Chronic Pain Flashcards
What does chronic mean?
persisting for a long time or constantly recurring
What is pain?
an unpleasant sensory and emotional experience associated with actual or potential tissue damage
What is another term for short-term pain?
Acute pain
What is another term for long-term pain?
Chronic or persistent pain
What time period is considered for long-term pain?
6 months or more
What are the 3 different types of pain?
Recurrent, short-term, long-term
What is chronic pain?
Most pain resolves promptly after a painful stimulus is removed and the body has healed, but sometimes the pain persists despite removal of the stimulus; and sometimes pain arises in the absence of any detectable stimulus, damage or disease
What does the holistic model of pain show? (B-TEMP)
Shows how pain affects your life
Behaviour
Thoughts
Environment
Moods
Physical
Explain pain gate theory.
- developed to account for the importance of the mind & body in pain perception
- explains that all sorts of factors influence our experience, including thoughts and feelings
- nerves from all over the body run to the spinal cord - they proposed we can imagine a series of gates into which messages about pain arrive from all over the body
- these gates can sometimes be more open than others
Give examples of pain gate theory
- e.g. you will likely be aware that there are many times, even though you have pain, you are only dimly aware of it
- e.g. pain can feel much worse - the more you think about your pain, the worse it can feel
What kind of factors affect opening and closing of pain gates?
- Stress & Tension
- Psychological factors
- Lack of activity
What is central sensitisation?
- condition of the CNS that is associated with the development & maintenance of chronic pain
- CNS goes through a process called ‘wind up’ and gets regulated in a persistent state of high reactivity
- persistent state of reactivity lowers the threshold for what causes pain and subsequently comes to maintain pain even after the initial injury might have healed
What are the 2 main characteristics of central sensitisation?
Allodynia & Hyperalgesia
What is Allodynia?
occurs when an individual experiences pain with things that are not normally painful.
nerves in the area are sending messages to a brain which is in a state of heightened reactivity - producing a sensation of pain and discomfort
What is Hyperalgesia?
occurs when a stimulus that is typically painful is perceived as more painful than it should be.
heightened reactivity produces pain that is amplified
What psychological factors are there for chronic pain?
Expectation and anticipation
How does expectation and anticipation cause chronic pain?
- beliefs and interpretations influence our emotions and behaviour - not just the objective characteristics of an event
- people with negative beliefs about their pain can experience greater suffering
What is the primary appraisal?
where an event is evaluated in terms of its threat to wellbeing i.e. we allocate meaning
What is the secondary appraisal?
Questioning how you are able to cope with the level of threat.
What are cognitive appraisals?
the belief and ideas that create our meaning of things & hence contribute significantly to our perception of pain
What are cognitive errors/
such as catastrophising can contribute to the distress and disability associated with pain
What is the avoidance cycle?
- pain
- ‘i should rest’
- ‘there’s no explanation for my pain so I can’t control it’
- maladaptive coping - mood + decrease in activity
- more pain when trying to exercise
- reinforcing beliefs and continuing
What is the self-regulation model of illness representations?
- developed to explain how people make sense of and respond to health threats and illness
- when faces with an illness people generate both cognitive representations and emotional responses of their illness
- illness representations are a persons ‘view’ of their illness, constructed in order for them to make sense of and create meaning
What are the 5 components of illness representations?
- identity
- cause
- timeline
- consequences
- curability/controllability
What is the identity representation?
The label or name given to the symptoms. Many people like a label for legitimisation
What is the cause representation?
Underlying cause. May not be medically accurate. Based on information gathered from personal experience, opinions & discourses of significant others, health professionals, media sources etc
What is the timeline representation?
How long the condition might last. It can be very difficult for patients to hear that their long-term pain will not get better. Some patients persist in thinking that one day it will go away. This can hinder a self-management approach. Beliefs will be re-evaluated as time progresses
What is the consequence representation?
What are the consequences and how will this impact? These representations may only develop into more realistic beliefs over time.
What is the curability/controllability representation?
Beliefs about whether the condition can be cured or kept under control and the degree to which the individual plays a part in achieving this.
