12 - Understanding Pain Flashcards
What is the definition of pain?
Pain is an unpleasant and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
What is the alternative definition of pain?
Pain is what the patient says it is an exists when s/he says it does
What is pain as a construct? (5 parts of pain)
Physiological --> nociception Sensory --> quality, intensity Affective --> unpleasantness Cognitive --> expectations, mental models Behavioural --> vocalising, posture
What is nociception?
The sensory nervous system’s response to certain harmful or potentially harmful stimuli
What is congenital analgesia?
Condition where person cannot feel physical pain
How many people live with chronic pain?
18 million (>3 months)
What can chronic pain lead to?
Clinical anxiety and depression (mental health problems)
How can pain be expressed?
- Facial expression
- Vocalisation - ‘ouch’
- Rubbing/holding/guarding
- Posture changes
- Reduced behavioural repertoire
- Taking pain relief
How can pain be assessed using rating scales?
- Pain thermometer (a fixed point rating scale with vertical orientation)
- Visual analogue scales (often 100mm long) from no pain to extremely painful (mark on line)
How can pain be assessed using the McGill Pain Questionnaire?
Sensory, affective, evaluative, tempora;
Body area affected
Uses global rating
How can pain be assessed using Faces Pain Scale?
From 1 to 10 depending on facial expression
Standardised paediatric assessment
What is the gate control theory of pain?
Asserts that non-painful input closes the nerve ‘gates’ to painful input, which prevents pain sensation from travelling to the CNS
TENS can close the gate
What is bottom-up processing of pain?
Sensory driven (by stimuli) and information is send to brain, leading to response (reflex - often moving away)
What is top-down processing of pain?
Driven by knowledge, experience and association of pain with stimulus
Enables individual to recognise and avoid stimulus (determines perception)
What is TENS? What is it used for?
Transcutaneous Electrical Nerve Stimulation
Method of pain relief involving the use of a mild electrical current
What are the advances/problems of Gate control theory?
Advances:
- Pain as a perception
- Individual as active
- Individual variability expected
- Multiple causes of pain
Problems:
- Still assumes an organic basis for pain
- Physical evidence of gate? (central and peripheral neurotransmitters)
What is phantom limb pain?
- Painful sensations that seem to be coming from a limb that is no longer there
- Experienced by almost all amputees
- Changes in pain linked to mood, behaviour, environment
- Real pain, same position
- Persists but often diminishes
How is phantom pain managed in paraplegia? How does it work?
- Virtual walking –> watch themselves walk (their top half but virtual legs)
- 15 days of 10 mins per day
- Addresses a motor output - sensory feedback mismatch
What are the pain thresholds?
Sensation, perception, tolerance, encouraged/motivated tolerance
Cultural/social differences can affect these thresholds
What is phasic/acute/chronic pain?
Phasic –> comes in phases
Acute –> more sharp and severe, often lasts less than 3 months
Chronic –> persistent pain that lasts less than 3 months
What is Western cultural value of pain? What is the ‘stoical patient’?
Lack of complaining, ‘no pain no gain’
Enduring pain and hardship without showing one’s feelings or complaining
How does preparation for surgery reduce pain/fear afterwards?
Information, relaxation techniques, importance of expectations
Preparation for surgery linked to less pain relief required after surgery
How can social interaction of nurses/doctors affect pain?
Cognitive-behavioural therapy for pain management.
Encouragement of positive talking –> talking about how well you’re feeling instead of pain
Positive studies to show decreased pain
How can chronic pain affect people?
Threatens identity:
- Dominates life
- Changed sense of body (old before time)
- Pain relief is primary goal of life
- Maintaining cycle
- Psychological distress
What was Milgram’s research regarding authority of profession?
Scientist in white coat delivers electric shock to ‘victim’
He predicted their behaviour
Average obedience level for delivering full shock = 60-70%
Who was Harold Shipman?
UK’s worst serial killer –> doctor who killed elderly patients (used profession and ‘white coat’)
What is causalgia?
Most painful pain syndrome known
Severe burning pain in a limb caused by injury to a peripheral nerve
Joint hyper mobility syndrome
Always in chronic pain
Example of cultural differences in regards to pain
Nepalese climbers –> enduring pain w/o hardship, cope more
What was Croft’s study of pain?
Pain is a common part of adult life
Who came up with gate control theory?
Melzack and Wall
What was Moseley’s study on pain?
Using mirrors to cure phantom limb pain (virtual walking)
What was Clarke and Clarke’s study on different pain thresholds?
Nepalese climbers have a much higher pain threshold than Western climbers
What are 3 different pain qualities?
- Superficial
- Deep
- Referred
