LECTURE 10

Question 1

WHY MEASURE PAIN

Answer 1

1.) INTENSITY
2.) QUALITY
3.) DURATION
AIDS IN DX AND POTENTIAL THERAPIES/MGMT OF STRATEGIES

Question 2

WHY PRECLINICAL ANIMAL STUDIES

Answer 2

HUMANS ARE SUBJECTIVE IN SELF-REPORTING AND OBJECTIVE MEASUREMENTS
ETHICALLY LIMITING TO USE HUMANS
ANIMALS ARE NOT AS SUBJECTIVE AS HUMANS
HUMAN BIOMARKERS ARE POSSIBLE BUT LIKELY TOO MANY GENES INVOLVED TO BE NARROWED DOWN
GENETICS MEASURE TRAIT SENSITIVITY (NOT ON-GOING OR DAY-TO-DAY PAIN)

Question 3

MULTI-DIMENSIONAL PAIN EXPERIENCE

Answer 3

1. ) SENSORY DISCRIMINATIVE
2. ) MOTIVATION-AFFECTIVE
3. ) COGNITIVE-EVALUATIVE

Question 4

SENSORY DISCRIMINATIVE

Answer 4

SENSORY PROCESSES INFORMATION ABOUT THE STRENGTH, INTENSITY, QUALITY, AND TEMPORAL AND SPATIAL ASPECTS OF PAIN
INFLUENCED BY RAPID-ACTING SPINAL SYSTEMS

Question 5

MOTIVATION-AFFECTIVE

Answer 5

CONSIDERS MOTIVATIONAL DRIVES AND UNPLEASANT AFFECT OF PAIN

INFLUENCED BY RETICULAR/LIMBIC SYSTEM - SLOWLY CONDUCTING SPINAL SYSTEM

Question 6

COGNITIVE-EVALUATIVE

Answer 6

INVOLVES ATTENTION, LEARNED BEHAVIOR, AND PAST EXPERIENCES CONCERNING PAIN (BLOCKS, MODULATES, OR ENHANCES PAIN PERCEPTION)
MOST-UNIQUELY HUMAN

Question 7

ANIMAL MODELS

Answer 7

SUBJECT - SPECIES –> STRAIN –> MUTANT –> SEX –> AGE –> HUSBANDRY –> TESTING PROCEDURES*
* AROUSAL, COMMUNICATION, HANDLING, RESTRAINT
ASSAY - ETIOLOGY* –> BODY PART –> TIME PATIENT POST-INJURY
*ETIOLOGY - NOCICEPTIVE ANIMAL MODELS = MOST COMMON (ACUTE PAIN)
INDUCED INFLAMMATORY/NEUROPATHIC PAIN (CHRONIC PAIN)
MEASURES - REFLEX –> SPONTANEOUS –> OPERANT –> PAIN AFFECTED COMPLEX BEHAVIOR
*OPERANT - PUTTING THE ANIMAL IN CONTROL OF THE STIMULUS (STUDY PAIN STATES BASED ON RESPONSE)

Question 8

PAIN-RATING SCALES

Answer 8

ADVANTAGES - RATES PAIN ONLY BASED ON INTENSITY
DISADVANTAGES - PAIN SHOULD NOT BE BASED SOLELY ON INTENSITY (NOT UNIDIMENSIONAL), SUBJECT TO DISRUPTIONS IN PERCEPTION AND MOTOR ABILITIES

Question 9

McGILL PAIN QUESTIONNAIRE

Answer 9

ASKS 4 QUESTIONS TO EVALUATE (1) SENSORY, (2) COGNITIVE-EVALUATIVE, AND (3) AFFECTIVE ASPECTS OF PAIN
1.) WHERE IS YOUR PAIN?
2.) WHAT DOES YOUR PAIN FEEL LIKE?
3.) HOW STRONG IS YOUR PAIN?
4.) HOW DOES YOUR PAIN CHANGE W/ TIME?
ANSWERS ARE THEN CODED AND DX INFO AND LIKELY SET OF PAIN STATES IS DETERMINED
CAVEAT - PAIN STATES HAVE TO BE STATIC/HIGH LEVELS OF ANXITY/PSYCHOLOGICAL DISTURBANCES LIMIT DISCRIMINATION
MOST FREQUENTLY USED

