HEALTH- Pain

Question 1

State 2 important functions of pain

Answer 1

• It acts as a signal to let us know that whatever we are doing is potentially damaging and we should stop
• Works by making us less likely to repeat it

Question 2

State the two types of pain

Answer 2

> Acute pain
Chronic pain

Question 3

Describe acute pain

Answer 3

• This pain can be severe but lasts for a relatively short period of time
• It has a specific location that is identifiable
• It is usually easy to treat with some medication or therapy

Question 4

Describe chronic pain

Answer 4

• This pain lasts for a relatively long time and is usually at least for one month
• It is due to long-term behavioural changes such as cancer
• Difficult to treat and has a significant impact on the persons quality of life, relationships and mental health

Question 5

What is phantom limb pain

Answer 5

• This usually happens when someone loses a limb and still feels pain coming from that area

Question 6

Describe the symptoms of Alan in MacLachlan et al.

Answer 6

• He felt as if his 2 toes were crossed and experienced ‘pins and needles’ in his toes.
• He felt as if his leg was shorter than his other dog
• He felt that his leg was stretching backward and his toes were pointing downward.

Question 7

Describe the procedure Alan went through with the mirror treatment

Answer 7

• He had 10 repetitions of 10 different leg exercises, including:
  >Straightening
  >Bending
  >Pointing the foot up and down
• Exercises were first carried out twice a day with a physiotherapist
• A few days later, he could carry out the exercies alone and even without the mirror

Question 8

What did they conclude in MacLachlan

Answer 8

This study showed that mirror treatment is an effective treatment for PLP in lower limbs

Question 9

Describe the Specificity Theory

Answer 9

• By Von Frey 1895
• It proposes that there is a separate sensory system reserved for pain in the same way there is for sense.
• There are specialised pain receptors that respond to stimuli and via nerve impulses and send it to the brain.
• The brain will process this signal as the sensation of pain and quickly respond with a motor response in order to releive that pain

Question 10

Describe the Gate Theory

Answer 10

• This theory suggests that the spinal cord contains a ‘gate’ that either prevents pain signals from entering the brain or allows them to continue.
• This theory also explains why our emotional state affect how much something hurts.
  -The gating mechanism occurs in the dorsal horn of the spinal cord and it includes both small nerve fibres and large nerve fibres
• When theres more large fibre activity, theres less pain and vice versa for small fibre activity

Question 11

List 3 measures of pain:

Answer 11

> Subjective measures
Psychometric measures and visual rating scales
Behavioural/Observatioal measures

Question 12

How do subjective measures measure pain

Answer 12

Clinical Interviews:
- This will ask the patient a range of open-ended questions and a range of factors that influence the patients experiences
- A quide for an initial clinical interview as follows:
>How does the pain affect your life?
>How do you cope with the pain?
>How do people respind when you have pain?
- They also gather factual information during the interview; the doctor will observe the patient’s behaviour as well as their thoughts.

Question 13

Evaluate the subjective measures

Answer 13

+Allows clinicians to get a good understanding of the patients background and their experience of pain because pain is a very subjective experience
-It relies solely on the patient giving their opinion and interpretation of pain which may not be accurate (either downplay or exaggerate their symptoms)

Question 14

Describe Psychometric measures

Answer 14

The McGill Pain Questionnaire (MPQ) :
- This is designed to assess the quality and intensity of subjective pain
- The MPQ is composed of 78 words, of which the patient chooses the words that best describe them
- The scores range from 0 (no pain) to 78 (severe pain)
The MPQ covers several categories:
- Pain descriptors
- Affective
- Evaluation
- Miscellaneous

Question 15

Evaluate the MPQ

Answer 15

+Can assess changes in pain over time and assess the effectiveness of pain management
+Gathers quantitative data, allowing statistical analysis to be carried out
+Relatively quick and easy to administer
-Theres the lack of open questions which leads to forced answers and may not get a full detailed response

Question 16

Describe the visual rating scales

Answer 16

Visual Analogue Scale (VAS)
- It is an instrument that measures pain on a continuum from no pain to extreme pain without any categories
- It is mostly presented as a horizontal line with the ends having the extreme limits
- The patient marks where along that line they feel describes their pain and a numerical value is transferred by measuring the distance
Example:
- Moderate: 45-74 mm
- Mild pain: 5-44 mm

