Counselling Week 5 Flashcards
What is the McGill Pain questionnaire? (What does it assess?)
- Melzac 1975
- assessed:
(1) Sensory (qualitative description)- Throbbing, stabbing, sharp, hot/burning
(2) Affective (psychological)
- tiring/exhausted, sickening, fearful, punishing
(3) Intensity (rate of pain)
- No pain worst possible pain
(4) What pin are you in now? (scale)
- 1 mild, 2 discomforting etc.
-BEFORE that: just ask “What pain are you in?” (1-5)
Define pain
-need to have an understanding of physiological/psyc hological mechanisms
(pain perception and management)
-BOTTOM UP:
*picked up by free nerve endings in skin
*Neurotransmitter (Substance P)
*Periadueductal grey region in brain
(brainstem=receives pain information)
*pain prioritised in NS (can’t think about anything else,
demands to be attended to)
*e.g. spicy foods, bright lights, loud noise
-TOP DOWN:
*e.g. mood, activity (modulate pain perception)
*more injured than we thing we are
*beta-endorphins (brains own pain killers/opiates)=> released
during pain/anxiety=fight or flight)
*e.g. hurt leg-> tiger comes near you -> beta-endorphins inhibit pain perception to focus on survival
*Lymphocytes (white blood cells that fight infections)=endorphin receptors reduce the activity of white blood cells over a longer-term
*lots of anxiety-> less active white blood cells-> less active to fight diseases (maybe why heroin adults are more prone to illness-long term stress and opiates)
Gate Control Theory of Pain
- physiological and psychological factors
- ascending (hand to brain) and descending (brain to hand) pathways
- different people experience pain differently at different times
- calm and relaxed=> brain’s gate system is more closed=> less likely to perceive things as painful
- counter-irritation (less painful)=> gate closed slightly by non-painful stimulation (e.g. hurt wrist-> slap it. This is how accupuncture/scratching works)
- pain sensation is more than likely to be carried into consciousness
Types of pain
ORGANIC
-response to obvious tissue damage
PSYCHOGENIC
- no obvious tissue damage
- of psychological origin (psych-mind, genic=origin)
- just because they can’t find it, doesn’t mean pain doesn’t exist
ACUTE
- immediate short term response to pain
- <6 months
- expectation=will sibside (heal/get better)
- understandable (normal response to injury, know it will get better over time)
CHRONIC
- > 6 months or after tissue has healed (doesn’t appear to make sense)
- distressing/disabling
- significant
How to manage pain
PSYCHOLOGICAL
- biofeedback (learn to monitor and alter biological status) e.g. muscle tension for tension headaches
- hypnosis
- relaxation
- guided imagery
- distracted
- counter imitation (learning what you shouldn’t do through watching others)
BIOLOGICAL
- analgesic drugs
- surgery to pain pathway
- accupuncture
How is pain behaviour communicated?
- everyone experiences pain
- expressed/presented (how?)
- essentially a communicative act (expressing pain, saying something about how you’d like to be seen)
- everyone expressed pain in different ways (not 1:1 straightforward) (e.g. tough, fear, sad, thrill seeker)
What is the chronicity tap?
-Chronicity tap=some aspects of pain are “created” by client/professional interaction
e.g. go to physio
=cause of pain NOT located
=dismissive response because they can’t find route (pain hasn’t changed, but feel different about health experience)
=another professional mentions “secondary gain” (doing it for a reward)or “functional” (serves a purpose)
=tells family *they doubt pain, but pain has not changed
=person use to down lay pain (stops doing that because now no one believes it)
=still experiencing real pain BUT ADJUSTING pain behaviour to communicate “realness” of my experience (to try and convince others-> expressing continuously that it is real)
*clinicians must take time to understand NOT doubt (patients have a right to down time and treatment)
Ways chronic pain patients can act
- doctor shopping (not taking what doctor gives, goes to another one)
- complaining
- “career” of pain (central thing in their life)
Things to consider about pain
-CNS prioritises pain (difficult to ignore it)
*e.g. people with Rheumatoid Arthritis have difficulties
with working memory (not because of a cognitive
issue, but because their brain is overconsumed by
pain)
-pain is insistent
*takes up working memory, space/impacts processing
of info, insists that you give it attention
-pain is isolating
*relcuctant to participate in activities that could
exacerbate current or cause another pain
-pain related to depression and anxiety
*25-80% comorbidity for mental illness and pain
*e.g. fear of re-injury during social situations
Considerations when talking to people who are in pain
*don’t deny pain experience reality
-trust them (though some do lie)
*don’t disable them
-allow them to TRY activities like walking (pain
comes and goes, might as well do it when they can)
*don’t let pain define or constrict every activity
-person-first language (“client with pain”)
*think about group or family activities
-reduce isolation (common experience with pain)
*focus on activity and participation rather than pain
-get them to do things
-I cannot make your pain go away but can deal with
psychological issues surrounding it (living the best
life you can!)
Honey and Mumford “Learning Styles” (aka problem solving styles)
ACTIVIST (“Can do”)
THEORIST (understand THEN do)
REFLECTOR (looking back)
PRAGMATIST (worked once, will work again)
Honey and Mumford “Learning Styles”
=ACTIVIST
-act first, think later
-easily bored with the details of making things happen
-enjoy working with teams (if they share their own vision)
❤️ At best when:
*offered new experiences/opportunities
*teamwork
*thrown into deep end
*being organised/focused
👎🏻 At worse when:
*listening to long speeches, lectures and explanations
*being left to make complicated decisions by themselves
*make sense of complex information
*dealing with precise and specific instructions
Honey and Mumford “Learning Styles”
=THEORIST
-logical and organised
-understand through logic/theory
-cool/analytical (not hot and emotional)
-look at the situation (takes time to think through before acting)
❤️At best when:
*delve and question things
*asked to use knowledge
*understand and explain
*engaged in idea (even when not immediately relevant)
👎🏻 At worst when:
*asked to deal with emotions and feelings (as they are level headed/logical)
*activity is unstructured or briefing is poor-like rules (opposite to activist)
*asked to act without considering principles involves (hate being thrown in)
*feeling left out of team processes because they “think too much” or “intellectualise situation” (may not align with team vision)
Honey and Mumford “Learning Styles”
=REFLECTOR
-stand back and look at information from all perspectives
-“sound out” others before conclusion (e.g. “Kate said…put that with James’…that will work”)
-“feeling” the room
-listening to others’ views before offering their own
❤️At best when:
*gives opportunity to consult with/observe others
*given the opportunity to review what has happened and think about what they have learnt
*producing work WITHOUT a tight deadline
👎🏻At worst when:
*asked to lead role-play in front of others (e.g. hate going first in a group presentation because they haven’t seen what people had offered)
*expected to make a decision with a deadline (and insufficient prep time)
*hassled/rushed for deadline
Honey and Mumford “Learning Styles”
=PRAGMATIST
-see what happens, does things that work
-love practical/applicable concepts
-impatient with lengthy discussions (LOVE practicality)
-do-able and concrete (hate abstract concepts)
-What worked before? Let’s just do that! Makes sense
❤️At best when:
*obvious link to discussion and task
*task and activities=clear feedback (don’t like counting and measuring)
*what works BEST (saves time and money): Things that have advantages
*show a model they can copy (don’t care who came up with it, if it works just do it!)
At worst when:
*conversation with NO obvious real-world outcomes (no practicality)
*asked to do something that has NOT been done before (e.g. no practical solution developed from previous experience?)
*cannot see any clear payback from strategy/plan (no reward)
-hate theoretical
