25-11-21 - Patient Pain Flashcards
Learning outcomes
- Describe the common methods of assessment including behavioural and self-report
- Compare methods of psychological approaches to the alleviation of acute and chronic pain
- Define acute and chronic pain
- Understand the main theories of pain
What are 3 reasons we care about pain?
• Reasons we care about pain
1) Common health problem causing people to seek medical care
• Pain accounts for >80% of all visits to doctors
• Chronic pain is a prominent cause of disability worldwide
2) Poses major consequences for individual and society
• Disabling: interrupts, interferes, impacts
• Economic burden
3) Warning signal
• Motivates behavioural change
• Critical to long-term health and survival
What is the definition of pain?
• Pain is ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’
What is acute pain?
- Acute pain:
- Intense, but time limited
- Result of tissue damage or disease
- Typically disappears over time as injury heals
- Lasts < 3-6 months
- Sufferers highly motivated to seek out its causes, treat it
- Effectively treated by a number of pain-control techniques
What is chronic pain?
What are the 3 subsets of chronic pain?
- Chronic pain:
- Often begins as acute pain
- Does not dissipate after a minimum 6 months (e.g. lower-back pain, headache, pain associated with arthritis, cancer)
- High anxiety, feelings of hopelessness, helplessness
- Interferes with daily life
- 3 sub-categories:
- Recurrent acute
- Intractable-benign
- Progressive
What are the 3 types of chronic pain?
• 3 types of chronic pain:
Recurrent acute -
- Caused by benign or harmless condition
- repeated, intense episodes separated by period w/out pain
Intractable-benign -
- Benign but persistent pain
- Varying levels of intensity, but never disappears
Progressive -
- Pain often originates from a malignant condition
- Continuing pain, and discomfort
- Pain worsens over time, as underlying condition worsens
What is the gate control theory?
- Nerve endings in damaged area transmit impulses to the spinal cord
- A ‘gate’ exists in spinal cord -‘neural gate’
- – OPEN to let the pain signal through
- – CLOSE to reduce the pain experience
- Gating mechanism modulates incoming pain signals before they reach the brain
- Includes the role of psychological factors in the experience of pain
What is Gate control in Gate theory influenced by?
• Gate Control is influenced by:
1) Amt of activity in pain fibres (A-delta & C)
• More activity - gate opens - more pain
• - AG: pricking/ stabbing (fast impulse transmission)
• - C: burning/ aching (slow impulse transmission)
2) Amt of activity in other peripheral fibres (A-beta)
• Harmless stimuli or mild irritation (touching, rubbing)
• closes the gate o less pain
3) Messages descending from brain - effects of anxiety,
• Excitement etc…. open or close gate
What does the gate control theory explain?
- The gate control theory explains:
- Psychological + physiological factors
- Explains why the same event can be interpreted by different people as more or less painful
- Explains why sometimes pain is not experienced Immediately
- Describes the individual as having some control over the experience of pain
What are the 3 ways pain is measured?
• Assessment of pain: 1) Physiological 2) Self-report 3) Behavioural • Advisable to use 2 or more methods
What are the physiological measures of pain?
- Assume pain perception is associated with specific physiological responses
- E.g Increase in heart rate, BP, respiration, muscle tension
- Relationship between physiological responses and experience of pain not consistent
- Limited use
What are self-report measures of pain?
What are 3 ways this can be done?
- Patients asked to describe their pain
- E.g where, what, when…
- Questions often incorporated within a clinical interview (for chronic pain pts)
• Methods of self-reporting pain:
1) Interviews
2) Pain rating scales and diaries
3) Pain questionnaires
What are the 3 limitations of self-reporting of pain?
• Limitations of self-reporting pain:
1) Often require fairly high levels of verbal skills
2) Less useful for children; not fluent in English
3) Misrepresentation of pain can occur, which can lead to exaggeration or downplay experience of pain
What are 3 behaviours assessed during behavioural assessment of pain?
What 2 situations are these assessed in?
• Observing behaviour:
1) physical symptoms (limping…)
2) verbal expressions (sighing…)
3) facial expressions (grimacing, frowning…)
• Procedures for assessing pain in 2 types situations:
1) everyday activities
2) structured clinical sessions
• Useful, but again open to misrepresentation
What are 4 psychological factors influencing the experience of pain?
• Psychological factors influencing experience of pain:
1) Learning
• To display illness related behaviours e.g children of chronic pain patients
• To experience/express pain as a way of receiving gain
• E.g pain leads to avoidance (negative reinforcement)
• E.g pain leads to desirable consequences (positive reinforcement)
• To avoid certain activities based on fear that the specific activities lead to pain e.g dentist
• Cultural differences
2) Cognition
• Context affects pain perception (e.g athletes and soldiers – civilians with less severe pain were hospitalized over soldiers)
• Beliefs about pain e.g anxiety about pain – may lead to focussing on negative aspects and reporting more severe pain
• Expected ability to cope with pain e.g intensity, duration of pain
3) Personality
• Positive association between chronic pain sufferers and anxiety of depressive disorders
• Sense of control over events in one’s life
• Loss of control (internal vs external)
4) Stress
• Major life events e.g family conflict, work pressures, anxiety)
• Can lead to the development of an ulcer
