Biopsychosocial management of chronic pain Flashcards
What is chronic pain?
Pain which persists for longer than 3 months, associated with significant emotional distress or functional disability.
What are the physiological features relevant to chronic pain?
Specific areas of the body have more denser nociceptors and more glial cells to produce inflammation. Neuroplasticity where neural networks are rewired due to experience like pain can mean avoiding using painful area will cause increased recovery difficulty.
What influences pain perception?
Psychological factors like boredom or health beliefs, low activity, stress and tension.
What is central sensitisation?
The nervous system is in a hyperactive state that leads to increased receptivitiy of nociceptors to low level stimuli. Heightened sensitivity to pain such as hyperalgesia or allodynia, poor concentration and memory and greater emotional distress.
How can chronic pain be managed in an MDT?
In a multi-disciplinary team by occupational therapists to set goals, physiotherapists, psychologists and medical anaesthetists. By medicating but this has limited long term benefits, use of NSAIDS
How can chronic pain be managed?
Behavioural: Goal setting, pacing
Psychological: CBT techniques, psychoeducation, acceptance
Physical: physiotherapy, graded exercise
What is the holistic model of pain?
Pain affects many aspects of life such as behaviour like your hobbies or work or placing limitations
Moods
Physical- > sleep, effect of medication
Environment -> relationships, finances, where you live
Thoughts -> self deprecation
What are the psychological factors in pain?
-> Appraisal of Pain
-> Expectation of the impact of pain such as limitations
What is the cognitive behavioural model of pain?
Based on the psychological factors of appraisal and expectation of pain. Uses CBT technique to challenge or alter thoughts and behaviours and emotions based on physical symptoms.
What influences chornic pain?
Childhood trauma which establishes prior state of central sensitisation which can lead to chronic pain with physical trauma or becoming ill
How can patients with chronic pain be supported?
With CBT which has an impact on the pain-depression relationship, mindfulness and understanding psychological trauma and working through it.
What are the challenges of chronic pain for patients?
Invalidation, symtpoms may be overlooked due to miscommunication, feeling blame and misjudged.
What are the challenges of chornic pain for HCPs?
Setting realistic expectations for patients, worry about drug-seeking behaviours to relieve pain and helplessness
