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PHTY2101 EOS > B2 L30 Psychological Perspectives for Pain & its Management > Flashcards

B2 L30 Psychological Perspectives for Pain & its Management Flashcards

1
Q

What is the biomedical model?

A
  1. Mind-Body Dualistic & Reductionistic
  2. Tissue Damage:
    • Pain relationship –> 1:1
  3. Treatment Model:
  • Step 1: Find the pain generator
  • Step 2: Remove it or fix it And, if you can’t remove it? …And can’t fix it?
  • Step 3: Palliative approach (medicate)
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2
Q

What are the 3 steps to the treatment model of the biomedical model?

A
  1. Step 1: Find the pain generator (eg. through ultrasound… imaging)
  2. Step 2: Remove it or fix it (eg. cast) And, if you can’t remove it? …And can’t fix it?
  3. Step 3: Palliative approach (medicate)
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3
Q

When should physios refute evidence? 3 factors

A
  1. Mental interpretations
    • reports indicate solders requiring to take less medication than normal civilians due to different interpretation of their injury (interpretation influences pain)
  2. Influence of social context
  3. Pain in the absence of direct stimulation
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4
Q

What is the paradigm shift?

A

“The presence of the biochemical defect… at best defines a necessary but not sufficient condition for the occurrence of the human experience of the disease, the illness.”

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5
Q

When does the treatment model work?

A

Works well for acute injuries

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6
Q

What is the biopsychosocial model?

A

overlaps and inter-relation determines whether disease and pain is prolonged

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7
Q

Pain is complex and _______

A

multidimensional

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8
Q

Pain is influenced by ______, ______, ______, and ______ factors

A

internal/external; biological; psychological; social

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9
Q

Treatment can intervene at _______ of these levels

A

any one (or more)

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10
Q

What is the gate control theory?

A

The brain plays a dynamic, interpretive role

  • Psychological processes can shape the way painful stimuli are interpreted
  • Rationale for psychological interventions for pain
    • We use this in session 1
    • Also helps shift clients who are “stuck” in a biomedical understanding
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11
Q

________ processes can shape the way painful stimuli are interpreted

A

psychological

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12
Q

In the gate control theory, what does an “open” gate mean, in terms of pain?

A

More pain

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13
Q

In the gate control theory, what does an “closed” gate mean, in terms of pain?

A

Less pain

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14
Q

Why do we use psychological treatment for pain? 2 reasons

A
  1. Can have the neurological plasticity
  2. Can increase brain matter- reverse effect (pain decrease brain matter)
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15
Q

What are 5 factors that influence pain?

A
  1. Mood
  2. Neurochemical changes
  3. Genetics
  4. Attention/expectation
  5. Sensitisation
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16
Q

What is IASP’s definition of pain?

A

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

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17
Q

What are the 2 definitions of chronic pain?

A
  1. Pain that persists beyond the normal/expected healing time
  2. Pain experienced at least ½ of the days of the month for the past 3 to 6-months
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18
Q

What is epidemiology of chronic pain? Cost and effect?

A
  • Affects 3.2 million Australians
  • Costs $34.4 billion annually
  • Chronic pain increases with age (since is an ageing population = more pain starting to affect people –> increase cost)
  • Has been under-diagnosed and under-treated in the past
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19
Q

What are 3 co-morbid conditions of chronic pain?

A
  1. Depression: 40-50%
    • Lifetime prevalence of suicidal ideation = 20%
    • Rates of suicide 5-14% = twice as high as in the general population
  2. Anxiety: 44-51% - May be especially common when cause un-dx
  3. Comorbid sleep disorder prevalence of 53-88%
20
Q

What are 3 predictors of disability?

A
  1. Attention (e.g., hypervigilance) (absorbed on pain- in fear-avoidance- strong predictor of disability over time)
  2. Maladaptive Primary Appraisals: Threat, Loss
    • Threat appraisals most common in pain
      • Lead to hypervigilance, fear-avoidance
  3. Secondary Appraisals: (great predictor of poor pain improvement) Pain catastrophizing is a negative mental set about actual or anticipated pain (eg. this pain is terrible, this pain has ruined my life)
    • Pain management self-efficacy (often arising from challenge appraisals) is protective & motivates action (more positive outlook –> enhance and build confidence)
21
Q

What are 7 evidence-based psychological treatments for chronic pain?

A
  1. Pharmacological interventions
  2. Behavioural Therapy
  3. Cognitive Behavioural Therapy
  4. Hypnosis
  5. Mindfulness-Based Therapies
  6. Acceptance-Based Therapies
  7. Condition Specific Therapies
22
Q

How is attention a predictor of disability?

A

Attention (e.g., hypervigilance) (absorbed on pain- in fear-avoidance- strong predictor of disability over time)

23
Q

How is Maladaptive Primary Appraisals: Threat, Loss a predictor of disability?

