HLCD WEEK 7→ Pain Flashcards
Pain
- Pain is the sensory and emotional experience of discomfort, which is usually associated with actual or threatened tissue damage or irritation
- Our sensations of pain can be quite varied and have many different qualities. We might describe some pains as “sharp” and others as “dull,” for example—and sharp pains can have either a stabbing or pricking feel. Some pains involve a burning sensation, and others have a cramping, itching, or aching feel.
- Organic Pain→ Pain we experience that is clearly linked to tissue pressure or damage (E.g. Burn or sprain)
- Psychogenic pain→ Discomfort involved in these pains can result from psychological processes
- Acute pain→ discomfort people experience with temporary painful conditions that last less than 3 months
- Chronic pain→ When a painful condition lasts longer than its expected course or for more than a few months
- Nociceptors→ The afferent nerve endings that respond to pain stimuli and signal injury
The gate-control theory of pain proposes that neural signals of pain pass through a gate that can modulate the signals before they reach the brain. - A person’s pain can be measured in several ways. Self- report methods include interviews, rating scales, and pain questionnaires
STRESS AND COPING
Definitions of stress fall into 3 broad categories; stress as a stimulus, as a response and as an interaction
- Stress as a stimulus
- Focus of this model→ stressful events (stressors) and the external environment
- Most well known advocates of this approach are Holmes and Rahe (in 1967 proposed their Social Readjustment Rating Scale)
Implication is that these events can be objectively defined and measured and some events could be considered positive
Criticism of this model→ many listed events weren’t applicable to everyone, and events may be intertwined or cancel each other out. Assumes all people rank events in a similar way
Stressor
An event that appears likely to an observer to produce stress or events or circumstances that we perceive as threatening or harmful
Traumatic events
Traumatic events are broad in their impact, usually involve devastation to the environment and may affect the social structure of the community (E.g. earthquakes, fires, floods etc)
PTSD
PTSD→ When individuals have been exposed to a traumatic event and may experience an intense emotional response can sometimes lead to later psychological problems (characteristics include nightmares, insomnia, fear, flashbacks, depression etc)
1932 Walter Cannon→ described ‘fight or flight’ response
- When an organism was threatened there was an arousal of sympathetic nervous system and endocrine system (prepares organisms to respond to anticipated danger by either reacting aggressively or fleeing)
Sympathetic Nervous System Arousal→ stimulates adrenal glands to secrete adrenaline and noradrenaline (following physical responses are→ elevated blood pressure, increased heart rate, dilated pupils, dry mouth, muscles tense, digestion slows)
Endocrine System Activation→ prompts secretion of cortisol by adrenal cortex that provides quick bursts of energy, heightened alertness and memory, increases organisms pain threshold
So together the sympathetic nervous system and the endocrine system enable the organism to confront or withdraw from the threat
General Adaptation Syndrome (related to the adrenocortical response to stress)
(3 phases of GAS)
Alarm Reaction→ Organism is alerted to a perceived threat→ body is mobilised- physiological responses
Resistance stage→ continued exposure to threat- the body attempts to regain equilibrium and adapt to the stressor
Exhaustion stage→ Occurs when the body attempts to resist the stressor→ if unsuccessful in adapting to or overcoming the threat. Body is weakened and more prone to disease, damage to internal organs and possibly death.
Criticisms of this model→ (GAS) General Adaptation Syndrome
Now generally recognised that there is not a single generalised response to environmental demand, overlooks the role of cognition and refers to actual stress not an anticipated stressor
Stress as Process (Biopsychosocial model of stress)
Stress is seen as process involving a complex interaction between the individual and the situation→ involves continuous interactions and adjustments called transactions
Important element of stress as process is cognitive appraisal→ introduced by Lazarus (1966)
- Involves appraising the demands of the stressor and the coping strategies available
In this process→ person will distinguish between distress (negative stressors) and eustress (positive stressors)
- The individual will interpret the event or situation as; relevant or irrelevant, benign or positive and threatening or harmful
Cognitive appraisal
The process of perceiving the stressor and judging one’s ability to manage or respond to the stressor
Hardiness→ Includes 3 characteristics
- A sense of personal control
- Commitment- A person’s sense of purpose or involvement
- Challenge- Tendency to view changes as incentives or opportunities for growth
Suggestion that hardy people remain healthier under stress because they are better able to deal with stress and less likely to become anxious
Can we measure stress?
