FMC Unit 8 Parts 1-3 *Psychosocial Aspect of Care* Flashcards
The Biopsychosocial includes what 3 factors?
Biology
Psychology
Social Environment
In the Dimensions of Pain, in the Cognitive portion, what factors may contribute to pain? (6)
- Meaning of Pain
- View of Self
- Coping skills and strategies
- Previous Treatment
- Attitudes and Beliefs
- Factors influencing Pain
In the Dimensions of Pain, in the Sociocultural-Ethnocultural portion, what factors may contribute to pain? (6)
- Family and social life
- Work and home responsibility
- Recreation and leisure
- Environmental factors
- Attitudes and beliefs
- Social influence
In the Dimensions of Pain, in the Sensory portion, what factors may contribute to pain? (3)
- Intensity
- Quality
- Pattern
What are the Psychological and Social Risk Factors? (7)
- Divorce/Marital Problems
- Job stress/insecurity
- Financial Challenges
- Living Resources
- Social Support
- Co-morbidities: Chronic pain, lifestyle conditions
- History of trauma
What are Red Flags?
Serious medical pathology that warrants referral to another qualified healthcare practitioner
- Does not implicate the presence of psychosocial factors
For Red Flags, what is the nature and some examples?
Nature: Signs of serious pathology
Ex: Cauda Equina syndrome (Nerve root compression), fracture, tumor
What are Yellow Flags?
Findings in patient history that may require further inquiry or examination and includes psychosocial factors, may correlate with the development of pain
For Yellow Flags, what is the nature and some examples?
Nature:
- Beliefs, appraisals and judgements
- Emotional Response
- Pain behavior (Including pain and coping strategies)
Ex:
- Unhelpful beliefs about pain
- Expectations of poor treatment outcomes
- Worry, Fears, Anxiety
- Avoidance of activities
- Over-reliance on passive treatments (hot or cold packs)
For Blue Flags, what is the nature and some examples?
Nature: Perceptions about the relationship between work and health
Ex:
- Belief that work is too onerous and likely to cause further injury
- Belief that workplace supervisor and workmates are unsupportive
For Black Flags, what is the nature and some examples?
Nature: System and Contextual Obstacles
Ex:
- Legislation restricting options for work
- Conflict wit insurance staff over injury claim
- Overly solicitous family and health care providers
- Heavy work, with little opportunity to modify duties
What are Orange Flags?
- When their is presence of psychiatric disorder that warrants referral to another qualified healthcare practitioners
-Clinical Depression
-Mental Health disorders - PT intervention may still be warranted
What are psychological processes involved in most pain problems? (4)
- Awareness
- Cognitive Processing and interpretations
- Emotional response
- Pain Behavior
What is the description of the psychological process involved in pain with Awareness? (3)
- Pain experiences demand our attention
–First psychological process of pain experience - Normal to attend and deal with pain but no longer necessary
–Pain is a warning signal
–Intensity and location mandate varied response - Abnormal
–Hypervigilance: Abnormal focus on possible pain signals to injury
- Persistent thoughts regarding pain
(distraction may decrease pain activity)
What is the description of the psychological process involved in pain with Cognitive Processing?
–Begin to think about what the pain means
- Assessing level of threat and need for care
- Closely tied to emotional responses
- Cognitive Schemas
- Beliefs and attitudes
In the Cognitive Processing portion, in the psychological process involved in pain, what are cognitive schemas?
What is Expectation and Catastrophizing?
- Thoughts about pain shaped by previous experiences
-
Expectations: Situational context matters
–Paper cut stings then goes away
–Medical injections children vs. adult - Catastrophizing: Inability to foresee anything but the worst possible outcome, or experience a situation as unbearable when it should be just uncomfortable
In the Cognitive Processing portion, in the psychological process involved in pain, what are Beliefs and Attitudes?
Social Influence vs. Cognitive influence?
What can negative thoughts lead to?
- Social Influence: Culture, geographic setting, socioeconomic status, access to care
- Cognitive Influence: What we think pain means
-Negative thoughts and beliefs = hurt is harm, pain
means stop what your doing, rest is best. This
leads to activity avoidance linked to the
development of chronic pain and disability
What is the difference between emotional distress and emotional regulation?
Posivtive vs. Negative regulation/affect?
Emotional Distress is expected in response to pain
- Anxiety, fear, anger, guilt, frustrations, and depression
Emotional Regulations is about how we deal with those emotions
- Positive regulation: acknowledge that emotional response and confront them in a constructive manner so they dont drive our behavior
- Negative Affect: Negative emotions results in unhelpful pain behaviors; linked with increasing risk of developing chronic pain and long-term disability.