A

Maladaptive Primary Appraisals: Threat, Loss

  • Threat appraisals most common in pain
    • Lead to hypervigilance, fear-avoidance
24
Q

How is Secondary Appraisals a predictor of disability?

A

(great predictor of poor pain improvement)

  • Pain catastrophizing is a negative mental set about actual or anticipated pain (eg. this pain is terrible, this pain has ruined my life)
  • Pain management self-efficacy (often arising from challenge appraisals) is protective & motivates action (more positive outlook –> enhance and build confidence)
25
Q

What evidence-based psychological treatment for chronic pain is the “gold” standard?

A

Cognitive behavioural therapy (CBT)

26
Q

What is Cognitive behavioural therapy (CBT)?

A
  • Goal-oriented, psychoeducational, didactic, homework based
  • Includes both cognitive and behavioural components (what we think and what we do)
27
Q

What does Cognitive behavioural therapy (CBT) promote? List 2 things.

A

More realistic/positive reappraisal of situations initially judged as stressful (e.g., cognitive restructuring)  Relaxation & behavioural activation & engagement (e.g., pacing)

28
Q

What are 3 key variables of cognitive behavioural therapy (CBT)?

A
  1. Catastrophizing
  2. Self-efficacy
  3. Increased “up time”
29
Q

What is one program of cognitive behavioural therapy like?

A

10 sessions x 1-1.5 hr sessions

30
Q

In a stressful situation –> change in emotions (eg. anxiety) -> changes in body (tension) –> changes in behaviour (eg. road rage) —> ______ (increased/decrease) pain

A

increase

31
Q

Also sometimes can only feel pain when _____ because pain has accumulated.

A

relaxed

32
Q

What are the 3 goals of treatment?

A
  1. Increase Physical activity
  2. Increase Engagement in enjoyable, meaningful, or pleasurable activities
  3. Increase Participation in activities consistent with values and personal goals
33
Q

Activities the the CBT, should have 5 specific characteristics. What are they?

A
  1. “Anti-depressant” & “anti-pain” (i.e., reinforcing, valued) (eg. while heat pack is helpful, this is pain-focussed)
  2. Scheduled (versus waiting until the person “feels better” or “feels like doing it”) (do activities regardless of pain)
  3. Increased gradually and systematically (“paced”) (don’t let pain dictate behaviour)
  4. Time-contingent (versus pain-contingent) (stop when they want to stop, not when pain tells them to- unless getting baseline)
  5. Set in the context of specific, measurable, & attainable goals
34
Q

How is Anti-depressant” &“anti-pain” a treatment in CBT?

A

Anti-depressant” &“anti-pain” (i.e., reinforcing, valued) (eg. while heat pack is helpful, this is pain-focussed)

35
Q

How is scheduled activity a treatment in CBT?

A

Scheduled (versus waiting until the person “feels better” or “feels like doing it”) (do activities regardless of pain)

36
Q

How is an increase gradually and systemically a treatment in CBT?

A

Increased gradually and systematically (“paced”) (don’t let pain dictate behaviour

37
Q

How is Time-contingent behaviour a treatment in CBT?

A

Time-contingent (versus pain-contingent) (stop when they want to stop, not when pain tells them to- unless getting baseline)

38
Q

Why are 3 reasons why pacing is key?

A
  1. Track “over-doing” (susceptible)
  2. Set time limits on these activities (red flags)
  3. Plan activity to allow rest or relaxation to be interspersed with the activity
39
Q

What is quota-based reactivation?

A
  • Conduct a baseline assessment of target behaviors
    • e.g., walking time for 3 days (see what average is)
  • Set initial goal (quota) that is within the patient’s capacity (so they achieve success)
    • usually 5-10% less than average of baseline (don’t want them to have a sense of failure- boost confidence first
  • Increase behavior gradually & systematically
    • by about 5%
  • Do not allow pain to guide behaviour
40
Q

What is the important thing about quota-based reactivation?

A

don’t do big progressions (eg. 5% is suitable to elicit improvement but not too challenging ) set at a paced and appropriate grade

41
Q

What are 5 relaxation techniques that are included in most CBT programs?

A
  1. Deep breathing techniques
  2. Biofeedback
  3. Guided imagery
  4. Hypnosis
  5. Mindfulness
42
Q

What is a relaxation technique that is not recommended in a CBT program? Why?

A

progressive muscle relaxation for pain

  • Chronic pain victims are already tense –> avoid this kind of relaxation
43
Q

Where is a clinical psychologist found?

A

Most clinic and hospital-based interdisciplinary programs will have a clinical psychologist on the team

44
Q

What are 2 ways to enhance efficacy?

A
  1. Tailoring interventions
  2. Combining elements of treatments
45
Q

What are 2 things that there is an urgency to understand?

A
  1. How treatments work (mediators)
  2. For whom do treatments work (moderators)

PHTY2101 EOS (22 decks)

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