Nursing Care of Patients in Pain – Flashcards

too much sleep and rest overuse of pain medication overuse of alcohol gender correct ​Rationale: The pain threshold is the point at which a stimulus elicits a response. Clinical and animal studies show that women have a lower pain threshold and experience a higher intensity of pain than men.​ Medications, alcohol,​ sleep, and rest may raise pain tolerance.

specificity cultural and genetic factors This is the correct answer. pattern previous sensitization ​Rationale: The neuromatrix theory of pain integrates cultural and genetic factors with basic neurophysiological function. According to this​ theory, the brain contains a​ body-self neuromatrix, a widely distributed network of neurons that are affected by both genetic factors and sensory experiences. The neuromatrix integrates multiple sources of input in addition to the stimuli of pain and touch. Other sensory systems that help interpret the​ input, such as​ attention, expectation,​ personality, and​ culture, innate pain modulation​ systems, and components of​ stress-regulation systems, all contribute to the pain experience for the individual. Specificity and pattern theories describe nerve impulses of varying intensity terminating in pain centers in the forebrain. According to the pain sensitization​ theory, painful signals create a cascade of changes in the nervous​ system, which increases the responsiveness of the peripheral and central neurons. These changes increase the response to future signals and amplify pain.

The patient wants attention. The patient is demanding. The​ patient's pain is real. This is the correct answer. The patient just wants medication. ​Rationale: If the patient says he or she has​ pain, the patient is in pain. All pain is real. Nurses should not be judgmental when responding to a​ patient's report of pain. This is a common bias and is a barrier to effective pain management. Concluding that the patient is demanding or just wants attention reflects a biased interpretation.

chronic nonmalignant pain This is the correct answer. recurrent acute pain chronic malignant pain ongoing​ time-limited pain ​Rationale: Chronic nonmalignant pain is​ non-life-threatening pain that nevertheless persists beyond the expected time for healing. Chronic lower back pain falls into this category. Malignancy is not mentioned as a cause of the pain. Recurrent acute pain is characterized by relatively​ well-defined episodes of pain interspersed with​ pain-free episodes. Ongoing​ time-limited pain is not a commonly used term for pain.

1 Choose a new site and cleanse and dry an upper torso location. 2 Clip chest hair and open the medication package. 3 Place the patch, making sure all edges are in contact with the skin. 4 Keep the patch intact for 72 hours. ​Rationale: A transdermal patch is applied to a​ clean, dry area on the upper torso. If hair is​ present, it should be clipped before applying the patch. Apply the patch immediately after opening the​ package, ensuring complete contact with the​ skin, especially around the edges. The patch is effective for about 72 hours.

Increased A fiber transmission increases the potential for addiction in older adults. Delirium should be evaluated as pain. This is the correct answer. Assessment of pain in the cognitively impaired older adult is not possible. An increased risk of depression in older adults is related to chronic pain. This is the correct answer. Less reporting of referred pain may mask myocardial infarction in older adults. correct ​Rationale: In older adults there are decreased fiber​ transmission, no greater risk for​ addiction, and an increased risk of depression related to chronic pain. There is also a lower level of reported referred​ pain, so that the patient may not exhibit classic symptoms of myocardial infarction. Research has shown the numeric​ rating, verbal​ descriptor, and FACES rating scales to be effective with older adults. These scales are also effective with cognitively impaired older​ adults, although the FACES scale is the preferred tool. The older adult may present with manifestations such as delirium rather than subjective reports of pain.

PQRST guide This is the correct answer. scale psychological evaluation tool biofeedback rating ​Rationale: A​ patient's pain perception can be assessed by using the PQRST​ technique: P​ = What precipitated​ (triggered, stimulated) the​ pain? Has anything relieved the​ pain? What is the pattern of the​ pain? Q​ = What is the quality and quantity of the​ pain? Is it​ sharp, stabbing,​ aching, burning,​ stinging, deep,​ crushing, viselike, or​ gnawing? R​ = What is the region​ (location) of the​ pain? Does the pain radiate to other areas of the​ body? S​ = What is the severity of the​ pain? And T​ = What is the timing of the​ pain? When does it​ begin, how long does it​ last, and how is it related to other events in the​ patient's life? The FACES scale is a pain rating tool. Use of a psychological evaluation tool is not indicated. A biofeedback rating would not address all areas of a pain assessment.

