Ted-Ed. (2012, June 26). How Do Pain Relievers Work? - George Zaidan [Video]. YouTube. https:\/\/youtu.be\/9mcuIc5O-DE<\/a>[\/footnote]<\/p>\r\nhttps:\/\/www.youtube.com\/watch?v=9mcuIc5O-DE\r\n\r\n<\/div>\r\n

The Concept of Mobility and the Musculoskeletal System<\/h1>\r\nThe concept of [pb_glossary id=\"809\"]mobility[\/pb_glossary] is defined as \"purposeful physical movement, including gross simple movements, fine complex movements, and coordination; State or quality of being mobile or movable.\"[footnote]Jean Giddens, Concepts of Nursing Practice \u2013 2nd edition (Missouri: Elsevier, 2017)[\/footnote]. <\/span>\r\n\r\nIn the musculoskeletal system, the muscular and skeletal systems work together to support and move the body. The bones of the skeletal system serve to protect the body's organs, support the weight of the body, and give the body shape. The muscles of the muscular system attach to these bones, pulling on them to allow for movement of the body.[footnote]Khan Academy. (n.d.). The musculoskeletal system review.<\/em>https:\/\/www.khanacademy.org\/science\/high-school-biology\/hs-human-body-systems\/hs-the-musculoskeletal-system\/a\/hs-the-musculoskeletal-system-review<\/a>[\/footnote] See Figure 10.2c for an illustration of the musculoskeletal system.[footnote]This image is a derivative of \"1105 Anterior and Posterior Views of Muscles.jpg<\/a>\" by CFCF<\/a> is licensed under CC BY 4.0<\/a>[\/footnote]\r\n\r\n<\/div>\r\n
\r\n\r\n \r\n\r\n[caption id=\"attachment_474\" align=\"aligncenter\" width=\"918\"]\"Illustration, Figure 10.2c The Musculoskeletal System[\/caption]\r\n

Muscles<\/h2>\r\nThe body contains three types of muscle tissue: skeletal muscle, smooth muscle, and cardiac muscle. See Figure 10.2d for images of different types of muscle.[footnote]\"414 Skeletal Smooth Cardiac.jpg<\/a>\" by OpenStax College<\/a> is licensed under CC BY 4.0<\/a>[\/footnote]\r\n\r\n \r\n\r\n[caption id=\"attachment_474\" align=\"aligncenter\" width=\"304\"]\"Micrographs Figure 10.2d (a) Skeletal muscle; (b) Smooth muscle; (c) Cardiac muscle[\/caption]\r\n\r\nSkeletal muscle is voluntary and striated. These are the muscles that attach to bones and control conscious movement. Smooth muscle is involuntary and non-striated. It is found in the hollow organs of the body, such as the stomach, intestines, and around blood vessels. Cardiac muscle is involuntary and striated. It is found only in the heart and is specialized to help pump blood throughout the body.[footnote]Khan Academy. (n.d.). The musculoskeletal system review.<\/em> https:\/\/www.khanacademy.org\/science\/high-school-biology\/hs-human-body-systems\/hs-the-musculoskeletal-system\/a\/hs-the-musculoskeletal-system-review<\/a>[\/footnote]\r\n\r\nWhen a muscle fiber receives a signal from the nervous system, myosin filaments are stimulated, pulling actin filaments closer together. This shortens sarcomeres within a fiber, causing it to contract.[footnote]Khan Academy. (n.d.). The musculoskeletal system review. <\/em>https:\/\/www.khanacademy.org\/science\/high-school-biology\/hs-human-body-systems\/hs-the-musculoskeletal-system\/a\/hs-the-musculoskeletal-system-review<\/a>[\/footnote]\r\n\r\n<\/div>\r\n

Image Description<\/h1>\r\n<\/a>Figure 10.2a Pain Concept Map image description:<\/strong>\u00a0This is a concept map that shows the components of pain. It starts with the definition for pain:\u00a0an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Then, the concept map continues through the following categories:\r\n\r\nScope\r\n