HC 7 Flashcards
pain definition
unpleasant sensory & emotional experience associated with actual or potential tissue damage or described terms of such damage
sensory & emotional component of pain
tissue damage is NOT necessary; pain may occur in the absence of any physical problem
Classification of pain
- cause
2. duration
classification according to cause
- nociceptive pain - tissue damage
- neuropathic pain - damage to the central peripheral nervous system
- mixed pain - nociceptive & neuropathic pain (hernia)
- idiopathic pain - pain with no organic cause
neuropathic pain
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)
Classification according to duration
- 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
Biological model
pain stimulus –> pain perception
= assumption that the pain experience is a direct representation of the injury
Psychobiological model: Gate Control Theory
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’
Interaction of both processes: upward & downward signal
chemicals will be released at the gate:
- open the gate –> increase pain experience (anxious thoughts)
- close the gate –> decrease pain experience (calming thoughts)
importance of the gate control theory
explains why/how psychological variables can influence the pain experience
Learning theory: Thorndyke
Law of effect = when a specific response is followed by a reward, the probability of (re)occurrence of this response
Learning theory: Skinner
Operant conditioning paradigm =
the learning process that takes place by giving rewards, eliminating negative consequences, eliminating rewards or administering punishment
Applied operant conditioning to pain (Fordyce)
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
Learning theory vs cognitive behavioral theory
LT does not consider the cognitive and emotional aspect of pain
CBTemphasizes the role of behavior, cognitions AND emotions
Cognitive behavioral model: Cognitive factors
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
Important dimensions to assess in pain perception
- pain intensity
- pain duration
- pain frequency
- type of pain
- pattern of frequency and duration
Pain catastrophizing scale
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”)
Pain coping strategies Questionnaire
6 subscales:
- diverting attention (try to think of something nice)
- reinterpreting the pain sensation (I rather think of it as a dull/warm feeling)
- catastrophizing (it is awful and overwhelming)
- ignoring sensations (I don’t think about it)
- praying or hoping (I pray to god)
- coping self-statements (I tell myself that I can overcome)
Treatment of acute pain
medical treatment –> painkillers
psychological treatment –> distraction, relaxation& hypnosis
distraction & relaxation also used in children before undergoing a lumbar puncture
Distraction by making use of a virtual reality
can serve as a powerful pain control technique:
- spiderworld
- snowworld
burn patients during wound care
spiderworld
burn patients during physical therapy
snowworld
explanation effect of virtual reality
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
treatment of chronic pain
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
antidepressants as pain medication
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
relaxation influences the pain directly & indirectly
- directly: muscle tension decrease - blood perfusion increase –> pain decrease
- indirectly: feeling relaxed –> stress had less impact upon the body, better coping = pain decrease
hypnosis to ease the pain
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)
RET: Rational Emotive Therapy (Albert Ellis)
–> challenge irrational (dysfunctional) automatic thoughts by means of the ABC scheme:
A - actual situation
B - Irrational belief
C - consequences (emotional & behavioral)
RET & CBT
identify and challenge the irrational belief and replace it with a rational and functional belief
Group therapy
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)
Self-help programs
Make use of behavioral and cognitive techniques to:
- improve problem-solving skills
- self-management
- perceived locus of control (self-efficacy)
effects & advantages self-help programs
- effective in decreasing pain intensity
- cost-effective
- larger patient groups reached
- limited contact with a therapist increases effectiveness
limitations of self-help programs
- -> 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