​"There might be more​ pain, because the pain response can get worse with​ aging." This is the correct answer. ​"You are most likely​ correct." ​"It should not be quite as bad with the newer​ technology." ​"Pain responses diminish with​ age." ​Rationale: Pain tolerance decreases with​ aging, perhaps related to the prevalence of chronic pain in this population. The nurse should not agree that the patient will have less pain because this may not occur. The amount of pain may or may not be impacted by the use of newer technology. The pain response does not diminish with age.

Evaluation by a psychiatrist to determine if the patient is depressed A thorough analysis of the pain to determine if it is truly pain A pain medication schedule to help avoid the onset of pain This is the correct answer. Avoiding the use of narcotics ​Rationale: It is now widely accepted that anticipating pain has a noticeable effect on the amount of pain a patient experiences. Offering pain relief before a pain event is well on its way can lessen the pain. The pain has already been identified as being real and chronic in nature. There is no mention of a depressed​ state, only the​ patient's need to address the pain. Avoidance of narcotics may not meet the​ patient's immediate needs.

The patient performs peritoneal​ self-dialysis for chronic kidney failure. This is the correct answer. The patient takes medication for peptic ulcer disease. This is the correct answer. The patient has a pacemaker inserted for atrial fibrillation. The patient takes medication and vitamin K for a clotting disorder. This is the correct answer. The patient had a total hip and total knee replacement a year ago. ​Rationale: NSAIDs are not recommended for use in people with kidney or liver​ disease, bleeding​ disorders, or peptic ulcer disease. A pacemaker would not be a contraindication for using NSAIDs. Total joint replacements are not a reason to contraindicate NSAIDs.

Offer pain relief before the patient complains of pain. This is the correct answer. Allow the patient to​ "sleep off" the​ anesthesia, then offer pain medication. Assess the pain level every 4 hours around the clock. Wait until the patient can describe the pain specifically. ​Rationale: Anticipating a​ patient's pain will ensure a more manageable pain experience than will waiting until the patient complains of pain. Pain management needs to be implemented before the patient describes specific postoperative pain or​ "sleeps off" anesthesia. The patient should not be awakened to assess pain unless there are other significant nonverbal signs during sleep that indicate the patient is in pain. These can include​ grimacing, moaning,​ thrashing, or guarding of a surgical site.

muscle tear This is the correct answer. myocardial infarction frostbite burn ​Rationale: There are three types of painful​ stimuli: mechanical,​ chemical, and thermal. Mechanical causes of pain include​ spasm, compression, or extreme muscle stretch or contraction. A muscle tear creates pain from a mechanical source. Myocardial infarction involves pain from a chemical source. Burn and frostbite involve pain from a thermal source.

The pain reported is usually less severe than acute pain. Pain typically lasts 2 months or less. The pain rating may be inconsistent with the underlying pathology. This is the correct answer. There is usually a​ clear, physiologic cause. ​Rationale: The patient might not exhibit signs of pain such as elevations in vital​ signs, grimacing,​ writhing, or moaning. Chronic pain may persist for longer than 2 months and may not have an identified physiologic cause. There is no indication that chronic pain is less severe than acute​ pain, although in some instances it may be more diffuse.

inconsistent behavioral response to pain This is the correct answer. fake pain the desire for narcotics denial ​Rationale: Behavioral responses to pain may or may not coincide with the​ patient's report of pain and are not very reliable cues to the pain experience. The nurse needs to manage the pain if the patient verbalizes that it is​ present, even if the nonverbal signs are not congruent. The nurse cannot decide if the​ patient's pain is real. No mention is made of the patient requesting narcotics.

There may be loss of motor function associated with the nerves that will be severed. This is the correct answer. Pain medication will still be needed after the surgery. The surgery will need to be repeated when the nerves regenerate. The patient will be a paraplegic after the surgery. ​Rationale: Motor function loss is an unwelcome side effect of some​ surgeries, so the patient needs to consider the amount and degree of potential motor loss. The nerves will not​ regenerate, so surgery will not need to be repeated. Pain medication may or may not be needed after the surgery. Not all surgeries to sever nerves to control pain result in paraplegia.

low cost can relieve all types of pain avoiding the adverse effects of pain medication This is the correct answer. can be used by all patients ​Rationale: A transcutaneous electrical nerve stimulator has the advantages of avoidance of adverse drug​ effects, patient​ control, and good interaction with other therapies. Disadvantages of this device are the cost and the need for expert training. This device is not effective at relieving all types of pain or for all patients. Patients with pacemakers should not use this device.

ability to ambulate pain level This is the correct answer. urine output peripheral pulses ​Rationale: Pain is increasingly being referred to as the​ "fifth vital​ sign," with recommendations to include assess pain assessment in every vital signs assessment. Assessment of peripheral pulses is done to check for presence and​ strength; it is not routinely done to assess a pulse rate. Ambulation and urine output are not vital signs.

