ICL 7.4: Behavioral Aspects of Pain Flashcards
what is somatization disorder?
chronic pain where both psychological factors and a general medical condition are considered to be significant contributors to the disorder
this is not conversion disorder which is all psychological and no biological basis for the pain
what are common chronic pain conditions?
- fibromyalgia
- osteoarthritis
- IBS
- tension headaches
- tempromandibular joint disorders
- dental pain
- visceral pain hypersensitivity disorders
- post surgical pain
there’s lots of others!
the experience off pain comes from the source of the damage: T/F
false
you need the brain to interpret pain!
what are the psychological aspects of pain?
pain impact one’s mental, emotional state of health
but also, one’s mental, emotional state of health can influence – and in fact – override the intensity, duration and frequency of one’s experience of pain
this does NOT negate the pain having a biological basis
we feel pain because of how our brain interprets input transmitted to it from all our senses.
what is the biopsychosocial model? how do they all play a part in a patients treatment?
- biological = structural and functional issues
- psychological issues = emotional responses like depression, anxiety, isolation
- social = inability to do ADLs
so you need to think about all of these when you think about chronic pain; you need to see chronic pain from both a biomedical and psychosocial perspective
the psychosocial factors (mind) often viewed as secondary, separate or irrelevant – disconnected from disease of the body – this approach can often categorize patients into two categories: “real” disease (clearly definable organic pain) and those with “psychogenic” disease (all in patient’s head)
what is the greatest strength of the biopsychosocial model?
it helps explain the large inter-individual differences we see in patient pain presentations – two people could have identically damages discs but one of them can’t move and the other is functional
it helps tell us how a patient interprets their pain.
what is pain effected by?
- genetics
- past trauma and experiences
- social learning
- habitual movements
- thoughts and feelings
what psychosocial inputs effect your brain’s modulation of pain?
- cognitions: attention, hypervigilance, catastrophizing, expectations; prefrontal cortex, insula (interface between sensory and cognitive state)
- emotions: stress, anxiety and depression -hypothalamus (autonomic regulation), amygdala
- context: social/cultural norms, values, occupation, social support; prefrontal cortex
- behavior: inactivity, deconditioning; prefrontal cortex
why does the context of someone’s pain matter?
lets say you have comeone with low back pain that always gets worse when they are stressed
you can help the patient discover the biopsychosocial strategies that are most helpful to them is a great way to enhance their resilience and reduce their stress!
what are the different aspects of a psychosocial assessment?
- pain
- reduced activity
- sleep disturbances
- muscle wasting, joint stiffness
- functional disability,
- emotional distress
- anxiety, depression, helplessness
these all play a roll in a patients pain!
what can be the most influential on the brain’s experience of pain?
- pain catastrophizing
- fear avoidance model
- anxiety –> pre-surgery anxiety correlated with post-operative pain
- deconditioning
what can be the most influential on the brain’s experience of pain?
- pain catastrophizing
- fear avoidance model
- anxiety –> pre-surgery anxiety correlated with post-operative pain
- deconditioning
what is the fear avoidance model of chronic pain?
pain experience –> catastrophizing (yellow flag) –> fear of pain –> pain anxiety –> pain avoidance –> disability/depression –> injury/pain experience
this cycle just keeps going and going
pain avoidance is not doing anything, sitting around, deconditioning and then you can’t do anything you get depressed and disabled
what is the suffering model of chronic pain?
there’s pain and then there’s suffering from pain
pain is relatively steady but with increasing factors like inactivity, anxiety, stress, poor sleep, failed treatment, depression, loss of purpose; all of this can lead to a huge increase in suffering from the pain
what are the protective factors against experiencing chronic pain?
- physical: fitness strength, health
- lifestyle: sleep, diet, pacing
- emotion: positive emotions, calmness
- social Support: family and friends
- mind: self-efficacy, reasonable expectations
