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PSY333 > L4: Pain and Chronic Illness > Flashcards

L4: Pain and Chronic Illness Flashcards

1
Q

pain definition

A

localized/ generalized unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and typically results from bodily disorder

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2
Q

Pain insensitivity/ congenital insensitivity to pain (CIP) / congenital analgesia

A

Defective gene SCN9A - involved in transmission of nociceptive signal
Can feel touch and sometimes temperature but not pain

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3
Q

experience of pain is…

A

Individualized and subjective
Situational
Cultural norms influence expression of pain and pain behaviors

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4
Q

measuring pain

A

verbal reports, simple self-report scales

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5
Q

McGill Pain Questionnaire

A

assesses pain intensity and character

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6
Q

multidimensional pain inventory

A

characteristics of pain, responses of others, interference with daily activities, mood…

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7
Q

pain behaviors

A

facial and audible expressions, posture and gait, negative affect, avoidance of activity

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8
Q

physiological measure of pain

A

no actual measure
Muscle tension, skin temperature, and HR show some relation to pain

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9
Q

acute pain

A

normally brief, adaptive

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10
Q

chronic pain

A

over moths/years, no adaptive reason or benefit

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11
Q

pre-chronic pain

A

between acute and chronic

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12
Q

chronic recurrent pain

A

alternating between having and not having pain

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13
Q

order of nociception

A

transduction –> transmission –> modulation –> perception

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14
Q

transduction

A

stimuli activating nerve endings

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15
Q

transmission

A

traveling of information through the nervous system

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16
Q

modulation

A

process of alterations in the pain signals along the transmission pathway of pain

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17
Q

nociceptors

A

neurons that sense painful stimuli, subtype of neurons capable of sensing other sensations like touch or pressure

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18
Q

somatic pain

A

located on the surface of the body

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19
Q

visceral pain

A

internal organs

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20
Q

3 types of fibers for nociception

A

A-delta, C, A-beta

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21
Q

A-delta fibers

A

small, myelinated
rapid transmission of initial and sharp pain (mechanical and thermal)

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22
Q

C fibers

A

unmyelinated fibers
transmit secondary, dull, or aching pain

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23
Q

A-beta fibers

A

large diameter myelinated
information about pressure and vibration

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24
Q

where does info for pain go from spinal cord?

A

to reticular formation and thalamus

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25
Q

a-delta fibers where do they go in the brain

A

somatosensory cortex

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26
Q

homunculus

A

size of cortex proportional to the sensitivity of that part of the body

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27
Q

referred pain

A

when pain is experienced in a part of the body other than the site where stimulus originates. - identifying location less distinct on the inside

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28
Q

Gate Control Theory and Pain Modulation

A

Structures in spinal cord act as a gate that can open and close → modulating the sensory input that the brain interprets as pain
Physical, emotional and cognitive factors can all impact modulation

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29
Q

Ascending Pathways in Gate Control Theory

A

signals from periphery can open and close gates (rubbing injuries) → activates afferent touch neurons or Abeta fibers, occupy the same pathway through spinal cord, interfere with afferent pain signals

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30
Q

Descending Pathways in Gate Control Theory

A

gate control trigger: nerve impulses that descend from the brain and influence gate mechanism (ex: distraction, relaxation, adrenaline rush can cause gate to close) - Abeta closes, others open gate

31
Q

Gate Control Theory Strengths

A

Helps explain injury without pain, role of emotions in experience of pain
Psychological factors central
New possibilities for intervention

32
Q

Gate Control Theory Limitations

A

Can’t explain some types of chronic pain
Ex: phantom limb

33
Q

phantom limb pain

A

Experience of chronic pain in a part of body that is missing - amputees
Mirror therapy

34
Q

tuning chemicals … threshold for pain after injury

A

lower

35
Q

nTs play a role in pain perception

A

endorphins, enkephalins, dynorphin - endogenous opiates

36
Q

pro-inflammatory cytokines and pain

A

may contribute to chronic pain by sensitizing neurons in spinal cord

37
Q

Neuromatrix Theory of Pain

A

we have networks of neurons that form our felt representations of our unified physical selves
This unified conception of self = body-self neuromatrix → genetically determined, but can be modified with experience
Characteristic patterns of activation are stored at neurosignatures (individual experience of pain, stored and can be reactivated without new sensory input)
interaction of cognitive, sensory and affective

