Chronic Pain Flashcards
Define acute pain
Acute - Unpleasant sensory and emotional experience associated with actual or potential damage.
Chronic - Pain which has persistence beyond normal tissue healing
What is the difference between management of acute and chronic pain?
Acute - Addresses the cause of the pain.
Chronic - Addresses the effects of pain and finding ways to maximise function and quality of life
What are the burdens of chronic pain?
1) Patients burden - Continuing quest for relief which can lead to depression.
2) Significant others/family’s burden - Shared frustration so chronic stress and worry.
3) Healthcare provider’s burden - Shared frustration with patients.
4) Societies burden - loss of productivity and disability benefits
What types of activites are affected in patients with chronic pain?
Working outside home, having sexual relationships, household chores, lifting, exercising and sleeping.
What are the chronic pain theories?
Gate control theory, biopsychosocial and cognitive-behavioural perspective
Describe features of gate control theory
- Includes ascending phsyiological inputs and descending psychological inputs.
- Gate open allows for transmission of pain whereas gate closes and prevents transmission pf pain impluses
- Gate is opened by inactivity, poor pacing, emotional, worry about the pain.
- Gate is closed by appropriate medication, massage, heat/cold, coping strategies, relaxation and exercise.
What are the pros and cons of the gate control theroy?
Pros - Provides physiological explanation and moves away from sensation to perception.
Cons - Evidence is mixed, lack of direct evidence of ‘gate’
What is the Biopsychological model of pain?
- Includes cognitive, affective and behavioural compounent of pain.
- Views factors such as anxiety, previous experiance, self-efficacy, fear, meaning, secondary gains and pain behaviour play a role in pain experiance
What is the cognitive behavioural perspective of pain?
- Patients who interpret pain as significant life threatening illness will focus on the pain and therefore find it harder to deal with.
- Patients who interpret it as the result of a minor injury will focus on other things, have a realistic approach and will deal with it better.
What are some methods of pain assesment?
- Pain intensity self-report by verbal rating scale, numerical rating scale or visual analogue scale.
- Pain intensity by observational scales,
- Pain distress
- Other aspects to asses would be mood, physical functioning and cognitive processing.
What are some limitations to self-report measurements?
- Tend to be time consuming,
- Verbal skills,
- Limited use of psychological scales to people whos first language is not English,
- Misrepresentation of pain (exaggeration or downplaying,)
- Chronic pain is difficult to capture using verbal or numerical sclaes
What is the scottish model of pain?
Level 1 - Self management (activity, relaxation non-opioid painkillers, support from 3rd party sectors),
Level 2 - Primary care (GP, physio, pharmacist, medications, exercise programmes, alternative therapies.
Level 3 - Secondary care (hospital based pain clinics or services.
Tertiary Care - Highly specialised services
What is the management of chronic pain?
- Pharmacological and physiological,
- Goals include improving physical and lifestyle functioning, decrease reliance on drugs and increasing social support and family life.
What is the behavioural management of pain?
Based on principles of operant behavioural conditioning (pacing to break the overactivity-rest cycle, prevent overactivity on good days so you don’t induce rapid fatigue and pain) so build up activity levels
What is the cognitive behavioural management of chronic pain?
CBT which aims to alter the intensity, form or frequency of unhelpful thinking styles, emotional responses and coping patterns to improve pain-related functioning
