Chronic Pain Flashcards
definition of acute pain
an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described by the patient in terms of such damage
chronic pain definition
pain which has persisted beyond normal tissue healing time
what is the management for acute pain
addressing the cause of the pain
management for chronic pain
addressing the effects of pain and finding ways to maximise the patients function and quality of life
what is the burden on the patients with chronic pain
continuing quest for relief therefore stems feeling of helplessness, hopelessness and depression
what is the burden on the loved ones
share of frustration which leads to chronic stress and worry, which itself can be a pathway for disease
what is the burden on society
lost of productivity and disability benefits
leading to strains on the NHS
what are the three theories surrounding chronic pain
- gate control theory
- biopsychosocial
- Cognitive-Behavioural perspective
what is the gate control theory
there is a gating mechanism in the dorsal horn of the spinal cord that ‘opens’ (permits) or ‘closes’ (inhibits) the transmission of pain impulses
what ‘opens’ the gate in the gate control theory
- inactivity/poor fitness (physical)
- poor pacing (behavioural)
- anxiety/depresison/hopelessness emotional
- catastrophising , worrying about the pain (cognitive)
what ‘closes’ the gate in gate control theory
- appropriate use of medication
- massage
- heat/cold
- positive coping strategies
- relaxation
- exercise
what are the pros of gate control theory
- provides a physiological explanation for how psychological factors affect pain perception
- moves the narrative away from sensation and towards perception
cons of gate control theory
physiological evidence is mixed
lack of evidence there is a ‘gate’
it does not explain why the same event can be interpreted by different people as more or less painful
Biopsychosocial Model
includes:
- cognitive, affective and behavioural components of pain
views illness as a dynamic and reciprocal interaction among biological, psychological and sociocultural variables that shape a persons response to pain
Cognitive-Behavioural perspective
emphasis on people beliefs, appraisals and coping repertoires, as well as sensory, affective and behavioural contributions, in the formation of pain perceptions
- attention
- patterns of thinking and beliefs
- self-efficacy
give me three examples of pain assessment
- pain intensity self-report
- pain intensity by observational scales
- pain distress
what are the three types of scales in the measurement of pain
- verbal rating scale
- numerical rating scale
- visual analogue scale
what is the McGill pain questionnaire
this is the most widely used pain intensity self report:
78 items in 20 groups
con = its VERY time consuming
what are the Limitations of Self-report Measures
- take a long time
- verbal skills are required
- exaggeration vs downplay of pain
what are the 4 levels in the Scottish pain management model
- advice and information about pain
- combination of activity and relaxation, non-opioid painkillers and support from a 3rd sector organisation (pain association Scotland) - help from GP or therapist if needed
- GP, physio, pharmacist, meds, exercise programme - chronic pain management service
- hospital based pain clinics, consults trained in chronic pain, psychologists, pharmacists, occupational health - highly specialised help
- Scottish national residential pain management programme SNRPMP
Goals on the management of pain
- decrease reliance on drugs
- increasing social support and family lie
- improving physical and lifestyle functioning (improving muscle tone, self-esteem, addressing pain behaviours and secondary gains)
what is the overactivity-rest cycle
this is
- overactivity
- fatigue/pain
- rest and frustration
- easing of symptoms
and repeat…
what is the aim of CBT
- alter the intensity, frequency or form of maladaptive or unhelpful thinking styles, emotional responses and coping patterns to improve pain-related functioning
ACT – Acceptance and commitment therapy
approach most directly linked to this model
focused on facilitating psychological flexibility and improve quality of life in the presence of pain
Psychological flexibility model
focuses on the function and workability of
Functional management
behavioural responses, i.e. whether behaviours in response to pain-related fear lead people toward or away from what is important to them in life
