chapter 16 Flashcards
nociception
◦Nociceptive pain (musculoskeletal)
◦ Due to tissue damage (muscles, bones, joints,
skin) e.g. a fracture or burn wounds
acute pain
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
chronic benign pain
pain remains at the same level (back pain)
Chronic progressive pain
pain gets worse with progression of the disease (rheumatiod arthritis)
five meta-themes can be foun in studies of pain
- body as obstacle
- invisble but real
- disrupted sense of self
- unpredictability
- keeping going (balancing between hope and giving up)
thee types of gain from pain
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
what are the 5 Ds when personal beliefs trigger a benefit from pain?
- dramatisation of symptoms
- disuse due to inactivity
- drugs misuse due to over-medication
- depenency on others due to learned helplessness and less coping
- disability due to inactivity
specificity theory (epicurus, descartes)
pain receptors –> brain –> sensory experience of pain
What did von Frey say about pain and nerves?
three types of nerves in the skin (for touch, warmth and pain)
Goldscheider’s pattern theory of pain
we experience pain only when it crosses a threshold
what is evidence disproving the specificity theory?
- phantom pain
- people are insensitive to pain, even though there are receptors
- psychological influences on pain: mood, attention, cognitions, experience, causation, catastrophing, social context.
how does placebo work? name the two mechanisms
classical condiitioning and response expectancy theory
Gate control theory of pain
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)
name the three types of nociceptors
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
What do A and C fibres do for pain?
they send information to the substantia gelatinosa in the spinal cord, which will give it to the braim
substantia gelatinosa, what does it do?
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
where does information from the A fibres go?
Thalamus and cortex (planning and initiating action to make the pain stop)
Where does information from the C fibres go to?
Limbic system, hypothalamus and autonomic nervous system (emotional component and to react quickly)
endorphins
can close the gates so that you won’t feel pain. like the runners high
neuro matrix: three assumptions
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.
McGill pain questionnaire
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.
Patient-controlled analgesia (PCA)
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
Transcutaneous electrical nerve stimulation (TENS)
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.
biofeedback
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.
neuropathic pain
◦ 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
◦Idiopathic pain
◦ Pain for which no clear organic cause can be
found → no diagnosis referring to a clear
structural (organic) problem
Law of Effect
when a specific response is followed by reward, the
probability of (re)occurrence of this response in the future
increases
Operant Conditioning
= the learning processes that take place by giving
rewards, eliminating negative consequences,
eliminating rewards or administering punishment.
Fordyce (1968) applied Operant Conditioning to
pain
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
Learning Theory vs. the CognitiveBehavioral Theory
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
Symptom CheckList-90 R (SCL-90R) (for emotions during pain)
9 subscales
◦ Anxiety
◦ Depression
◦ Sleep
◦ Somatic complaints
There is a brief, validated version of the SCL-90R, the
Brief Symptom Inventory (BSI)
Hospital Anxiety and Depression Scale
(HADS)
▪HADS was developed for patients with a medical
condition (does not contain any somatic items)
▪2 subscales
◦ Anxiety
◦ Depression
Pain Catastrophizing Scale (PCS)
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”)
Pain Coping Strategies Questionnaire (CSQ)
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”)
◦ Transcutaneous Electrical Nerve Stimulation (TENS)
◦ 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?
HYPNOSIS
Why does it work?
▪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)
RET: Rational Emotive Therapy (Albert Ellis)
→ Challenging irrational (dysfunctional)
automatic thoughts by means of the ABC
scheme
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
Limitations of self-help programs:
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)