Everyone has a unique tolerance to pain. This is the correct answer. Everyone has the same pain threshold. Everyone perceives painful stimuli at the same intensity. Most people have the same the pain response to surgery. ​Rationale: Each​ person's pain tolerance is different and will need to be assessed on an individual basis. Everyone does not have the same pain threshold or perceive pain at the same intensity. Different people have a different pain response to surgery.

an increase in concentration a decrease in pain an increase in pain This is the correct answer. a decrease in anxiety ​Rationale: Pain interferes with a​ person's ability to fall asleep and stay asleep and can induce fatigue. Fatigue can lower pain tolerance. The nurse will most likely assess an increase in pain in the patient who is unable to sleep. There will not be a decrease in pain. Anxiety may increase the perception of pain and pain may cause more anxiety. The patient in pain often has difficulty concentrating.

1 a noxious stimulus is perceived by cutaneous nociceptors and then transmitted thru A- delta and even smaller C nerve fibers to the spinal cord dorsal horn. 2 dorsal horn synapses relay impulses up the cord. spinal neurons transmit the impulses via axon that cross over to the spinothalamic tract 3 the impulses ascend the spinothalamic tracts and pass thru the medulla and midbrain to the thalamus and evaluated by the person experiencing the sensation. 4 thalamus and cerebral cortex, the pain impulse becomes pain when the sesation reaches conscious levels and is perceived ​Rationale: The neural pain pathway physiology follows this​ order: A noxious stimulus is perceived by cutaneous nociceptors and then transmitted through​ A-delta (A?) and even smaller C nerve fibers to the spinal cord dorsal horn. Dorsal horn synapses relay impulses up the spinal cord. Spinal neurons transmit the impulses via axons that cross over to the spinothalamic tract. The impulses ascend the spinothalamic tracts and pass through the medulla and midbrain to the thalamus. In the thalamus and cerebral​ cortex, the pain impulse becomes pain when the sensation reaches conscious levels and is perceived and evaluated by the person experiencing the sensation.

Patient C only This is the correct answer. Patients B and D Patients A and D Patient A only ​Rationale: Patient C has an increased risk of experiencing phantom pain. Phantom pain is a type of neuropathic pain that occurs after amputations.

fiber This is the correct answer. vitamin D protein carbohydrates ​Rationale: Patients receiving narcotics are at risk for constipation. Increasing fiber in the diet will help to reduce this effect. Increasing vitamin​ D, protein, or carbohydrates is not specifically related to the effects of a narcotic medication.

a local anesthetic a nonsteroidal​ anti-inflammatory drug​ (NSAID) an antidepressant This is the correct answer. a narcotic ​Rationale: Antidepressants within the tricyclic and related chemical groups act on the production and retention of serotonin in the​ CNS, thus inhibiting pain sensation. They also promote normal sleeping​ patterns, which further alleviates the suffering of the patient in pain. They are useful with neuropathic pain. Other medications are prescribed before introducing narcotics. The NSAID group can have serious side​ effects, including bleeding​ tendencies, and would not be appropriate in a​ long-term situation. A local anesthetic would not be appropriate for​ long-term pain management.

1 Acetaminophen (Tylenol) 325 mg PO 2 Ibuprofen 400 mg PO with the anticonvulsant gabapentin (Neurontin) 300 mg PO 3 Propoxyphene HCL (Darvon) 250 mg. PO 4 Acetaminophen (Tylenol) 325 mg PO ​Rationale: The nonopioid analgesics acetaminophen and ibuprofen are the least​ invasive, followed by the mild opioid analgesics with adjuvant​ therapy, and finally the opioids.

