II-18 Pain Control Techniques and the Management of Chronic Pain

Question 1

Cite evidence that the risk of addiction to painkillers is not particularly great.

Answer 1

In three studies involving 25,000 patients treated with opioids who had no history of drug abuse, only seven cases of addiction were reported, suggesting that the concern over addiction is indeed exaggerated.

Question 2

Explain why surgical control of pain is not a practical form of treatment. (6)

Answer 2

1. Surgical control of pain is not a practical form of treatment because
2. The effects of surgery are temporary.
3. The risks are great.
4. It has significant side effects.
5. The cost is prohibitive.
6. It can worsen the problem by damaging pain fibers.

Question 3

Describe the process of biofeedback training. (4)

Answer 3

Biofeedback consists of four sessions:

1. Baseline sessions—These sessions measure the baseline levels of a specific physiological function, such as heart rate or blood pressure
2. Shaping/reinforcement sessions—In these sessions, the individual learns to control a specific function with the use of instrumental feedback, such as lights or tones coming from a biofeedback device.
3. Test sessions—The individual controls the same function on his or her own, without the use of a device.
4. Follow-up—The individual is tested after a few weeks to make sure that the gains made in the previous sessions have been maintained.

Question 4

Discuss the effectiveness of biofeedback and relaxation in controlling pain.

Answer 4

Both relaxation and biofeedback are moderately effective at relieving pain, but relaxation is less expensive and more convenient.

Question 5

Identify the kinds of pain that hypnosis has been effective in controlling.

Answer 5

Hypnosis has been shown to work with acute pain (e.g., surgery, dental procedures, childbirth, burns, and headaches) and chronic pain (e.g., cancer patients). It is most effective when used in conjunction with other techniques.

Question 6

Cite evidence that distraction works as a method for controlling pain.

Answer 6

Dental patients who listen to distracting music through headphones experience less pain.

Question 7

Describe two very different types of imagery used to control pain.

Answer 7

Relaxing guided imagery: The patient is encouraged to visualize a peaceful, relatively unchanging scene, to hold it in mind, and to focus on it fully. This process brings on a relaxed sate, concentrates attention, and distracts the patient from the pain or discomfort.

Aggressive imagery: Instead of using imagery to calm and soothe themselves, patients may take a more aggressive stance in dealing with the source of the pain, perhaps imagining a combative, action-filled scene in which microbes or cancer cells are destroyed.

Question 8

Identify the kinds of cognitive-behavioral techniques that are especially successful in controlling pain.

Answer 8

The most effective cognitive-behavioral techniques used in pain management instruct the individual to:
• reinterpret the pain as manageable
• believe that one has the skills to control the pain
• redefine oneself as someone who is active in the pain management process
• monitor thoughts to avoid non-productive self-talk
• attribute one’s success to one’s own efforts
• cope with situations that give rise to pain
• enhance self-efficacy

Question 9

Name the components of chronic pain management programs.

Answer 9

• Patient education provides all patients with complete information about the nature of their condition.
• Patients are trained to implement measures that can help them reduce pain.
• Because many pain patients are emotionally distressed, group therapy is often conducted to help patients gain control of their emotional responses.
• Given what has often been a history of unsuccessful treatment of their pain, patients often catastrophize, and so interventions are aimed at the distorted negative perceptions patients hold about their pain and their ability to overcome and live with it.

Question 10

pain control

Answer 10

The ability to reduce the experience of pain, report of pain, emotional concern over pain, inability to tolerate pain, or presence of pain-related behaviors.

Question 11

counterirritation

Answer 11

A pain control technique that involves inhibiting pain in one part of the body by stimulating or mildly irritating another area, sometimes adjacent to the area in which the pain is experienced.

Question 12

biofeedback

Answer 12

A method whereby an individual is provided with ongoing, specific information or feedback about how a particular physiological process operates, so that he or she can learn how to modify that process.

Question 13

hynosis

Answer 13

A pain management technique involving relaxation, suggestion, distraction, and the focusing of attention.

Question 14

acupuncture

Answer 14

A technique of healing and pain control, developed in China, in which long, thin needles are inserted into designated areas of the body to reduce discomfort in a target area of the body.

Question 15

guided imagery

Answer 15

A techniques of relaxation and pain control in which a person conjures up a picture that is held in mind during a painful or stressful experience.

Question 16

pain management programs

Answer 16

Coordinated, interdisciplinary efforts to modify chronic pain by bringing together neurological, cognitive, behavioral, psychodynamic expertise concerning pain; such programs aim not only to make pain more manageable but also to modify the lifestyle that has evolved because of the pain.