HC 7

Question 1

pain definition

Answer 1

unpleasant sensory & emotional experience associated with actual or potential tissue damage or described terms of such damage

Question 2

sensory & emotional component of pain

Answer 2

tissue damage is NOT necessary; pain may occur in the absence of any physical problem

Question 3

Classification of pain

Answer 3

1. cause

2. duration

Question 4

classification according to cause

Answer 4

1. nociceptive pain - tissue damage
2. neuropathic pain - damage to the central peripheral nervous system
3. mixed pain - nociceptive & neuropathic pain (hernia)
4. idiopathic pain - pain with no organic cause

Question 5

neuropathic pain

Answer 5

damage to the central peripheral nervous system

• can become permanent in nature over time
• sensation of needle pricks, electrical shocks, burning sensations & ants

Sensory changes:

Allodynia = pain through stimulus that doesn’t cause pain (wattenstaafje)

Hyperalgesia = disproportional pain to a stimulus (verhoogde pijn ervaring)

Question 6

Classification according to duration

Answer 6

• acute pain - generally pain disappears when the injury is healed. Could be recurrent: migraine
• chronic pain - stays longer than 3-6 months
• identifiable cause
• non-identifiable cause

Question 7

Biological model

Answer 7

pain stimulus –> pain perception

= assumption that the pain experience is a direct representation of the injury

Question 8

Psychobiological model: Gate Control Theory

Answer 8

degree of pain that we experience is the result of an interaction between bottom up & top down processes:

Bottom up: signals transmitted from the sight of the injury to the spinal ‘gate’ by nociceptors

Top-down: pain-related cognitions and emotions activate nerves taking info from the brain to the spinal ‘gate’

Question 9

Interaction of both processes: upward & downward signal

Answer 9

chemicals will be released at the gate:

• open the gate –> increase pain experience (anxious thoughts)
• close the gate –> decrease pain experience (calming thoughts)

Question 10

importance of the gate control theory

Answer 10

explains why/how psychological variables can influence the pain experience

Question 11

Learning theory: Thorndyke

Answer 11

Law of effect = when a specific response is followed by a reward, the probability of (re)occurrence of this response

Question 12

Learning theory: Skinner

Answer 12

Operant conditioning paradigm =
the learning process that takes place by giving rewards, eliminating negative consequences, eliminating rewards or administering punishment

Question 13

Applied operant conditioning to pain (Fordyce)

Answer 13

pain responses are learned and maintained by reinforcement:

• grimacing and complaining about pain may be maintained because of attention from others
• use of medication and avoidance of activity lead to pain relief

Question 14

Learning theory vs cognitive behavioral theory

Answer 14

LT does not consider the cognitive and emotional aspect of pain

CBTemphasizes the role of behavior, cognitions AND emotions

Question 15

Cognitive behavioral model: Cognitive factors

Answer 15

Attention: paying attention or diverting it and focussing on something else

Attributions concerning the cause of pain: brain tumor vs hungover

Expectations:

• ability to tolerate
• ability to control
• ability to engage in certain activities
• about pain relief

Question 16

Important dimensions to assess in pain perception

Answer 16

1. pain intensity
2. pain duration
3. pain frequency
4. type of pain
5. pattern of frequency and duration

Question 17

Pain catastrophizing scale

Answer 17

3 subscales:

• rumination (“can’t seem to keep it out of my mind”)
• magnification (“afraid that it might get worse”)
• helplessness (“it’s never going to get better”)

Question 18

Pain coping strategies Questionnaire

Answer 18

6 subscales:

1. diverting attention (try to think of something nice)
2. reinterpreting the pain sensation (I rather think of it as a dull/warm feeling)
3. catastrophizing (it is awful and overwhelming)
4. ignoring sensations (I don’t think about it)
5. praying or hoping (I pray to god)
6. coping self-statements (I tell myself that I can overcome)

Question 19

Treatment of acute pain

Answer 19

medical treatment –> painkillers

psychological treatment –> distraction, relaxation& hypnosis

distraction & relaxation also used in children before undergoing a lumbar puncture

Question 20

Distraction by making use of a virtual reality

Answer 20

can serve as a powerful pain control technique:

• spiderworld
• snowworld

Question 21

burn patients during wound care

Answer 21

spiderworld

Question 22

burn patients during physical therapy

Answer 22

snowworld

Question 23

explanation effect of virtual reality

Answer 23

Gate control theory: conscious attention is necessary to experience pain, by creating a virtual reality the patient’s attention is directed away from the body (pain) to the virtual world

Question 24

treatment of chronic pain

Answer 24

medical treatment: interrupting the transmission of pain signal to the brain

• surgical interventions: neural pathways that are responsible for the transmission of pain signals to the brain are severed –> no transmission of pain signals
  ! short term effects
  ! side effects: damage to nervous system –>neuropathic pain

Question 25

antidepressants as pain medication

Answer 25

influence depression and pain –> may have an impact on the downward signals coming from the pain related cognitions and emotions, and have a direct impact on pain

Question 26

relaxation influences the pain directly & indirectly

Answer 26

• directly: muscle tension decrease - blood perfusion increase –> pain decrease
• indirectly: feeling relaxed –> stress had less impact upon the body, better coping = pain decrease

Question 27

hypnosis to ease the pain

Answer 27

basis: deep relaxation

during hypnosis patients are instructed to think differently about the pain (=reinterpretation of the pain)

Hypnosis implies distraction (moving your attention away from the pain)

Question 28

RET: Rational Emotive Therapy (Albert Ellis)

Answer 28

–> challenge irrational (dysfunctional) automatic thoughts by means of the ABC scheme:

A - actual situation
B - Irrational belief
C - consequences (emotional & behavioral)

Question 29

RET & CBT

Answer 29

identify and challenge the irrational belief and replace it with a rational and functional belief

Question 30

Group therapy

Answer 30

Studies have shown it to be as effective as individual therapy.

Advantages: cost-effective & group dynamics can be used as an additional therapeutic technique –> modeling of adequate pain management + social support (patient satisfaction)

Question 31

Self-help programs

Answer 31

Make use of behavioral and cognitive techniques to:

• improve problem-solving skills
• self-management
• perceived locus of control (self-efficacy)

Question 32

effects & advantages self-help programs

Answer 32

• effective in decreasing pain intensity
• cost-effective
• larger patient groups reached
• limited contact with a therapist increases effectiveness

Question 33

limitations of self-help programs

Answer 33

• -> importance of stepped care approach
• to what extent is patient able and willing to participate in his/her own recovery

! self help is not advisable in cases of clinical depression, cognitive impairment or social isolation