Chapter 12: pain and pain management Flashcards
What is Pain
unpleasant sensory or emotional experience associated with actual or potential tissue damage
Clinical pain
when people need to seek treatment
Acute pain
usually associated with recent ongoing tissue damage (e.g. an injury - short term
- Pain after surgery impairs endocrine and immune functioning (impairs wound healing)
What are the evolutionary/adaptive functions of acute pain?
- Survival
- Information
- Warn of potential serious injury
- Promote learning to avoid same situations later
- Limit physical activity and promotes rest
What is Chronic Pain?
Persists beyond the normal expected healing period or is otherwise persistent over time (at least 3-6 months)
- Patients perception of chronic pain is different than acute pain. As you don’t see an end to pain.
What occurs during the Transition from acute to chronic pain?
- Increase in disability
- Loss of self-efficacy
- Fear of activities causing more pain
What are some Rating Scales for Pain
- Self-report rating (rate from 1-10 how bad your pain is)
- Visual Analog scale (move a measure along a scale - more precise)
What is Observational pain rating
- May be needed if you can’t communicate with the patient
- Use ongoing vs transient system to determine if the patient is in pain
McGill pain Questionnaire
Gives people words to vocalize their pain
- Circle one word in each group
- Circle 3 words in group 1-10
- Circle 2 words in group 11-15
- Pick one word from group 16
- Pick one from group 12-20
- These seven words will be used when talking to your doctor
Treatment of Pain a Few centuries ago
- Poked pain away with a “vigorous” twig, and twig absorbs the pain
- Buried twig to prevent others from getting pain
Treatment of Pain in the 19th Century
Medicine was laced with opium or alcohol to relieve pain and perform surgeries
Treatment of Pain Today
- Two primary sources of pain management
- Surgical and chemical
- Chemical treatment is most frequently used today
When does Surgical Treatment of Pain take place/ what methods are used?
- Typically only performed when chemical methods have failed
- Neuroablation (rarely used in Canada - has side effects and rarely works long term)
- More effective treatments include Synovectomy, Spinal Fusion
What is Neuroablation
surgery to remove part of the PNS or spinal cord (remove part of the nervous system causing pain - rarely used in Canada as it can affect your life in other ways)
- Has side effects and rarely works long term
What is Synovectomy
inflamed membranes are removed in arthritic joints
What is Spinal Fusion
joins two or more adjacent vertebrae to treat severe back pain (fuse two vertebrae - used in Canada but not other developed countries)
What are some Chemical Treatments of Pain?
- Analgesics (opioid, non-opioid, non steroidal anti-inflammatory drugs), Anesthetics.
Medications are given as
1. As a prescribed schedule
2. Pro re nata (PRN) - “as needed” (becoming the standard)
What is an Opioid
Centrally acting - used to be called narcotics.
Act on receptors in the spinal cord and brain to reduce intensity of pain message or brain’s response to the message (e.g. morphine, heroin, and methadone)
What is a Non-opioid
Peripherally acting.
Pain reduction without sedation, reduce inflammation and reduce body temperature when there’s a fever (work where tissue damage is happening, work locally).
What are Local anaesthetics
block nerve cells in the region from generating impulses
- Not for long term use, can work for several hours or days (for acute pain)
- E.g. Novocain, lidocaine
Psychosocial factors impact chronic pain
- Chronic headache patients use poorer coping strategies than non-chronic headache patients
- Arthritis patients with feelings of helplessness before treatment have lower success compared to those with lower feelings of helplessness
- Placebos work through psychological processes to relieve pain
Psychologist’s Role with pain
- Psychosocial factors impact chronic pain
- Recommending a patient see other health professional needs consideration (perceptions that the doctor doesn’t believe pain is “real”)
When suggesting patient meet with a psychologist physicians should clearly state
- The pain is real
- Patients can help themselves get control by working with others (e.g. psychologists)
- The physician will remain an active member of the team
What is Active emotion focused coping
ignoring pain, or actively trying to distract yourself (related to better outcomes than passive for both acute and chronic pain)
What is Passive emotion focused coping
go to bed early, stop social activities (“letting your emotions go”), not trying to actively regulate emotions
What are the different ways of Coping With Pain
- Problem vs emotion focused coping
- Active vs passive emotion focused coping
The presence of pain, fear and stress…
can exacerbate physiological mechanisms of pain (back away from activities that lead to pain. E.g. someone with back pain may be scared to walk somewhere, but then muscles become weaker making their pain worse)
- Controlling fear and stress, might reduce pain (e.g. back pain)
What are the Behavioural and Relaxation Techniques?
- Relaxation
- Biofeedback
- Meditation
- Mindfulness
Relaxation
systematic relaxation of the large muscle groups (e.g. legs, arms)
- Relaxation tends to be useful for acute pain
- Can be useful for chronic pain but not by itself - it’s best if combined with other methods (e.g. relaxation and emotion focused coping)
Progressive muscle relaxation
tense muscles for a certain amount of time and then relax - allows people to be more aware of when/where they’re tense and how to relax
Biofeedback
provides feedback about some bodily process the patient is unaware of (e.g. forehead muscle tension) Hook someone up to EMG machine, machine tells the person where they’re tense and then the patient practices relaxing.
- Biofeedback is more effective for relieving headache pain
Meditation
focus on an object (sound or event)
Mindfulness
attend to the pain but detach from the thoughts and feelings about it (feel pain and let your thoughts about the pain “flow freely”)
What are some Cognitive Methods
changing thoughts and focus
- Distraction
- Guided Imagery
- Redefinition
What is Distraction (cognitive technique)
Focus on non-painful stimulus in the immediate environment to divert attention from discomfort
- Tends to be more effective for mild/moderate pain (not severe) and more effective for acute pain.
- Focus on something real
What is Guided imagery (cognitive technique)
therapist coaches someone through imaging something that’s more pleasant. Try to alleviate pain by conjuring up a mental scene that is unrelated to or incompatible with the pain (taste, vision, hearing, smell, and touch)
- Something you picture in your head
What is Redefinition (cognitive technique)?
focuses on changing appraisals of pain and ability to deal with it (reappraise) Self-statements: 1. Coping statement 2. Reinterpretation statements - Similar to cognitive restructuring
What is Coping statement?
emphasized ability to cope “it hurts but you’re in control”
What are Reinterpretation statements?
negative unpleasant aspects “it’s not so bad”
Other Therapies and Approaches
- Stimulation Therapies
- Hypnosis (only works for those who are easily hypnotized)
- Physical Therapy (improves muscle strength, mobility, TENS)
Stimulation Therapies
- Counterirritation
- Transcutaneous electrical nerve stimulation (TENS)
What is Counterirritation
if you give someone a milder pain in the location where they’re experiencing pain it distracts them
Treatment for Chronic Pain
- Multidisciplinary (medical, psychological, physical therapy)
- Often work in groups
- Goals: Reduce pain, Improve physical function, Decrease medication and use of medical services, and Enhance family life
(potentially job life)
