12 - Understanding Pain

Question 1

What is the definition of pain?

Answer 1

Pain is an unpleasant and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

Question 2

What is the alternative definition of pain?

Answer 2

Pain is what the patient says it is an exists when s/he says it does

Question 3

What is pain as a construct? (5 parts of pain)

Answer 3

Physiological --> nociception 
Sensory --> quality, intensity
Affective --> unpleasantness
Cognitive --> expectations, mental models 
Behavioural --> vocalising, posture

Question 4

What is nociception?

Answer 4

The sensory nervous system’s response to certain harmful or potentially harmful stimuli

Question 5

What is congenital analgesia?

Answer 5

Condition where person cannot feel physical pain

Question 6

How many people live with chronic pain?

Answer 6

18 million (>3 months)

Question 7

What can chronic pain lead to?

Answer 7

Clinical anxiety and depression (mental health problems)

Question 8

How can pain be expressed?

Answer 8

1. Facial expression
2. Vocalisation - ‘ouch’
3. Rubbing/holding/guarding
4. Posture changes
5. Reduced behavioural repertoire
6. Taking pain relief

Question 9

How can pain be assessed using rating scales?

Answer 9

1. Pain thermometer (a fixed point rating scale with vertical orientation)
2. Visual analogue scales (often 100mm long) from no pain to extremely painful (mark on line)

Question 10

How can pain be assessed using the McGill Pain Questionnaire?

Answer 10

Sensory, affective, evaluative, tempora;

Body area affected

Uses global rating

Question 11

How can pain be assessed using Faces Pain Scale?

Answer 11

From 1 to 10 depending on facial expression

Standardised paediatric assessment

Question 12

What is the gate control theory of pain?

Answer 12

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

Question 13

What is bottom-up processing of pain?

Answer 13

Sensory driven (by stimuli) and information is send to brain, leading to response (reflex - often moving away)

Question 14

What is top-down processing of pain?

Answer 14

Driven by knowledge, experience and association of pain with stimulus

Enables individual to recognise and avoid stimulus (determines perception)

Question 15

What is TENS? What is it used for?

Answer 15

Transcutaneous Electrical Nerve Stimulation

Method of pain relief involving the use of a mild electrical current

Question 16

What are the advances/problems of Gate control theory?

Answer 16

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)

Question 17

What is phantom limb pain?

Answer 17

• 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

Question 18

How is phantom pain managed in paraplegia? How does it work?

Answer 18

• 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

Question 19

What are the pain thresholds?

Answer 19

Sensation, perception, tolerance, encouraged/motivated tolerance

Cultural/social differences can affect these thresholds

Question 20

What is phasic/acute/chronic pain?

Answer 20

Phasic –> comes in phases
Acute –> more sharp and severe, often lasts less than 3 months
Chronic –> persistent pain that lasts less than 3 months

Question 21

What is Western cultural value of pain? What is the ‘stoical patient’?

Answer 21

Lack of complaining, ‘no pain no gain’

Enduring pain and hardship without showing one’s feelings or complaining

Question 22

How does preparation for surgery reduce pain/fear afterwards?

Answer 22

Information, relaxation techniques, importance of expectations

Preparation for surgery linked to less pain relief required after surgery

Question 23

How can social interaction of nurses/doctors affect pain?

Cognitive-behavioural therapy for pain management.

Answer 23

Encouragement of positive talking –> talking about how well you’re feeling instead of pain

Positive studies to show decreased pain

Question 24

How can chronic pain affect people?

Answer 24

Threatens identity:

• Dominates life
• Changed sense of body (old before time)
• Pain relief is primary goal of life
• Maintaining cycle
• Psychological distress

Question 25

What was Milgram’s research regarding authority of profession?

Answer 25

Scientist in white coat delivers electric shock to ‘victim’

He predicted their behaviour

Average obedience level for delivering full shock = 60-70%

Question 26

Who was Harold Shipman?

Answer 26

UK’s worst serial killer –> doctor who killed elderly patients (used profession and ‘white coat’)

Question 27

What is causalgia?

Answer 27

Most painful pain syndrome known

Severe burning pain in a limb caused by injury to a peripheral nerve

Question 28

Joint hyper mobility syndrome

Answer 28

Always in chronic pain

Question 29

Example of cultural differences in regards to pain

Answer 29

Nepalese climbers –> enduring pain w/o hardship, cope more

Question 30

What was Croft’s study of pain?

Answer 30

Pain is a common part of adult life

Question 31

Who came up with gate control theory?

Answer 31

Melzack and Wall

Question 32

What was Moseley’s study on pain?

Answer 32

Using mirrors to cure phantom limb pain (virtual walking)

Question 33

What was Clarke and Clarke’s study on different pain thresholds?

Answer 33

Nepalese climbers have a much higher pain threshold than Western climbers

Question 34

What are 3 different pain qualities?

Answer 34

1. Superficial
2. Deep
3. Referred