Chronic Pain Flashcards

1
Q

What is Intermittent Pain, Recurrent Pain and Chronic Pain?

A
  • Pain that comes and goes is called recurrent or intermittent pain
  • Short-term pain is called acute pain e.g. a sprained ankle
  • Long-term pain is called persistent or chronic pain e.g. back trouble or arthiritis
    1. 6 months or more
    2. Pain tha textends beyond the expected period of healing and frequently has no identifiable cause.
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2
Q

How frequent is Chronic Pain?

A

10%

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3
Q

What are the problems caused by Back Pain in terms of society?

A
  • 12% sick days in the UK
  • 116 million days lost production
  • 3.1 million adults in UK LBP
  • 9.4% GP consultations
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4
Q

What is Central Sensitisation?

A

- Central sensitisation is a condition of the nervous system that is associated with the development and maintenance of chronic pain

  • When central sensitisation occurs, the nervous system goes through a process called wind-up and gets regulated in a persistant state of high reactivity.
  • The 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
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5
Q

What are the flags for non-specific lower back pain?

A

Non-specific lower back pain is tension, soreness and/or stiffness in the lower back region for which it is not possible to identify a specific cause of the pain.

Yellow Flags:

  • A negative attitude that back pain is harmful or potentially severely disabling
  • Fear avoidance behaviour
  • Reduced anxiety levels
  • An expectation that passive, rather than active treatment will be beneficial
  • A tendency to depression, low morale and social withdrawal
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6
Q

What is ‘Pain Gate Theory’?

A
  • Developed as a way of explaining all sorts of factors influence our experience, including our thoughts and feelings.
  • For example, you will likely be aware that there are many times, even though you have pain, you are only dimly aware of it i.e. wounded soldiers.
  • In other situations, you will also be aware of how in other circumstances, your pain can feel much worse. The more you attend and think about pain, the worse it can feel.
  • Nerves from all over your body run to the spinal cord, which is the first meeting point in the nervous system. In the spinal cord there are gates.
  • These gates can sometimes be more open than at other times.
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7
Q

What factors are responsible for opening and closing of the pain gates

A
  • Stress/Tension i.e. anger
  • Psychological Factors i.e. boredom
  • Lack of activity
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8
Q

What are the characteristics of central sensitisation?

A

Allodynia - occurs when an individual experiences pain with things that are not normally painful (touch or massage) 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.

Hyperalgesia - occurs when a stimulus that is typically painful is percieved as more painful that it should. Hightened reactivity produces a pain that is amplified.

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9
Q

What is the cause of central sensitisation?

A
  • Central sensitisation involves specific changes to the nervous system.
  • Changes in the dorsal horn of the spinal cord & in the brain, particular at the cellular level, such as receptor sites.
  • Strokes & spinal injuries can cause CS - causes damage to the central nervous system
  • These injuries alter the parts of the CNS that are directly involved in central administration.
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10
Q

What drugs are used in chronic pain management?

A
  • Drug treatment for lower back pain: paracetemol, NSAID, tricyclic antridepressants, opioids (though opioids don’t work that well)
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11
Q

What is the persistent pain cycle?

A
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12
Q

What are some pain management strategies?

A
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13
Q

What elements of the multidisciplinary team are available in the management of chronic pain?

A
  • Medic/Anesthetists
  • Specialist Nurse
  • Physiotherapist
  • Occupational Therapist
  • Psychologist
  • Pain Management Programme
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14
Q

What are the Psychological factors in Chronic Pain?

A
  • Pain is a protective response to potential danger
  • Psychosocial treat can increase sensitivity to potential physical threats, leading to possibility of increased pain
  • Pain can be protective response to psychological stimuli
  • Pain sensation can be activated by non-physical elements e.g. memory
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15
Q

What is the Holistic Model of Pain?

A

Behaviour -> Thoughts > Environment > Mood > Physical

  • Psychological Factors: Expectation and Anticipation
  • People with negative beliefs about pain can experience greater suffering, for example, appraisal
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16
Q

How can appraisal influence pain?

A
17
Q

What is the CBT model of pain & depression?

A
  • Patients appraisals of the impact of their pain on their lives and their sense of control over the pain determines the pain-depression relationship.
  • These 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.
18
Q

What are the psychological approaches to working with chronic pain?

A

CBT (Cognitive Behavioural Therapy)

  • Third wave cognitive therapies:
  • Mindfulness
  • Acceptance and Commitment Therapy (ACT)
  • CompassionFocused Therapy (CFT)
  • Understanding and working with psychological trauma and the physical expression of psychological pain.
19
Q

Give an overview of CBT

A
20
Q

What is the link between childhood trauma and chronic pain?

A
  • Research has shown that prolonged anxiety, hypervigilence and fearfulness associated with early trauma can lead to pain behaviour.
  • 48%. of chronic pain patients report childhood physical or sexual abuse.
  • Somatisation is the physical expression of psychological pain ‘physical ailments, some of which have no physical or organic basis’ - the most common pain complaints are headaches, GI pain, pelvic and abdominal pain, back and neck pain.
  • 55% of women being treated for somatic disorders have also had a history of childhood sexual abuse.