38
Q

neurosignatures

A

individual experience of pain, stored and can be reactivated without new sensory input

39
Q

ibuprofen and acetaminophen

A

target tuning chemicals at site of injury to dampen nociceptive signals

40
Q

local anesthetics

A

block transmission to spinal cord

41
Q

spinal blocking agents

A

block transmission up the spinal cord

42
Q

stimulation-produced analgesia (SPA)

A

electrical stimulation of brain stem blocks pain signals

43
Q

opiates

A

morphine, codeine also block pain signals at brain stem

44
Q

acupuncture

A

stimulates release of endogenous opioids

45
Q

surgery for pain

A

lesioning pain fibers, but can be problematic

46
Q

stress induced analgesia

A

inability to feel pain

47
Q

stress induced hyperalgesia

A

more sensitive to pain, hyperactivity in emotional areas of the brain, individuals with anxiety and neuroticism most prone

48
Q

relaxation techniques for pain

A

mindfulness, guided imagery, hypnoanalgesia - reduces activity in limbic system

49
Q

attention-based techniques for pain

A

distraction

50
Q

exercise for pain

A

where possible, endorphins can help

51
Q

VR for pain

A

changes in brain activity, longer-more benefit

52
Q

chronic illness effects … of adults

A

1/3

53
Q

Myalgic encephalomyelitis (ME)

A

chronic fatigue syndrome

54
Q

concerns with chronic illness

A

Misdiagnosis, stigma, impact on daily life (spoon theory -12 spoons per day), impact on relationships (importance of social support), impact on self-concept

55
Q

coping with chronic illness

A

Efficacy of problem vs. emotion focused (active vs. passive) strategies depends on the illness
Social support key

56
Q

Psychological adjustment to chronic illness: activity and cytokines

A

mediate disease induced inactivity and distress

57
Q

Psychological adjustment to chronic illness: emotional regulation

A

2 main types: avoidance, inhibition (suppression) & expression and acknowledgement.
Cultural fit
emotion disclosure interventions, unresolved emotions can increase stress and interfere with treatment,
expression of emotion must be processed to be beneficial

58
Q

Psychological adjustment to chronic illness: self-management

A

health behaviors
lifestyle changes most difficult, may improve psychological adjustment but poor adjustment makes it more difficult to engage in self-management → bidirectional

59
Q

Psychological adjustment to chronic illness: cognitive processing and benefit finding

A

Post-traumatic growth and benefit finding “improved appreciation of life, enhanced sense of purpose” –> response shift

60
Q

recalibration

A

recalibrating what constitutes health and quality of life

61
Q

reprioritization

A

of values and goals

62
Q

reconceptualization

A

of what is important to maintain an acceptable quality of life

63
Q

what patients want as a good death

A

Pain and symptoms managed
Not prolonging life/death
Sense of autonomy
Not being a burden to others
Strengthening relationships with others

64
Q

what families want as a good death

A

Feel competent and prepared
To have enough info
Emotional support
Access to coordinated care
Following patient’s wishes

65
Q

palliate

A

to provide comfort

66
Q

palliative care

A

Focus on symptom control, relief from pain
Not focused on curing disease
Hospices and hospitals
Person can receive both curative treatment and palliative care

67
Q

hospice care

A

For people with <6m prognosis
No longer seeking curative treatment, wish to maximize remaining time, psychosocial and spiritual support
Increases lifespan

68
Q

euthanasia

A

good death, voluntary euthanasia= intentionally ending life with patient’s consent

69
Q

passive (voluntary) euthanasia

A

Life-saving procedures not be used under specific circumstances

70
Q

active (voluntary) euthanasia

A

Medical aid in dying (MAID), physician assisted death (PAD)

71
Q

2 types of the right to die in Canada

A

physician/nurse directly administers substance
physician/nurse can give substance that patient can self-administer

72
Q

requirements for MAID (6-1, must meet all)

A

Serious incurable illness
Advanced state of irreversible decline
Psychological and physical suffering that is intolerable
Natural death has become reasonably foreseeable (revoked)
18+ and mentally competent
Eligible for government-funded healthcare

73
Q

Kübler-Ross Grief Model

A

can be both before and after death
1- denial
2- anger
3- bargaining
4- depression
5- acceptance

PSY333 (5 decks)

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