If a patient has an emotional response to pain and its negative, this can lead to anxiety? What is Anxiety and how can it effect patients?
- Anxiety: worrying about pain and how it will impact out lives is normal
–Individuals with chronic pain display higher levels of anxiety related disorders
–Fear: A form of anxiety that prepares us for “fight and flight”
- Increased fear can lead to avoidant behaviors and disability
If a patient has an emotional response to pain and its negative, this can lead to depression? What is depression and how can it effect patients?
Depression: Psychological problem associated with negative mood, hopelessness, and despair
- Many individuals with acute, subacute pain experience depressive symptoms that do not rise to clinical depression
- Associated with increased risk of developing chronic pain and long-term disability
What is Pain Behavior?
- What we do to cope with pain
–Influenced by attention, cognitive processing and emotional responses - Pain characterized by pain
–Personal experiences with pain projected outward
- Actions or in-action in response to pain
- Communication about pain
What are Pain Behavior Considerations?
- Immediate behaviors to a painful stimulus trend toward pain relief strategies that have been successful in the past
– Rest, analgesics (pain-relievers), first-aid care
- Good strategies for addressing acute pain
- Detrimental in persistent pain states - Persistent pain treatment programs
– Reduce use of analgesics and increase physical activity
Review
When getting the patients story and they start to describe the pain and they start catastrophizing about the pain, what is the factor that is causing this?
A) Emotions
B) Attention
C) Cognitions
D) Overt behavior/Pain behavior
C) Cognitions
This is our thoughts regarding pain, if we catastrophize, we think of nothing but the worse possible outcome
If a patient is very anxious about their pain and this increases fear and avoidance to ADLs, what is the factor causing this?
A) Emotions
B) Attention
C) Cognitions
D) Overt behavior/Pain behavior
A) Emotions
What are the Psychological Models of Pain and Disability? (5)
- Fear-Avoidance Model
- Acceptance and Commitment Model
- Misdirected Problem-Solving Model
- Self-Efficacy Model
- Stress-Diathesis Model
What are Psychological Models of Pain?
These attempt to describe more specific pathways psychosocial factors influence the transition of acute pain to long-term pain problems
We use them to take a larger biopsychosocial approach to explaining psychosocial factors influence on development of persistent pain and long-term disabilities
What is the Fear-Avoidance Model?
This model describes the influence of psychosocial factors on pain behaviors and the development of persistent pain and disability
- Fear: A form of anxiety (Emotion) that results from cognitive interpretation that pain is threatening
- Creates Hyper-vigilance (Attention) , Pain catastrophizing (Cognition) and avoidant behaviors
- This then results in sedentary life-styles, cessation of participating in meaningful life experiences and activities
- May increase feelings of hopelessness, and despair
What is the Acceptance and Commitment Model?
This model addresses rigid beliefs in pain management
- Pain must be cured
- Failed attempts increases feelings of anger and frustrations
–Impedes the person from living their best life
- Tenants
- Reduce pursuing unrealistic goals (Complete resolution of pain
–Produces psychological flexibility - make a commitment to pursuing important life goals
–Life life to the fullest despite pain
- Reduce pursuing unrealistic goals (Complete resolution of pain
What is the Misdirected Problem-Solving Model?
Normal worrying about pain determines pain-relief strategies
- Biomedical approaches: Rest, analgesics, modifying/stopping painful activity
- Chronic Pain
–Strategies often fail
–Results in more worrying and hypervigilance regarding pain
- Vicious cycle
What is the Self-Efficacy Model?
Personal belief in ability to cope with pain
- High self-efficacy: Increased confidence in ability to address and relieve pain
- Low self-efficacy: Feelings the pain is uncontrollable resulting in physical and psychological dysfunction
What is the Stress-Diathesis Model?
Pain experienced by individuals with already high levels of psychological distress are more likely to generate higher levels of emotional distress and display unhelpful pain behaviors
– Fear avoidance, hypervigilance, anxiety, depression
- When coping ability is stretched too thin
–New pain results in higher than normal functional limitations and emotional distress
What is the difference between Personality and Personality Disorder?
Personality: The way you think, feel and behave
Personality Disorder: Are categories of personality disturbance
If someone has a personality that is conscientious and diligent, what might be their personality disorder?
Obsessive Compulsive
If someone has a personality that is self-critical and careful, what might be their personality disorder?
Avoidant
If someone has a personality that is devoted, passive and curious, what might be their personality disorder?
Dependent
If someone has a personality that is adventurous and is a risk taker, what might be their personality disorder?
Anti-social