What is the cognitive behavioural model of pain and depression?
- patients appraisals of the impact of their pain on their lives and their sense of control over their pain determines the pain-depression relationship
- those patient’s who believed they could still function despite their pain and those who believed they could maintain some control did not become depressed
- the presence of pain is not sufficient condition for the subsequent development of depression
What treatment/management options are there for chronic pain?
- Medical management
- Pain management strategies (individual)
- Pain management strategies (group)
What medical management strategies are there?
- medicine management
- spinal cord stimulator (SCS)/intrathecal devices
- injections
- acupuncture
What individual pain management strategies are there?
- specialist nurse
- physiotherapist
- occupational therapist
- psychologist
What group pain management strategies are there?
- PMP 4 session
- PMP 12 session
- SCS Education programme
What unhelpful thinking styles are usually involved in chronic pain?
- fortune telling
- mind-reading
- shoulds
- over-generalising
- black and white thinking
- catastrophising
What CBT interventions are used for chronic pain?
- Socratic questioning - help to raise awareness
- Thought monitoring, evaluating & challenging
- graded exposure
- behavioural experiments
- behavioural activation
- probability pie chart
- surveys
What is Socratic questioning?
open ended questions, helping people to reflect on the impact of pain on their mental health
What is behavioural activation?
more for low moods. might be exploring what activities that person doesn’t do as much anymore, but then also thinking about what activities help you feel that you’re getting a sense of pleasure, enjoyment, achievement, control + start to plan those activities for the week
What is a probability pie chart?
if we have an inflated sense of responsibility.
the person might be feeling completely responsible for their father falling on holiday and so they should map out the role of them there and use it to try to diffuse that sense of responsibility
What are surveys used for?
asking friends/family if their pain has led them to need a walking stick etc - questionnaire
What is mindfulness used for in chronic pain intervention?
the key approach is non-judgemental acceptance of pain.
trying to experience it in the present moment, rather than trying to avoid it
What is primary pain?
the physical pain
What is secondary pain?
the thoughts and emotions attached to the pain
What other things can cause pain behaviour?
prolonged anxiety, hypervigilance, and fearfulness associated with early trauma
What are the most common pain complaints?
- headaches
- gastrointestinal pain
- pelvic and abdominal pain
- back and neck pain
How can psychology help pain?
- identify other factors which may be exacerbating someone’s pain experience
- important to emphasise that whilst all pain comes from the brain, it does not mean pain is ‘imagined’ or ‘in your head’
- help patients understand the holistic/biopsychoscoail approach to pain
- validate individuals experiences and allow them to realise they are not malingering
- if trauma is a factor, therapy might allow the patient to revisit and explore their traumatic experience in a safe and supportive environment
- provide feedback to medical professionals
What CBT techniques are used to treat chronic pain?
- cognitive techniques
- behavioural techniques
- supportive educational techniques
- other techniques
What cognitive techniques are used in CBT?
- cognitive restructuring
- problem solving
What behavioural techniques are used in CBT?
- relaxation skills
- pacing
- behavioural activation
What supportive educational techniques are used in CBT?
- psychoeducation
- supportive psychotherapy
What other techniques are used in CBT?
- hypnosis
- biofeedback
- relapse prevention strategies
What did Jensen & Turk (2014) say about combined drug treatments for chronic pain?
- current treatments for persistent pain are inadequate
- there is concern about the side effects of individual medications
- with drug combinations there is the added concern about potential drug-drug interactions among some of the medications most frequently combined
Why do McCracken & Vowles (2014) think we still use CBT for chronic pain?
influenced by early success, CBT may have become firm on method and loose on process
they advocate reversing this so that research and treatment development are more firm on process and loose on method
What 3 step process of development did McCracken & Vowles (2014) suggest?
- let go of variables and processes that have ceased to be useful guides for research and treatment development
- choose scientific goals and philosophical assumptions
- begin treatment development guided by process and theory
Why is chronic pain difficult to explain?
because there is no anatomic defect or tissue damage
What is sensitisation?
when neurons responsible for sensing pain because sensitised, it means that they sense pain in situations where they previously would not have