The pain signal travels up to the brain portion called the thalamus. This is the correct answer. The pain signal releases catecholamines. The pain signal reduces blood flow to the gut. The pain signal travels along nerve fibers to the spinal cord. This is the correct answer. The pain signal spreads throughout the​ cortex, limbic​ system, and brainstem. correct ​Rationale: With sharp local​ pain, nociceptors transmit pain stimuli along myelinated fibers to the spinal​ cord, where it travels via the neospinothalamic tract to the thalamus. From the​ thalamus, the stimulus is distributed to the somatosensory cortex​ (perception and​ interpretation), the limbic system​ (emotional responses to​ pain), and brainstem centers​ (autonomic nervous system​ responses). The release of catecholamines explains the cardiovascular response to pain. The reduction of blood flow to the gut explains why nausea and vomiting occur with pain.

The patient will never experience breakthrough pain. It will not work as well as oral pain medications. The patient will never overdose with this delivery method. The dosage will be lower in the beginning. correct ​Rationale: Dosages for the​ "patch" start low and are increased as deemed necessary by the physician. The​ transdermal, or​ patch, form of medication is increasingly being used because it is​ simple, painless, and delivers a continuous level of medication. The continuous dosage is an advantage over oral medications. Transdermal medications are easy to store and​ apply, and reapplying every 72 hours enhances compliance. Additional​ short-acting medication is often needed for breakthrough pain. Overdosage can occur with this route.

The patient has a high pain tolerance. This is the correct answer. The patient has a low pain tolerance. The patient does not really have pain. The patient is addicted to pain medication. ​Rationale: Pain tolerance describes the amount of pain a person can tolerate before outwardly responding to it. A patient with a high tolerance to pain would rarely report pain or need analgesic management. With a low​ tolerance, the patient would be verbalizing pain and requesting medication. If​ addicted, the patient would eventually need more​ medication, not​ less, to manage the pain. There no evidence that the patient is not in pain.

Improve patient outcomes. Be completely pain free. Reduce the focus on pain. This is the correct answer. Reduce the sympathetic stress response. ​Rationale: With chronic pain the pain itself becomes the​ problem, creating​ physical, psychosocial, and economic stresses on the affected individual and the family.​ Furthermore, emotional and psychologic factors can cause the pain itself or make it worse. Reducing the sympathetic pain response and improving patient outcomes would be appropriate acute pain management goals. Being completely pain free might be an unattainable goal for a patient with chronic pain.

high pain tolerance depression This is the correct answer. adult attention deficit disorder chronic insomnia ​Rationale: Depression is clearly linked to​ pain, and insomnia is an associated symptom of chronic pain.​ Serotonin, a​ neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed​ people, serotonin is​ decreased, which leads to an increase in pain sensations. There is no evidence to support the risk of chronic insomnia or adult attention deficit​ disorder, or inferences concerning pain tolerance.

meditation distraction This is the correct answer. biofeedback guided imagery ​Rationale: Distraction involves redirecting attention away from the pain and onto something the patient finds more pleasant. Participating in an activity that promotes laughter has been found to be highly effective in pain relief. Laughing for 20 minutes or more is known to produce an increase in endorphins that may continue to relieve pain even after the patient stops laughing. Meditation is a process of emptying the mind of all sensory data​ and, typically, concentrating on a single​ object, word, or idea. This activity produces a deeply relaxed state in which oxygen consumption​ decreases, muscles​ relax, and endorphins are produced. Guided imagery is use of the mind to create a scene or sensory experience that relaxes the muscles and moves the attention away from the pain experience. In​ biofeedback, electrodes placed on the skin transform data into visual cues so the patient learns to recognize​ stress-related responses and replace them with relaxation responses.

320 mg ​Rationale: Fentanyl 100​ mcg/hr is equivalent to 4​ mg/hr morphine IV. If the first patch was for 72 hours and the second patch was for 8​ hours, the patient wore the patch for a total of 80 hours. Multiply the equivalent dose of 4 mg​ × 80​ = 320 mg.

degenerative joint disease phantom limb pain cholecystectomy This is the correct answer. complex regional pain syndrome ​Rationale: Acute pain has a sudden​ onset, is usually​ self-limited, and is localized. The cause of acute pain generally can be identified. It generally results from tissue injury from​ trauma, surgery, or inflammation. Surgical pain such as after gallbladder removal is considered acute pain. The neuropathic pain associated with​ amputation, phantom limb​ pain, may not begin immediately and may become a chronic problem. Complex regional pain syndrome is a chronic exaggerated response to a painful stimulus. Degenerative joint disease is​ chronic; the accompanying joint pain is also chronic.

