Chapter 14: Managing Pain Flashcards
clinical pain
pain that requires some form of medical treatment
acute pain
sharp, stinging pain that is short-lived and usually related to tissue damage
recurrent pain
episodes of pain followed by relief for more than three months
chronic pain
dull, burning pain that is long-lasting, either 6 months or longer
hyperalgesia
a condition in which a chronic pain sufferer becomes more sensitive to pain over time
100’s of studies have concluded that hyperalgesia occurs as a normal adaptation during sickness. most kinds of internal pain are accompanied by increased sensitivity in neraby tissue
physical measures of pain
EMG (electromyography) assesses the amount of muscle tension experienced by patients suffering from headaches or lower back pain.
Researchers have also recorded changes in heart rate, breathing rate, blood pressure, skin temperature, and skin conductance - all indicators of the autonomic arousal that may accompany pain
behavioral measures of pain
Pain response preference questionnaire
has been used to assess the degree to which a range of potential pain-related reponses are desired from a spouse or partner
self-report measures for pain
visual analog scale (with the 5 different facial expressions)
people locate the level of their pain at a point along a horizontal or vertical line that is anchored by two extremes: “no pain” and “worst pain.”
free nerve endings
sensory receptors found throughout the body that respond to
temperature
pressure
painful stimuli
nociceptor
a specialized neuron (pain receptors) that responds to painful stimuli
fast nerve fibers
large, myelinated nerve fibers that transmit sharp, stinging pain
slow nerve fibers
small, unmyelinated nerve fibers that carry dull, aching pain
substantia gelatinosa
the dorsal region of the spinal cord
region where both fast and slow pain fibers synapse with sensory nerves on their way to the brain
fast pain system
appears to serve only the skin and mucous membranes
slow pain system
servers all other body tissues expect the brain itslef, which does not experience pain
referred pain
pain felt in a part of the body other than its actual source
substance P
a neurotransmitter secreted by pain fibers in the spinal cord that stimulates the transmission cells to send pain signals to the brain
enkephalins (endogenous)
endogenous (naturally occurring) opioids found in nerve endings of cells in the brain and spinal cord that bind to opioid receptors
periaqueductal gap (PAG) (midbrain)
a region of the midbrain that plays an important role in the perception of pain
electrical stimulation in this region activates a descending neural pathway that produces analgesia by “closing the pain gate”
anterior cingulate cortex (ACC)
the front part of the cingulate cortex, which resembles a collar in surrounding the corpus callosum and plays a role in pain processing and many self-regulating functions
endogenous opiate (peptides)
opiatelike substances naturally produced by the body
stress-induced analgesia (SIA)
a stress-related increase in tolerance to pain, presumably mediated by the body’s endorphin system
naloxone
an opioid antagonist that binds to opioid receptors in the body to block the effects of natural opiates and painkillers
it can treat narcotic overdoses in emergency situations
gate control theory of pain
excitatory signals (pulses) tend to open the gate; inhibitory signals (minuses) tend to close the gate.
proposed the existence of neural structures in the spinal cord and brainstem that function like a gate, swinging open to increase the flow of transmission from nerve fibers or swinging shut to decrease the flow. with the gate open, signals arriving in the spinal cord stimulate sensory neurons called transmission cells, which, in turn, relay the signals upward to reach the brain and trigger pain. with the gate closed, signals are blocked from reaching the brain, and no pain is felt
age and pain
pain is strongly associated with decreased physical capacity
older adults with pain, particularly those with pain in multiple locations, had weaker muscle strength, slower walking speed, and poorer overall function than those without pain
gender and pain
men show pain less than women, but women experience pain more intensely and for longer than do men
phantom limb pain
pain following amputation of a limb, false pain sensations that appear to originate in the missing limb
socioeconomic status and stress
people of lower SES have greater levels of morbidity and mortality across many diseases when compared with those at higher SES levels. They also may experience more stressful life events.
the challenges associated with lower SES also make those who suffer chronic pain more vulnerable to the harmful effects of stress on health and physical functioning
pain behaviors
actions that are a response to pain, such as taking drugs, grimacing, or taking time off from school or work
opioid analgesics
formerly called narcotics, opioids are agonists (excitatory chemicals) that act on specific receptors in the spinal cord and brain to reduce either the intensity of pain messages or the brain’s response to pain messages
most powerful is morphine, but people build up tolerance to it very quickly and need steadily higher dosage for the same effects
non-steroidal anti-inflammatory drugs (NSAIDs)
aspirin, ibuprofen, acetaminophen, and other analgesic drugs that relieve pain and reduce inflammation at the site of injured tissue
prostaglandin
the chemical substance responsible for localized pain and inflammation; prostaglandin also causes free nerve endings to become more and more sensitized as time passes
counterirritation
analgesia in which one pain (for example, a pulled muscle) is relieved by creating another counteracting sensation (such as rubbing near the site of the injury)
transcutaneous electrical nerve stimulation
a counterirritation form of analgesia involving electrically stimulating spinal nerves near a painful area
cognitive behavioral therapy
a multidisciplinary pain-management program that combines cognitive, physical, and emotional interventions
catastrophizing
an error in thinking in which a person believes something, such as pain, is far worse than it actually is
sensory focus
attending directly to the sensations of a painful stimulus without necessarily trying to change those reactions
cognitive reappraisal
a key component to CBT that focuses on helping individuals reinterpret pain-related sensations, restructure maladaptive thought patterns, and make positive self-statements
pain management program
an individualized, multimodal intervention aimed at modifying chronic pain through neurological, cognitive, and behavioral strategies
analgesia
inability to feel pain
