Behavioural Approaches to Pain

Question 1

Is it possible to have pain and know about it

Answer 1

No - Pain is inherently regarding awareness; attention is separate

Question 2

Do we have special pain receptors

Answer 2

No, we have receptors that are involved in messaging which may signal pain

Question 3

What happens in terms of sensitivity as pain persists over time and why

Answer 3

Pain becomes less sensitive to tissue damage in the body as that pathway becomes more and more optimised

Question 4

Acute Pain

Answer 4

Pain that has lasted less than 3-6 Months

Useful protective function whilst body heals

Medication normally works quite well

Question 5

Persistent Pain

Answer 5

Continues after 3 months

Tissues have healed

Pain is unhelpful

Caused by changes to nerves and neuro-networks

Medication has limited effectiveness

Question 6

Levels of Pain

Answer 6

Tissue - Muscle, skin, ligament & bone

Spinal Cord

Brain

Question 7

Discuss the Pain that occurs in tissues

Answer 7

Nociceptors - Threat Detectors that detect changes in intense temprature, threats from chemicals/pressure or internal chemicals like inflammatory mediators

Question 8

Discuss the pain that occurs at the level of the spinal cord

Answer 8

Nociceptors send signals to the spinal cord

There is a synapse in the dorsal horn - neurotransmitters send signals to the brain; brain also sends signals to spinal cord

LIKE A GATE (when opened, signals are magnified)

Question 9

Discuss the pain that occurs at the level of the brain

Answer 9

Messages that reach the brain combine with other messages like what you can see (e.g. seeing your hand fall off/knowledge of what’s happening/emotions/memory)

The brain then has to decide “do i need to protect x”

Question 10

What is the goal of pain

Answer 10

Protecting the person

Question 11

Qualitative Discussion of degenerative pain

Answer 11

We all have degeneration like disk degeneration as we age; even people who are asymptomatic are likely to experience degenerative pain in some ways

(e.g. slip disks)

Question 12

DIMs and SIMs

Answer 12

Danger In Me
- Anything that suggests that tissues need protecting takes pain up

Safety In Me
- Anything that suggests your tissues are safe takes pain down

When DIMs outweigh SIMs, pain is produced

Question 13

Factors of DIMs and SIMs

Answer 13

Sensory Input (e.g. seeing a cut)
Things you do
Things you say/think/believe (thinking you have a serious injury)
Places you go (hospitals either way depending on bias)
People in your life (reassurance/stressing)
Things happen in your body (Anxiety/Joy/Inflammation)

Question 14

Examples of the brain using past experiences for pain

Answer 14

Electricians dealing with mild shock

Waiters and chefs with hot plates

Question 15

Effect of a bad smell on length of time holding your hand in an ice bucket

Answer 15

A poor smell has been found to reduce someone’s tolerance for freezing water

Question 16

Effects of understanding pain (Based on Explain Pain studies)

Answer 16

Quality of life improves
Sleep improves
Likelihood of full time work increases
Worry decreases
Pain-related expenses reduce
Pain decreases

Question 17

Concepts to teach patients how to improve pain

Answer 17

Pain is normal, personal and real (validation)

There are danger sensors not pain sensors

Pain & tissue damage rarely relate

Pain depends on balance of danger & safety

Pain involves distributed brain activity

Question 18

Elicit-Provode-Elicit Model

Answer 18

Elicit Information
Give Information
Elicit What They Think

Question 19

Acceptance & Commitment Therapy

Answer 19

ACT encourages people to embrace their thoughts and feelings rather than fighting or feeling guilty for them

Stops people from ruminating and focusing more on pain than they might need to

Growing life around pain as opposed to trying to diminish the pain - makes the pain seem smaller

Question 20

Pillars of ACT

Answer 20

Open (Skillfully relating to the inner world)
Aware (Present in the moment)
Active (Using values to guide ation)

Question 21

Central Concept(s) of ACT

Answer 21

Suffering is normal and part of the human condition

You can’t stop the waves but you can learn to surf