Can assess physiological arousal by measuring; Blood pressure, Heart rate, Respiration, Galvanic skin response
The effects of stress on health are complex;
Effects can have short or long term consequences; physical outcomes include→ impaired immunity and vulnerable to infection, increased risk for cancer, cardiovascular disease etc
Psychological consequences of excessive or prolonged stress include
Forgetfulness, anxiety, mood changes, changes to diet, sleep, increased risky health behaviours (drug and alcohol abuse)
Coping
Constantly changing cognitive and behavioural efforts (transactions) to manage external and or internal demands that are appraised as taxing or exceeding the resources of the person (Lazarus and Folkman 1984)
Functions of coping (and maladaptive/adaptive)
To alter the problem causing stress (problem- focused coping) and to regulate the emotional response (emotion- focused coping)
Coping can be maladaptive or adaptive
- Maladaptive→ feeling overpowered and helpless, seeking sympathy, not discussing stress, sitting tight and hoping it will go away
- Adaptive coping→ being objective, using past experience, taking action, giving problem attention and treating as a challenge
Dignity
- Respect. Universal right regardless or race, sickness, gender etc.
- E.g. Putting hospital gown on can be revealing for patient and may make them feel vulnerable (power imbalance)
- E.g. Examinations and procedures can make a person feel their dignity is compromised for example, nt pulling curtains around, leaving person uncovered while going to get something etc.
Ethics
- Code of Professional conduct for nurses
- Conduct statement 4→ “Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues”
- Conduct Statement 8→ “Nurses actively preserve the dignity of people through practised kindness and respect for the vulnerability and powerlessness of people in their care
- Ethical concepts→ Autonomy, nonmaleficence, beneficence, justice
Pain Definition
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
Acute Pain
- Sudden onset
- Mild to severe
- Causes increases in heart rate, respiratory rate and blood pressure
- Normal physiological response to alert body to actual or potential tissue damage
- Generally lasts less than 3 months and decreases over time
Chronic Pain
- Pain lasts for 3 months or more
- Characterised by waxing and waning
- Cause may be unknown
- Behaviour includes withdrawal, decreased physical movement and fatigue
- Untreated chronic pain affects people’s ability to work and study, their relationships and mental health and emotional well being- yet up to 80% are missing out on treatment because of lack of access to effective services
Gate Theory of Pain
- Gate theory of pain→ Neural gate in spinal cord; can be open or closed in varying degrees
- Pain signal activates transmission cells which send impulses to the brain
- When the output of transmission cells reaches a critical level- the person perceives pain
- The greater the output beyond this level- the greater the pain intensity
- So when the gate is open the transmission cells send impulses freely but when the gate is closed or partially closed, the transmission is inhibited
What controls the gate?
- The amount of activity in the pain fibres - activity here opens the gate- and the stronger the stimulus (pain) the more active they are
- Amount of activity in other peripheral fibres- some peripheral fibres (A-beta) carry info about harmless stimuli or mild irritation (E.g. rubbing skin)
- Activity here tends to close the gate- inhibiting perception of pain when noxious stimuli is present
- So an example is gentle massage or heat therapy to sore muscles can decrease pain
Messages that descend from the brain- neurons in brainstem and cortex can send impulses that open or close the gate
Conditions that open the gate
- Emotional conditions→ Anxiety, tension, depression
- Mental conditions→ Focusing on the pain, boredom (little involvement in life’s activities)
- Physical conditions→ Extent of injury, inappropriate activity level
Conditions that close the gate
- Physical conditions→ Medication, counter stimulation (E.g. heat or massage)
- Emotional conditions→ Positive emotions (happiness or optimism), relaxation, rest
- Mental conditions→ Intense concentration or distraction, involvement and enjoyment in life’s activities
- In the minutes after a stressful event, the gate is closed- period of stress induced pain reduction
