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 the burdens of chronic 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
‒ pts: continuing quest for relief, feelings of helplessness, hopelessness, depression
‒ significant others: share frustration, chronic stress, worry
‒ HCPs: share frustration with pts as their reports of pain continue
‒ economic burden: lost productivity and disability benefits
3) Warning signal
* Motivates behavioural change
What is the definition of pain?
- ‘An unpleasant sensory and emotional
experience associated with, or resembling that associated
with, actual or potential tissue 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 does the specificity theory propose?
- Specificity theory proposes:
- Separate sensory system for perceiving pain
- Specific sensory receptors for detecting pain stimuli
- Specific peripheral nerves and pathway to the brain
- Specific area within the brain for processing pain signal
What does the pattern theory propose?
- Pattern theory proposes:
- No separate system for perceiving pain
- Pain results from the pattern or type of stimulation received by the nerve endings
- Intensity of the stimulation is key determination of pain
- Strong and mild stimuli of the same sense modality produce different patterns of neural activity
What are the limitations of the Specificity Theory (ST) and Pattern Theory (PT)?
- ST: incorrect - no specific receptor cells in body that transmit only information about pain
- PT: requires that stimuli triggering pain must be intense
- Pain can be experienced without tissue damage (e.g. phantom-limb pain)
- Tissue damage can exist without pain (e.g. athletes)
- Both fail to account for the important role of psychology in the perception of pain
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
* - A delta: 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 so 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
What are 4 physical pain management strategies?
What are 5 psychological pain management strategies?
• Physical methods
1) Medical treatments (analgesic drugs)
2) Surgical
3) Physical stimulation therapies
4) Physical therapy/ exercise
• Psychological methods
1) Biofeedback
2) Relaxation and distraction
3) Cognitive methods
4) Behaviour therapy (operant approach)
5) Hypnosis
How does Behavioural therapy work for pain management?
- Behaviour therapy (operant conditioning)
- Changing patients pain behaviour
- Eliminate ‘perks’ of the pain
- Reinforcement for appropriate +ve behaviour (activity)
- Ignore -ve behaviours (complaints of pain)
- Enhance social reinforcement
- Aim to lower pain and disability, and lower reliance on medication
- Effective in lowering a variety types chronic pain
How does hypnosis work for pain management?
- Hypnosis
- Relieves pain only in individuals who can successfully undergo deeply hypnosis
- Provides a high degree of analgesia (minority of patients)
- Cognitive and behavioural techniques generally > effective