30-60 mg ​Rationale: The PO dose is 3 to 6 times the IM dose.

acupuncture guided imagery This is the correct answer. distraction This is the correct answer. progressive muscle relaxation This is the correct answer. regional pain management ​Rationale: Guided​ imagery, progressive muscle​ relaxation, and distraction can be taught by the nurse. Acupuncture can only be provided by persons with special training. Regional pain management is not an alternative complementary therapy.

complex regional pain syndrome This is the correct answer. myofascial pain syndrome phantom limb pain chronic postoperative pain ​Rationale: Complex regional pain syndrome is a neuropathic pain that results from nerve damage. It is characterized by continuous​ severe, burning pain. These conditions follow peripheral nerve damage and present the symptoms of​ pain, vasospasm, muscle​ wasting, and vasomotor changes. This pain was not described as chronic. No amputation has been performed that might explain phantom limb pain. Myofascial pain syndrome is a condition marked by injury to or disease of muscle and fascial tissue.

Patient A only Patients A and C Patient C only Patients B and D ​Rationale: Predictable physiologic changes occur in the presence of acute pain. These may include muscle​ tension; tachycardia;​ rapid, shallow​ respirations; increased blood​ pressure; dilated​ pupils; sweating; and pallor. Equal pupillary​ response, respiratory​ changes, and normal skin assessment are not predictable physiological changes with acute pain.

Improved sleep This is the correct answer. Improved mobility Reduced urine output Reduced pain This is the correct answer. Less nausea ​Rationale: Anticonvulsants are frequently used with opioids in pain control because these drugs reduce pain and sleep disruption. Anticonvulsants are not prescribed to reduce nausea or improve mobility. They should not adversely affect renal functioning.

​"Pain in the arm related to cardiac tissue damage is a type of referred​ pain." This is the correct answer. ​"What you are describing relates to psychogenic​ pain." ​"Cardiac pain is generally​ unexplainable." ​"Were you doing some physical activity with your arm just prior to the​ event?" ​Rationale: Referred pain is pain perceived in an area distant from the stimulus. Visceral sensory fibers synapse at the level of the spinal​ cord, close to fibers innervating other subcutaneous tissue areas of the body. Cardiac pain is explainable. Physical activity did not trigger the pain. Psychogenic pain occurs in the absence of a diagnosed physiological cause or event.

The pain medication has not been working. The patient is exaggerating the amount of pain. Medication to treat the depression is interfering with the control of pain. Depression can cause an increase in pain sensations. correct ​Rationale: Depression is clearly linked to pain.​ Serotonin, a​ neurotransmitter, is involved in the modulation of pain in the central nervous system. In clinically depressed​ people, serotonin is​ decreased, leading to an increase in pain sensations. The nurse has no way of knowing if the​ patient's pain medication is not controlling the pain. There is also no way of knowing if the medication used to treat the​ patient's depression is interfering with the control of pain. The nurse cannot make the assumption that the patient is exaggerating the amount of pain.

​A-delta fibers C fibers This is the correct answer. endorphins dynorphins ​Rationale: The pain from deep body​ structures, such as muscles and​ viscera, is primarily transmitted by C​ fibers, producing diffuse burning or aching sensations.​ A-delta fibers are myelinated and transmit impulses rapidly. They produce what is called fast pain or first​ pain, which is​ sharp, well-defined pain typically accompanying​ cuts, electric​ shocks, or the impact of a blow. Endorphins and dynorphins are endogenous opioids that block the transmission of painful impulses.

Determine if the patient should remain in the hospital Decide if the patient is being argumentative Figure out if the patient should leave the hospital against medical advice Assess the​ patient's level of pain correct ​Rationale: The most reliable indicator of the presence and degree of pain is the​ patient's own statements about the pain. Pain rating scales ensure consistent communication about the pain level. The nurse is not attempting to question the​ patient's admission or stay in the​ hospital, to decide if the patient is being​ argumentative, or decide whether the patient should leave the hospital against medical advice.

