chapter 16

Question 1

nociception

Answer 1

◦Nociceptive pain (musculoskeletal)
◦ Due to tissue damage (muscles, bones, joints,
skin) e.g. a fracture or burn wounds

Question 2

acute pain

Answer 2

pain that lasts less than 3-6 months. usually the pain goes w
away when the tissue is repaired, but doesn’t have to be the case

Question 3

chronic benign pain

Answer 3

pain remains at the same level (back pain)

Question 4

Chronic progressive pain

Answer 4

pain gets worse with progression of the disease (rheumatiod arthritis)

Question 5

five meta-themes can be foun in studies of pain

Answer 5

1. body as obstacle
2. invisble but real
3. disrupted sense of self
4. unpredictability
5. keeping going (balancing between hope and giving up)

Question 6

thee types of gain from pain

Answer 6

primary: having pain leads to less aversive consequences
2. secondary: having pain leads to positive outcomes (getting empathy)
3. tertiary: the pleasure of helping someone in pain

Question 7

what are the 5 Ds when personal beliefs trigger a benefit from pain?

Answer 7

1. dramatisation of symptoms
2. disuse due to inactivity
3. drugs misuse due to over-medication
4. depenency on others due to learned helplessness and less coping
5. disability due to inactivity

Question 8

specificity theory (epicurus, descartes)

Answer 8

pain receptors –> brain –> sensory experience of pain

Question 9

What did von Frey say about pain and nerves?

Answer 9

three types of nerves in the skin (for touch, warmth and pain)

Question 10

Goldscheider’s pattern theory of pain

Answer 10

we experience pain only when it crosses a threshold

Question 11

what is evidence disproving the specificity theory?

Answer 11

• phantom pain
• people are insensitive to pain, even though there are receptors
• psychological influences on pain: mood, attention, cognitions, experience, causation, catastrophing, social context.

Question 12

how does placebo work? name the two mechanisms

Answer 12

classical condiitioning and response expectancy theory

Question 13

Gate control theory of pain

Answer 13

pain receptors send info to gates in the spinal column, at the same time we experience cognitions and emotions sent from the brain to these gates.

Activation of the first system opens the gates (experience of pain), the second system can open and close the gates (distraction/attention –> less/more experience of pain)

Question 14

name the three types of nociceptors

Answer 14

A delta fibers: mechanical, thermal damage to tissue, short sharp pain, is fast!
C polymodal fibers: blunt, throbbing pain that lasts longer, very slow
A beta fibers, coutneracts pain (rub a sore spot) is faster than c fibers

Question 15

What do A and C fibres do for pain?

Answer 15

they send information to the substantia gelatinosa in the spinal cord, which will give it to the braim

Question 16

substantia gelatinosa, what does it do?

Answer 16

it releases substance Projection fibres which activates the transmitter fibres that direct pain sensation to the brain. Via reticulospinal fibres will the brain respond to cognitive and emotional responses influenced by distraction, attention and fear

Question 17

where does information from the A fibres go?

Answer 17

Thalamus and cortex (planning and initiating action to make the pain stop)

Question 18

Where does information from the C fibres go to?

Answer 18

Limbic system, hypothalamus and autonomic nervous system (emotional component and to react quickly)

Question 19

endorphins

Answer 19

can close the gates so that you won’t feel pain. like the runners high

Question 20

neuro matrix: three assumptions

Answer 20

in reaction to the gate theory ivm phantom pain. the brain contains a representation of the body in which we process and integrate pain.
information about pain experience together forms a neurosignature, with two components: body self matrix (processes and integrates sensory and emotional info) and action neuromatrix (develops behavioural responses). The neuromatrix is programmed to assume that the limbs can move. If the body does not move, stronger and stronger signals are sent to body parts, causing pain.

Question 21

McGill pain questionnaire

Answer 21

gives a multidimensional picture of pain. it measures type of pain, emotional response, intensity and timing (pattern). also measures vocalisations, motor behaviour, treatment behaviour and functional limitations.

Question 22

Patient-controlled analgesia (PCA)

Answer 22

patients can choose when and how much pain relief they want. As a results, patient are more satisfied with pain relief, less anxiety and less analgesia. <– medicine that relieves pain

Question 23

Transcutaneous electrical nerve stimulation (TENS)

Answer 23

stimulates A beta fibres to interfere with pain signals and stimulating C fibres to stimulate endorphin release. place the device on your skin several times a day, so control is with the patient. Not very convincing evidence tho.