Question 17

Evaluate the VAS

Answer 17

+It is quick and easy to administer
+Detects change in pain overtime and is more sensitive to small change
+Quantitative data
-Lacks a range of items

Question 18

Describe Behavioural/Observational measures

Answer 18

University of Alabama pain behaviour scale (UAB)
- This scale consists of 10 target behaviours and the person observing the patient records every detail
- for each target behaviour, the observer reports on the severity, frequency or intensity of each behaviour
Examples of target behaviours are:
- Verbal complaints
- Mobility

Question 19

Evaluate the UAB

Answer 19

+A useful tool that looks at the outward side of pain
-Because it relies on an observer, they many not know the true extent of the pain
-The scores in the UAB do not correlate well with the MPQ suggesting that outward signs of pain are not the same as subjective signs

Question 20

State the 3 aims in Brudvick et al.

Answer 20

• Investigate the level of agreement of pain intensity when measured by children, parents and physicians
• Estimate the influence of childrens age, medical condition and severity of pain on the difference in pain assessment given by children, parents and physicians
• See how pain assessments affected the physicians administration of pain relief.

Question 21

Describe the children sample

Answer 21

• 243 in total
• aged 3-15 years
• attended a Norwegian emergency department over a 17-day period

Question 22

Describe the physician sample

Answer 22

• 51 in total
• 57% were men
• 51% had children of their own
• Half of the sample had over 5 years of medical experience
• 30% had a specialty in family medicine
• None specialised in pediatrics

Question 23

describe the 2 measures used on the children and their ages

Answer 23

ages 3- 8 years : Faces Rating Scale- Revised (FRS-R)
- 6 faces showing increasing levels of pain
ages 9-15 : Coloured analogue scale
- The children would mark on a line where the pain was from no pain(green) to extreme pain(red)

Question 24

Describe the questionnaires parents had to complete

Answer 24

• They completed the Numeric Rating Scale (NRS)
• They were to estimate their childs pain from 0-10
• They had to complete a score before the child did but were not completely blind to the others ratings
• They also completed the demographic questionnaire

Question 25

Describe the questionnaires physicians had to complete

Answer 25

• They also completed the Numerical Rating Scale (NRS)
• Another questionnaire gathered information about their medical experience, speciality and if they had children.

Question 26

State 3 results found from the study

Answer 26

• Doctors NRS score=3.2, Parents NRS score=4.9, Childrens NRS score=5.5
• When comparing younger children to older children, younger children had a greater difference between the childs assessment and that of the parent and physician
• There was very little agreement of pain assessment between parents and physicians (15%) and between children and physicians (14.6%)

Question 27

What did they conclude in the study

Answer 27

• It showed that emergency department physciancs significantly underestimate pain compared to parents and children.

Question 28

Evaluate the study

Answer 28

+Standardised: doctors were trained to use the NRS and parents were given a detailed explanation on how to support their child when reading the faces
+The natural setting strengthens the ecological validity as doctors went about their usual routines. Had they been taken to another clinic, their attention to medical assessment would have been better
+Supports the nomothetic approach so uses statistical analysis to determine the significance of the findings
+Consent was given by all parents and for their children and right to withdraw
-The findings are not generalisable as they focused on a sample in one Norwegian Hospital. Also the doctors in this department did not practice paediatrics so may have given less pain relief
-Children were aware of their parents reactions and so may have answered according to that and not how they feel, this reduces validity
-Lack of qualitative data so could not target how and why some children experience greater pain than others.

Question 29

Biological treatment

Describe Analgesics and Acetaminophen (paracetamol)

Answer 29

ANALGESICS:
- These are a group of drugs that are used to relieve pain and are also known as painkillers. These are used to relieve mild pain

ACETAMINOPHEN:
- This works by reducing the number of prostaglandins. These substances can make you run a fever or feel more pain.

Question 30

Biological Treatment

Describe NSAIDs and Opiates

Answer 30

NSAIDs:
- They target pain that is caused by inflammation such as injury or arthritis.
- They block the bodys chemicals that are associated with inflammation and pain. They block 2 types of enzymes:
>One that protects the stomach lining
>Produced when joints are injured

Opiates:
- Such as morphine and codeine, they are mostly used to control acute, severe pain such as after surgery.
- They attach to proteins known as opioid receptors in the nerve cells of the brain
- The opioids block the pain messages that are sent from the body through the spinal cord to the pain, leading to analgesia

Question 31

Biology treatment

Describe Anaesthetics and indirect medications

Answer 31

Anaesthetics:
- These cause the total loss of feeling or sensation
- Novocaine is often used during dental procedures to numb your gum. They work by stopping the nerves in that area of the body from sending pain signals to the brain.