Talk the patient through the pain. Provide the medication ordered for breakthrough pain. This is the correct answer. Encourage the patient to ignore the pain. Give the patient a nonsteroidal​ anti-inflammatory drug​ (NSAID). ​Rationale: Breakthrough pain​ (BTP) occurs in patients who are receiving​ long-acting analgesics for chronic pain. It is a transitory experience of moderate to severe pain that is often precipitated by coughing or movement but may occur spontaneously.​ Short-acting opioids for this type of pain should be administered as needed in addition to the ATC dose for​ chronic, persistent pain. The pain must be​ addressed; it is not appropriate to talk the patient through the pain or encourage the patient to ignore the pain. NSAIDs can only be given with the​ physician's order.

Nociceptive Neuropathic Central Incident correct ​Rationale: Incident or episodic pain is​ predictable, precipitated by an event or activity such as​ coughing, changing​ position, or being touched. Central pain is caused by a lesion or damage in the brain or spinal cord. Nociceptive pain is caused by stimulation of peripheral or visceral pain receptors. Neuropathic pain arises as a consequence of a lesion or disease affecting the somatosensory system.

increase the intake of fluids and fiber. This is the correct answer. Do not take with​ over-the-counter medications. This is the correct answer. Avoid all alcohol. This is the correct answer. Do not operate machinery. This is the correct answer. Expect some respiratory depression. ​Rationale: The nurse should instruct the patient to avoid drinking alcohol while taking this​ medication, to use caution or avoid​ driving, to increase the intake of fluids and fiber to prevent​ constipation, and not to take​ over-the-counter medications unless approved by the healthcare provider. Respiratory depression can occur when taking this​ medication; however, it is not an expected effect and should be reported to the healthcare provider.

Patient D only Patients A and C This is the correct answer. Patient C only Patients B and D ​Rationale: Opioid analgesics are CNS and respiratory depressants and tend to have similar unintended effects. They commonly produce​ sedation, drowsiness, and dizziness. Nausea and vomiting are common adverse​ effects, as is constipation. Opioids are not typically given for stomach pain prior to a meal. Bruising is not a common side effect of opioid administration.

Untreated pain can result in poor wound healing. This is the correct answer. Patients with uncontrolled pain have an increased risk of blood clots. This is the correct answer. Family members will not want to visit patients showing visible signs of pain. There is little to no risk of addiction when taking narcotics for pain. This is the correct answer. Dehydration can result from poorly managed pain. ​Rationale: A common myth among healthcare professionals is that using opioids for pain treatment poses a real threat of addiction.​ Actually, when the medications are used as​ recommended, there is little to no risk of addiction. Pain causes physiological​ consequences, including poor wound healing and coagulation leading to DVT or PE. There is no evidence that poor pain relief causes dehydration or refusal by family members to visit.

The one to be administered orally The one that is ordered on a prn basis The one that will be given intramuscularly to work quickly The one that is to be administered intravenously by the patient and is under patient control correct ​Rationale: ​Patient-controlled analgesia allows​ self-management of pain and is a common method of administering postoperative pain medication. The advantages to this method are dose​ precision, timeliness, and convenience. An oral medication or a prn medication administered 2 hours after a major surgery would not be the most effective. The medication that is administered intramuscularly is not typically recommended for​ moderate-to-severe pain that will require more than one dose.

acupuncture guided imagery cutaneous stimulation This is the correct answer. biofeedback ​Rationale: It is believed that stimulation of the skin is effective in relieving pain because it prompts closure of the gate in the substantia gelatinosa. Cutaneous stimulation may be accomplished by​ massage, vibration, applying of heat and​ cold, and therapeutic touch. Touch was​ used, so biofeedback and guided imagery are not correct. There is no mention of the use of acupuncture needles.

a reason to reduce the amount of pain medication prescribed the​ body's ability to make endorphins This is the correct answer. a belief in alternative methods a theory of denial ​Rationale: There is a pain inhibitory center within the dorsal horns of the spinal cord. The exact nature of this inhibitory mechanism is unknown.​ However, the most clearly defined chemical inhibitory mechanism is fueled by endorphins​ (endogenous morphines), which are naturally occurring opioid peptides that are present in neurons in the​ brain, spinal​ cord, and gastrointestinal tract. Endorphins work by binding with opiate receptors on the neurons to inhibit pain impulse transmission. The patient is not denying the pain. Alternative methods have not been employed. There was no discussion of pain medication amounts.