Question 24

biofeedback

Answer 24

Biofeedback is a technique that trains people to improve their health by controlling certain bodily processes that normally happen involuntarily, such as heart rate, blood pressure, muscle tension, and skin temperature.

Question 25

neuropathic pain

Answer 25

◦ Consequence of damage to (or pathology of) the central/peripheral nervous system ◦In addition to pain, sensory changes are reported by patients ◦ Allodynia: pain is experienced as a consequence of a stimulus that does not normally cause pain ◦ Hyperalgesia: pain that is experienced is disproportional to the pain stimulus

Question 26

◦Idiopathic pain

Answer 26

◦ Pain for which no clear organic cause can be found → no diagnosis referring to a clear structural (organic) problem

Question 27

Law of Effect

Answer 27

when a specific response is followed by reward, the probability of (re)occurrence of this response in the future increases

Question 28

Operant Conditioning

Answer 28

= the learning processes that take place by giving rewards, eliminating negative consequences, eliminating rewards or administering punishment.

Question 29

Fordyce (1968) applied Operant Conditioning to pain

Answer 29

opain responses are learned and maintained by reinforcement ◦ Grimacing and complaining about pain may be maintained because of the attention the patient receives from others ◦ Use of medication and avoidance of activity lead to pain relief

Question 30

Learning Theory vs. the CognitiveBehavioral Theory

Answer 30

Learning Theory Does not consider the cognitive and emotional aspects of pain – restricted to behavior Cognitive-Behavioral Theory Emphasizes the role of behavior, cognitions and emotions

Question 31

Symptom CheckList-90 R (SCL-90R) (for emotions during pain)

Answer 31

9 subscales ◦ Anxiety ◦ Depression ◦ Sleep ◦ Somatic complaints There is a brief, validated version of the SCL-90R, the Brief Symptom Inventory (BSI)

Question 32

Hospital Anxiety and Depression Scale (HADS)

Answer 32

▪HADS was developed for patients with a medical condition (does not contain any somatic items) ▪2 subscales ◦ Anxiety ◦ Depression

Question 33

Pain Catastrophizing Scale (PCS)

Answer 33

3 subscales ◦ Rumination (e.g. “I can’t seem to keep it out of my mind”) ◦ Magnification (e.g. “I become afraid that the pain may get worse”) ◦ Helplessness (e.g. “It’s terrible and I think it’s never going to get any better”)

Question 34

Pain Coping Strategies Questionnaire (CSQ)

Answer 34

6 subscales ◦ Diverting attention (e.g. “I try to think of something pleasant”) ◦ Reinterpreting the pain sensation (e.g. “I don’t think of it as pain but rather as a dull or warm feeling”) ◦ Catastrophizing (e.g. “It is awfull and I feel that it overwhelms me”) ◦ Ignoring sensations (e.g. “I don’t think about the pain”) ◦ Praying or hoping (e.g. “I pray to God it won’t last long”) ◦ Coping self-statements(e.g. “I tell myself that I can overcome the pain”)

Question 35

◦ Transcutaneous Electrical Nerve Stimulation (TENS)

Answer 35

◦ Electrodes are placed on the skin in the area of the pain; ◦ A small, low-intensity electrical pulse is passed through the area (15-20 min) → pain signal is blocked ◦ Widely used but due to a lack of well-conducted trials, no conclusions can be drawn about its effectiveness ◦ Short-term effects?

Question 36

HYPNOSIS Why does it work?

Answer 36

▪Basis: Deep relaxation ▪Expectation that hypnosis will ease the pain (suggestion) ▪During hypnosis patients are instructed to think differently about the pain (reinterpretation of the pain – cognitive component) ▪Hypnosis implies distraction (moving your attention away from the pain)

Question 37

RET: Rational Emotive Therapy (Albert Ellis) → Challenging irrational (dysfunctional) automatic thoughts by means of the ABC scheme

Answer 37

A = Actual situation ◦ Partner proposes X to go for a walk B = Irrational belief ◦ X: “Physical activity will make the disease/symptoms worse” C = consequences ◦ Emotional: excessive anxiety ◦ Behavioral: X stays home ... . --> A = Actual situation ◦ Partner proposes X to go for a walk B = More rational, alternative belief ◦ X: “physical activity will strengthen my muscles → these will be better able to support my body/back → pain will gradually get better” C = consequences ◦ Emotional: anxiety decreases and self-efficacy increases ◦ Behavioral: X goes for a walk

Question 38

Limitations of self-help programs:

Answer 38

Importance of a “Stepped care approach” ▪ To what extent is this patient willing and able to actively participate in his/her own recovery/pain management (involvement of illness attributions)