Question 10

SHORT FORM McGILL PAIN QUESTIONNAIRE

Answer 10

22 QUESTIONS W/ 4 SUBSCALES AND RATINGS

1. ) CONTINUOUS PAIN
2. ) INTERMITTENT PAIN
3. ) PREDOMINANTLY NEUROPATHIC PAIN
4. ) AFFECTIVE PAIN

Question 11

OTHER PAIN RATING SCALES

Answer 11

DESCRIPTOR DIFFERENTIAL SCALE - SEPARATELY ASSESSES SENSORY VS. HEDONIC COMPONENTS OF PAIN (REDUCES BIAS)
PAIN QUALITY ASSESSMENT SCALE - MEASURES QUALITIES OF NEUROPATHIC AND NON-NEUROPATHIC PAIN
INCLUDES SPATIAL AND TEMPORAL QUALITY OF PAIN

Question 12

PEDIATRIC PAIN ASSESSMENT SCALES

Answer 12

SELF-REPORT MEASURES
*PIECES OF HURT (3-4 Y.O.)
*FACES PAIN SCALE (4-12 Y.O.)
*VAS (<8 Y.O.)
*McGILL PAIN QUESTIONNAIRE
BEHAVIORAL RESPONSES TO PAIN - VOCALIZATIONS, FACIAL EXPRESSION, BODY MOVEMENTS
*FLACC SCALES - FACE, LIMBS, ACTIVITY, CRYING, CONSOLABILITY
BIOLOGICAL MEASURES - WHEN IN PAIN…
*HR AND O2 SAT. INCREASES, SWEATING AND STRESS RESPONSE INCREASES
COMPOSITE MEASURES -
*COMFORT SCALE - BEHAVIORAL + PHYSIOLOGICAL MEASURES RATED AT THE SAME TIME
*PIPP - PREMATURE INFANT PAIN PROFILE (CONTROLS FOR GESTATIONAL AGE OF NEONATE AND CAPABILITIES COMPARED TO NEONATE BORN AT 9 MO.)
BEST ANALGESIC FOR PAIN IN NEONATES = SUCROSE

Question 13

PHYSIOLOGICAL ASSESSMENTS

Answer 13

HR AND BP INCREASED, PERIPHERAL BLOOD FLOW DECREASED/INCREASED DEPENDING ON TYPE OF PAIN
ELECTRODERMAL ACTIVITY - VARIATION OF ELECTRICAL PROPERTIES OF THE SKIN IN RESPONSE TO SWEAT SECRETION
ELECTROMYOGRAPHIC ACTIVITY - DX TECHNIQUE FOR EVALUATING/RECORDING ELECTRICAL ACTIVITY PRODUCED BY SKELETAL MUSCLES (GOOD FOR SOMATIC PAIN)
ERP - BRAIN RESPONSES THAT ARE PRODUCED ARE TIME-LOCKED TO AN EVENT

Question 14

NEUROIMAGING

Answer 14

fMRI - MEASURES BRAIN ACTIVITY BY DETECTING CHANGES IN BLOOD OXYGENATION AND FLOW THAT OCCUR IN RESPONSE TO EVENTS (CURRENTLY THE MOST USEFUL)
PET - USES TRACE RADIOACTIVITY MATERIAL TO MAP FUNCTIONAL PROCESSES IN THE BRAIN
MEG - MEASURES MAGNETIC FIELDS PRODUCED BY ELECTRICAL ACTIVITY IN THE BRAIN

Question 15

ASSESSING BELIEFS COPING AND FUNCTION

Answer 15

BELIEFS - SELF-EFFICACY (+), ACCEPTANCE (+), FEAR AVOIDANCE (-)
COPING STRATEGIES -
CATASTROPHIZING - TO MAGNIFY AND FEEL HELPLESS IN THE CONTEXT OF PAIN (CBT MOST SUCCESSFUL W/ THIS)
DISTRACTION, IGNORING AND DISTANCING
TASK PERSISTANCE
PAIN-RELATED FUNCTION
PSYCHOSOCIAL FUNCTION - MOOD/SLEEP

Question 16

MOST IMPORTANT ANIMAL MODEL CHARACTERISTICS

Answer 16

SUBJECT - 
TESTING PROCEDURES
*AROUSAL
*COMMUNICATION
*HANDLING
*RESTRAINT
HUSBANDRY
*CAGE DENSITY
*DIET
*SOCIAL FACTORS
ASSAY - 
ETIOLOGY 
*NOCICEPTIVE
*INFLAMMATORY
*NEUROPATHIC
*DISEASE STATE
MEASURES - 
PAIN-AFFECTED COMPLEX BEHAVIORS
*ANXIETY
*ATTENTION
*DISABILITY
*SOCIABILITY
*SLEEP
OPERANT - 
*LEARNED ESCAPE
*PLACE AVERSION
*REINFORECMENT CONFLICT