Case Study B \"Chronic Pain\" Please answer questions 1-8. General anesthesia in
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Case Study B "Chronic Pain" Please answer questions 1-8.
General anesthesia involves administering a gas to be inhaled such as nitrous oxide or injecting a barbi- turate such as sodium pentothal intravenouslv. Loss of consciousness accompanies general anesthesia. Anal- gesics are required with these drugs. Neuroleptanesthesia is a type of general anesthesia in which the patient can respond to commands but is relatively unaware of the procedure or of any discomfort. For example, diazepam can be administered intravenously in com- bination with a narcotic analgesic such as meperidine or morphine. Droperidol (a neuroleptic) and fentanyl (a narcotic analgesic) are a popular combination (e.g., Innovar) that is administered by intravenous or intra muscular injection. had been drinking heavily at a family party and who was par- tially conscious. When she and her partner attempted to trans- fer the 100-kg man to a stretcher, the man grabbed her neck, causing her severe pain. Ms. J's doctor diagnosed a spinal injury and completed papers for Ms. J. to be absent from work. He recommended rest and application of heat and cold to the neck. One week later, Ms. J. saw him again, reporting continu- ing pain. She was referred to a specialist who told her she had a herniated disk in the cervical area of her neck and would require ongoing care and rehabilitation. Ms. J. has been on dis- ability leave for 6 months, during which she has continued to have severe neck, jaw, and back pain. She takes acetaminophen with codeine as required, and sees a physiotherapist and a registered massage therapist routinely in an attempt to control chronic pain. She is worried that her disability benefits will cease before she can return to work and has incurred debts during her leave. She also finds it difficult to care for her two children and keep the house clean. 1. What factors are significant in Ms. J.'s perception of pain? CASE STUDY A Acute Pain L.Y. is a healthy 13-year-old who had all her wisdom teeth removed 6 hours ago and is experiencing significant pain. She has been prescribed acetaminophen and codeine for pain relief and is at home recovering. Her mother wants her to rest and stop text messaging her friends about her dental surgery 1. How do acetaminophen and codeine act to reduce pain? 2. Why has Ms. J.'s doctor not prescribed stronger narcotic 3. Why does Ms. J. experience pain in her jaw and lower back 4. Where in the pain pathway do massage therapy and 5. Ms. J. is concerned about maintaining her physical fitness How might each be reduced? medication? when the injury was to her neck? physiotherapy act to alleviate pain? What is a side effect of high levels of each drug? Why has the dentist prescribed only a limited supply of the medication? and decides to attend exercise classes in her community pool.She finds this gives her more energy and reduces her pain. How does appropriate exercise affect pain perception? What precautions does Ms. J. need to observe when exercising? 2. How does L.Y.'s text messaging behavior affect her perception of pain? 3. Does L.Y. need to rest in bed quietly to reduce pain? 4. L.Y. becomes increasingly irritated with her mother and 6. Ms. J. hears about acupuncture as a help for back pain and tells her to "get off my case." How does L.Y.'s stress affect pain perception? does some research on the Internet before making arn appointment for treatment. How could acupuncture act to block impulses for pain? 7. After 8 months, Ms. J. is cleared to return to work on a part-time basis, which she manages well Why does she not return to full-time work immediately? CASE STUDY B Chronic Pain 8. What can Ms. J. expect in the future as a result of this Ms. J. is a 30-year-old healthy single mother with two children She has worked as a paramedic in her community for 6 years She and her partner responded to a call involving a man who injuryExplanation / Answer
CASE 1:
ANSWER 1. Acetaminophen is an analgesic, antiinflammatory and anti pyretic drug which acts primarily in CNS, increasing the pain threshold by inhibiting the both isoforms of cyclooxygenase. The codeine is a opioid drug used to relief pain. Codeine binds with opioid receptors in the brain that transmits the sensation of pain and increases the pain threshold.
ANSWER 2) The texting behavior of L.Y is a type of coping mechanism that will reduce the perception of pain. This act of text messaging exerts a divertional therapy which will allow her to divert her mind and cope with the painful event.
ANSWER 3) Not, its not that necessary to lie still in the bed to reduce pain. She can perform her actions according to her pain tolerance and those activities which will help her to reduce pain perception.
ANSWER 4) Stress is always directly proportional to the pain perception. The more stress more the perception of pain. Therefore L.Y's stress will increase her perception to pain.
CASE STUDY B
ANSWER 1) The factors that are significant in Ms.J pain perception is her family support, the financial burdens, sense of debility to carry daily rountines. Due to the injury to spine and herniated disc in the cervical area, she is already experiencing great amount of pain but her personal issues have decreased her pain threshold.
In order to reduce these stressors strong family support is needed. Her husband should participate in taking care of family and other household events. The financial burden can be reduced if she has a medical insurance that can cover her medical expenses. Use of physiotherapy and massage therapy will probably assist her to increase pain threshold and plan her activities.
ANSWER 2) The pain resulting herniated disc is a longterm pain for which the patient will have to take analgesic for a long duration of time. So if a stronger narcotic is prescribed then it will develop drug dependence and will also result in self intake of overdosage and toxicity.
ANSWER 3) The nerve roots present in the cervical area supplies impulses to jaw and back also. So irritation of the nerves due to herniation of disc result in jaw and back pain.
ANSWER 4) The massage therapy activates the pain gate mechanism so produces short hand analgesia. In physiotherapy, skin ytouch is believed to be powerful modulator, proprioceptive stimuli which will help in inhibit of painful stimuli in CNS. The strong stimulation of dorsal horn laminae activates interneurons thus modulates pain by inhibitory action.
ANSWER 5) Exercise which help the muscles to relax and increase the blood flow to the particular site of damage tissue. Thus it will increase the pain threshold and thereby decreases the pain perception. During exercise, the position of the neck is important. Walk erect with neutral head position. Exercise only after the pain has subsided.
ANSWER 6) Acupuncture exerts pain relief through various methods. Its acts upon the gath control mechanism. The pressure over the acupuncture site sends multiple fast moving impulses to the thalamus of brain which block the pain gate towards the impulses that travels slowly through thin fibers. It has been also found that acupunture increases the endorphins and encephalins in the fluid of brain which blocks the ability of pain to perceive pain.
ANSWER 7) Prolonged sitting and standing is not allowed after spine injuries especially with cervical injuries. She is a paramedic staff which involves risk for injury to her back and neck. More over maintaining neck and head posture after cervical spine injury is important so it will be difficult for the her to return to full time work immediately.
ANSWER 8) As a result of her injury, her activity level will get compromised. She has to remain cautious during her work in future to avoid heavy weight lifting and activities that may result in undue stress on neck and back.
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