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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
a-delta fibers where do they go in the brain
somatosensory cortex
26
homunculus
size of cortex proportional to the sensitivity of that part of the body
27
referred pain
when pain is experienced in a part of the body other than the site where stimulus originates. - identifying location less distinct on the inside
28
Gate Control Theory and Pain Modulation
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
29
Ascending Pathways in Gate Control Theory
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
30
Descending Pathways in Gate Control Theory
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
Gate Control Theory Strengths
Helps explain injury without pain, role of emotions in experience of pain Psychological factors central New possibilities for intervention
32
Gate Control Theory Limitations
Can’t explain some types of chronic pain Ex: phantom limb
33
phantom limb pain
Experience of chronic pain in a part of body that is missing - amputees Mirror therapy
34
tuning chemicals ... threshold for pain after injury
lower
35
nTs play a role in pain perception
endorphins, enkephalins, dynorphin - endogenous opiates
36
pro-inflammatory cytokines and pain
may contribute to chronic pain by sensitizing neurons in spinal cord
37
Neuromatrix Theory of Pain
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
neurosignatures
individual experience of pain, stored and can be reactivated without new sensory input
39
ibuprofen and acetaminophen
target tuning chemicals at site of injury to dampen nociceptive signals
40
local anesthetics
block transmission to spinal cord
41
spinal blocking agents
block transmission up the spinal cord
42
stimulation-produced analgesia (SPA)
electrical stimulation of brain stem blocks pain signals
43
opiates
morphine, codeine also block pain signals at brain stem
44
acupuncture
stimulates release of endogenous opioids
45
surgery for pain
lesioning pain fibers, but can be problematic
46
stress induced analgesia
inability to feel pain
47
stress induced hyperalgesia
more sensitive to pain, hyperactivity in emotional areas of the brain, individuals with anxiety and neuroticism most prone
48
relaxation techniques for pain
mindfulness, guided imagery, hypnoanalgesia - reduces activity in limbic system
49
attention-based techniques for pain
distraction
50
exercise for pain
where possible, endorphins can help
51
VR for pain
changes in brain activity, longer-more benefit
52
chronic illness effects ... of adults
1/3
53
Myalgic encephalomyelitis (ME)
chronic fatigue syndrome
54
concerns with chronic illness
Misdiagnosis, stigma, impact on daily life (spoon theory -12 spoons per day), impact on relationships (importance of social support), impact on self-concept
55
coping with chronic illness
Efficacy of problem vs. emotion focused (active vs. passive) strategies depends on the illness Social support key
56
Psychological adjustment to chronic illness: activity and cytokines
mediate disease induced inactivity and distress
57
Psychological adjustment to chronic illness: emotional regulation
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
Psychological adjustment to chronic illness: self-management
health behaviors lifestyle changes most difficult, may improve psychological adjustment but poor adjustment makes it more difficult to engage in self-management → bidirectional
59
Psychological adjustment to chronic illness: cognitive processing and benefit finding
Post-traumatic growth and benefit finding “improved appreciation of life, enhanced sense of purpose” --> response shift
60
recalibration
recalibrating what constitutes health and quality of life
61
reprioritization
of values and goals
62
reconceptualization
of what is important to maintain an acceptable quality of life
63
what patients want as a good death
Pain and symptoms managed Not prolonging life/death Sense of autonomy Not being a burden to others Strengthening relationships with others
64
what families want as a good death
Feel competent and prepared To have enough info Emotional support Access to coordinated care Following patient’s wishes
65
palliate
to provide comfort
66
palliative care
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
hospice care
For people with <6m prognosis No longer seeking curative treatment, wish to maximize remaining time, psychosocial and spiritual support Increases lifespan
68
euthanasia
good death, voluntary euthanasia= intentionally ending life with patient’s consent
69
passive (voluntary) euthanasia
Life-saving procedures not be used under specific circumstances
70
active (voluntary) euthanasia
Medical aid in dying (MAID), physician assisted death (PAD)
71
2 types of the right to die in Canada
physician/nurse directly administers substance physician/nurse can give substance that patient can self-administer
72
requirements for MAID (6-1, must meet all)
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
Kübler-Ross Grief Model
can be both before and after death 1- denial 2- anger 3- bargaining 4- depression 5- acceptance

PSY333 (5 decks)

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