9.11 Psychological and psychiatric interventions in pain control Flashcards
Pain is a multifactorial process. List 4 contributors to pain that are not physical in nature
personality, affect, cognition, behaviour, and social relations
What are the differential role of psychological therapies and somatic therapies in the management of pain?
Psychosocial therapies directed primarily at psychological variables may have an impact on pain intensity or distress, while somatic therapies directed at nociception may reduce the adverse psychological aspects of pain.
To manage complex chronic pain problems, both somatic and psychosocial therapies should be used in a multimodality approach
List six contributors to distress that pain can cause
impairment in activities of daily living
the experience of unpredictable painful episodes
negative thoughts about personal or social competence
thoughts about the cause of pain
greater anxiety or depressed mood
more existential concerns such as fears about the future
Describe the relationship between pain and suicidal ideation in patients with advanced illness. What aspect of pain is linked to suicidal ideation?
the majority of suicides involve patients who have severe, inadequately controlled or poorly tolerated pain.
Cancer patients who had significant pain, suicidal ideation was not directly related to pain intensity, but was strongly related to the degree of depression and mood disturbance.
Name three domains that are affected by pain-related quality of life
The variables that affect pain-related quality-of-life may be categorized in three domains:
(1) physical well-being
(2) psychological well-being (consisting of affective factors, cognitive factors, spiritual factors, communication, coping, and meaning of pain or cancer)
(3) interpersonal well-being (focusing on social support or role functioning)
You are asked to provide a psychiatric assessment on a palliative patient with severe pain. The patient is on low dose opioid therapy. What is a prerequisite before your assessment of psychological contributors to this patient’s pain?
Pain assessment and prescription of adequate pain relief
List five risk factors for having inadequately controlled pain in advanced illness
advanced cancer +
- discrepancy between physician and patient in judging the severity of pain
- the presence of pain that physicians did not attribute to cancer
- better performance status
- age of 70 or over
- female sex
diagnosis of AIDS +
- female
- limited education
- substance abuse history
- pain related barriers to opioid treatment
general: lack of knowledge about pharmacological interventions, focus on prolonging life rather than alleviating suffering, lack of communication between doctor and patient, limited expectations of patients to achieve pain relief, patients’ limited capacity to communicate, unavailability of opioid drugs, doctors’ fear of opioid toxicity, and doctors’ fear of amplifying addiction and substance abuse
Describe two ways that inappropriate assessment of psychological aspects of pain can lead to poor pain control
Psychological variables may be ignored, or contrariwise, may be proposed to explain pain when in fact medical factors have not been adequately appreciated
What are the three major types of psychological and psychiatric approaches to pain management? What does response to one of these interventions mean about the etiology of the pain?
psychotherapeutic, cognitive behavioural, and psychopharmacologic interventions, usually in combination.
The mechanisms by which these techniques relieve pain are not known and it widely accepted that a favourable response to a psychological technique should not be viewed as evidence that pain is psychogenic.
What are the three major goals of psychotherapeutic intervention for pain management? Table 9.11.2. Provide an example of how each goal can be achieved
Support - provide continuity
Individuals -supportive/crisis intervention
Knowledge - provide information
Family patient and family are the unit of concern
Skills - relaxation, cognitive coping, communication, use of analgesics
Group - share experiences, identify
successful coping strategies
What is the role of analysis in the psychotherapy utilized in advanced illness?
primarily non-analytical and focuses on current issues, exploration of reactions to illness often involve insights into earlier, more pervasive life issues
Therapy can take place individually or in what two other forms? When are other forms of therapy helpful
Individual, family, group
As the illness progresses, psychotherapy with the individual patient may become limited by cognitive or speech deficits -> focus of supportive psychotherapeutic interventions shifts primarily to the family
Group interventions with individual patients (even in advanced stages of disease), spouses, couples, or families are a powerful means of sharing experiences and identifying successful coping strategies
Negative thoughts about pain are correlated with what 3 findings
pain intensity, degree of psychological distress, and level of interference in functional activities
Patients may be hesitant to utilize cognitive behavioural techniques for pain management due to concerns about their utility and non-pharm nature. What is required before suggesting these therapies? A patient asks how these therapies work, what do you explain about the mechanism?
Best to introduce cognitive behavioural interventions after some rapport has been established with a patient.
it is important to stress that an understanding of the mechanism is not needed for effectiveness and the outcome is most important.
What three contributors to pain make attempts at relaxation useful
Muscular tension, autonomic arousal, and mental distress exacerbate pain
