Effects of non-pharmacological and placebos treatments in pain management

Question 1

What is the general purpose of pain?

Answer 1

To draw attention to a potential/actual injury so that action can be taken for survival

Question 2

Explain the 2 ways in which an individual can respond to pain?

Answer 2

Hypervigilance: giving abnormal focus to pain that no action can be taken for, which could increase pain intensity

Distraction: shifting focus from pain, which can decrease pain intensity

Question 3

What is the difference between chronic pain and acute pain in terms of how the pain occurs?

Answer 3

Acute pain has clear occurrence, but chronic pain has less clear cause for occurrence as there’s no ongoing pathology/injury or healing

Question 4

Do acute and chronic pain have psychological components that need to be assessed and managed, and how does this affect the overall resolution of the pain?

Answer 4

Acute pain has good likelihood for resolution with healing/recovery as it usually doesn’t include psychological components

Chronic pain usually has psychological component also needs assessing, possibly managing too so resolution is more difficult

Question 5

What percentage of the general population is affected by chronic pain?

Answer 5

20%

Question 6

Are psychological or biomedical factors stronger determinants of case outcomes?

Answer 6

Psychological factors are stronger determinants of outcome than biomedical factors

Question 7

According to studies, which 3 populations’ persistence of pain and disability has strongest association with distress and severity of pain onset?

Answer 7

Community, workplace, post-surgical populations

Question 8

What 3 aspects of pain are influenced by an individual’s attitudes and beliefs?

Answer 8

Pain origin, severity and their response

Question 9

What are the 4 key psychological factors that influence how an individual responds to pain and processes its severity?

Answer 9

Cognitions (attitudes, beliefs)

Pain behaviour

Coping strategies

Emotions and distress

Question 10

What is meant by cognitions of pain, and give 4 examples of cognition aspects?

Answer 10

Thoughts about pain that influence pain experience and response

Includes anxiety-provoking thoughts, catastrophising, rumination, expectations

Question 11

What is meant by overgeneralisation of pain, and how is this an anxiety-provoking thought?

Answer 11

Overgeneralisation occurs when patient believes that pain will stay forever and never get better

which causes anxiety as patient worries about how this will affect their whole life which they cannot cope with

Question 12

How does jumping to conclusions lead to anxiety-provoking thoughts?

Answer 12

Patient immediately considers more unfavourable outcomes and worst-case scenarios

which makes patients anxious as they become more uncertain about whether their own prognosis will be the same

Question 13

What is meant by ‘should’ thinking, and how is this an anxiety-provoking thought?

Answer 13

‘Should’ thinking occurs when patient believes that they should be doing something different according to what they have previously observed eg. My lump should’ve been gone by now but isn’t

Causes anxiety as patient thinks that they are not responding to pain in the ‘normal’/’right’ way, which indicates to them that something is wrong with them

Question 14

What is meant by catastrophising, and explain 2 ways in which this can present in an individual’s response to pain?

Answer 14

Magnification: “I become afraid that the pain will get worse”. “I wonder whether something serious may happen”

Helplessness: “I can’t go on”. “It’s terrible & will never get better”

Question 15

What is meant by rumination, and how can this affect pain intensity?

Answer 15

Patient repetitively thinking about how much pain hurts, which can increase neural response to pain perception (which increases intensity), as they are constantly anticipating pain

Question 16

Give 3 ways in which a patient’s expectations about pain occurrence, management and recovery can cause negative behaviour?

Answer 16

Patient has unrealistic expectations and so is disappointed and pessimistic when expectation isn’t met

Expecting an unfavourable outcome can drive negative behaviour

Impact when an expectation isn’t met

Question 17

Give 3 examples of poor outcomes that arise from negative emotions generated by pain?

Answer 17

Slower recovery

Higher reporting of pain intensity

Length of sick leave taken

Question 18

Describe the 2 characteristic features of generalised anxiety disorder, and the requirement to confirm a diagnosis?

Answer 18

Characterised by excessive anxiety and worry, occured on majority of days in past 6 months for official diagnosis

Question 19

Give 5 symptoms of generalised anxiety disorder, and 2 direct results of anxiety?

Answer 19

Symptoms: Restlessness, Fatigue, Difficulty concentrating , Sleep disturbance, Marked muscle tension

The anxiety itself can cause distress and impairment

Question 20

Why is patient education an important intervention for anxious patients with chronic pain?

Answer 20

Educating patient helps them understand that their chronic pain has been thoroughly investigated and doesn’t indicate underlying pathology

Question 21

Give 3 examples of relaxation techniques used as interventions for anxiety?

Answer 21

Diaphragmatic breathing: stomach moves with each breath, which requires focus and so is a distraction

Guided imagery: visualising positive scenarios

Progressive muscle relaxation: slowly tense then relax muscles, demonstrates theory that you cannot have anxiety symptoms at same time as relaxation/well-being in body

Question 22

Give 2 examples of psychological conditions that use Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) as interventions?

Answer 22

Anxiety

Depression

Question 23

Give 2 characteristic features of depression, and how is it distinguished from low mood?

Answer 23

Characterised by persistent feeling of sadness and loss of interest

Clear diagnostic criteria to distinguish low mood from depressive illness disorder

Question 24

Give 4 interventions for depression?

Answer 24

CBT/ACT

Patient education to understand that there isn’t underlying pathology

Realistic goal setting

Graded, paced activity and exercise that is slowly increased to participate in other activities such as hobbies, work

Question 25

What is cognitive behavioural therapy, and give an example of when it can be used?

Answer 25

Intervention aiming to change unhelpful beliefs about pain cause, impact, cure, prognosis which are consistent with how that individual processed and managed pain

Eg. unhelpful beliefs cause stressful feelings, which increases stress hormone release, body tension and pain experience so CBT is helpful in this scenario

Question 26

Can CBT be applied to all conditions including pain?

Answer 26

Intervention originally developed for depression but can be applied to some other conditions including pain

Question 27

What 2 helpful cognitions are used to develop better coping strategies?

Answer 27

addressing unhelpful thinking patterns and underlying beliefs

Question 28

How can CBT be individualised?

Answer 28

Patient keeps record of unhelpful thinking patterns and tests out thoughts in order to build their own confidence regarding coping by themselves with pain

Question 29

What is Mindfulness Based Stress Reduction (MBSR)?

Answer 29

Focuses on increasing awareness of moment-to-moment experiences, as pain and suffering is a part of life that can be dealt with so that one can go on living

Question 30

How is Mindfulness Based Stress Reduction (MBSR) view different from the medical culture view of pain?

Answer 30

Mindfulness view is that pain is a part of life that can’t be avoided but can be dealt with by individual’s action and behaviours

Medical culture view is that pain can be fixed

Question 31

What 4 factors are Pain Management Programmes (PMPs) composed of?

Answer 31

CBT, ACT , patient education, exercise

Question 32

What 4 advice do Pain Management Programmes (PMPs) provide to patients?

Answer 32

PMPs educate about pain, techniques to address anxiety and depression, promoting coping, effective medication use

Question 33

What is Acceptance and commitment therapy (ACT)?

Answer 33

Uses acceptance and mindfulness skills to increase psychological flexibility, which allows individual to focus their energy on what they can achieve despite pain so that they can live a more meaningful life

Question 34

Who proposed the prospect of ACT?

Answer 34

Hayes & Stoshal 2004

Question 35

According to ACT, do problems arise from pain itself, and what role does psychological flexibility play in this?

Answer 35

Proposes that pain is normal and problems arise from individuals attempting to avoid and internalise negative experiences such as pain, so psychological skills help to deal with pain so that it has less impact on individual