Indirect medications:
- Antidepressants are used for chronic pain such as migranes.
- They work by increasing the neurotransmitters within the spinal cord which reduce pain signals. They do not take a short time and can take several weeks

Question 32

Evaluate Biological treatments

Answer 32

+The side effects from paracetamol is not severe and is safe
+NSAIDs are effective in reducing fever, inflammation from headaches.
+Take a nomothetic approach and assume pain medication will be effective for all
+Idiographic approach can also apply as individuals reach differently to these medications
-NSAIDs work on enzymes, which affect the functioning of organs such as stomach irritation
-High doses of paracetamol have been found to be risky and a comparison to placebo show theres no difference and is only effective in few people with chronic pain(moore 2016)
-The research of Ibuprofen is conflicting. One research states if it is used in excess, it may lead to Alzheimer’s disease while other research states it may lead to Breast cancer in women
-Reductionist and ignore environmental factors that could affect pain perception

Question 33

Cognitive treatments

Attention diversion:

Answer 33

• This means using distractions to help reduce the pain perception. This could be as simple as going shopping or watching a movie
• Another way is listenig to music. Williamson (2020) reviewed a number of trials using music to reduce pain in breastfeeding with trials in India, Thailand and Malaysia.
• The most positive effect was when women got to choose the music themselves
• Because pain is very personal, the individual needs to have an emotional engagement with their own personal music. The music increases endorphin levels and nitric oxide, helping in reducing stress and tension
  +Research was done in RCTs and found positive results linking pain being reduced by music
  -The individual has to be fully committed and have a high level of belief in the ability of distraction techniques to relieve pain.

Question 34

Cognitive treatment

Non-pain imagery:

Answer 34

• Helps reducing pain by guiding the patient to imagine a pleasant scene that is unreleated to the pain being experienced.
• Other types of this treatment involve replacing the pain sensation with something less pleasant such as imagine having an argument with someone. It could also be replaced with tingling or pins and needles
• works best for moderate pain rather than severe
  +Helps manage pain without side effects. Once learned the technique, they have control over their pain
  -Is useful for only short-periods of pain but may be less useful for longer

Question 35

Cognitive treatment

Cognitive redefinition

Answer 35

• This treatment helps the patient think more rationally and realistically about their fear.
• They do this by understanding what type of pain they are likely to feel.
• By being told realistically about the procedures, they can redefine their pain and reduce their fear
• Another approach involves using positive statements that help with coping their pain. e.g “It hurts, but I can get through this,”
• This treatment can also be used to challenge illogical thoughts that the patient might have.
  -This treatment may not work for everyone for instance, those that believe they are immune to local anaesthetic so they think the next procedure they will have will be painful. Their fears become rationalised based on past experiences

Question 36

Alternative treatments

Acupuncture:

Answer 36

• This is a technique that involves metal needles being inserted under the skin in various parts of the body and then they are swivelled around or mild electrical current is passed through them to create stimulation.
• The effectiveness is understood by the gate control theory of pain. The stimulation of the needles activates large fibres which closes the gate, stopping the pain signals getting through.
  +Hu et al. found that cancer patients using acupuncture had a greater reduction in pain than drug therapy.
  +Good research support from Yuan et al. where they conducted 23 trials investigating acupuncture for lower back pain.

Question 37

Alternative

Stiumaltion therapy/TENS

Answer 37

• The gate control theory can also be explained with this treatment
• Electrodes are placed on the skin close to where the patient is experiencing pain. The current can be increased if the pain is severe.
  +Is effective especially during labour. Kaplan et al. gave 104 Israeli women questionnaires and found that TENS was an effective pain reliever.

Question 38

Evaluate psychological/cognitive treatments

Answer 38

+Patients have free-will over their ability to manage their own pain.
+None of the treatments have side effects
+An idiographic approach is used to ensire the appropriate treatment fits their individual needs
+Applicable to everyday because it involves learning effective techniques
-Some patients especially those with severe pain, may be unable to manage the pain themselves ad they may believe they have failed to cope with the pain
-Some treatments may not be effective for everyone such as acupuncture. This may not work for those with needle phobia. Visual imagery may also be ineffective for someone who cannot create mental imagery.