Lecture 3.1: Acute and Chronic Pain

Question 1

What is Pain?

Answer 1

Pain is an unpleasant sensory and emotional experience associated with
actual or potential tissue damage or described of in terms of such damage

It has visceral or somatic origin & elicits sensation with autonomic, somatic, endocrine and emotional responses

Question 2

What is Suffering?

Answer 2

Suffering is a composite phenomenon that can arise not only when pain is present, but also, sometimes, just when pain is overcome

It is neither a sensation nor an emotion, but a state of being that encompasses the whole mind

Question 3

What is Empathising Pain?

Answer 3

Women experiencing physical pain activate similar brain regions (affective not sensory) to those involved when feeling empathy to their partner’s suffering

Question 4

Is Pain Good or Bad: Pros

Answer 4

• It confers an evolutionary advantage and
provides a warning of harm or impending threat
• It alert us to real or impending injury and triggers
appropriate protective responses

Question 5

Is Pain Good or Bad: Cons

Answer 5

• Unfortunately, pain often outlives usefulness as
warning system
• Instead becomes chronic and debilitating

Question 6

What is Nociception?

Answer 6

Non-conscious neural traffic originating with trauma or potential trauma tissue

Question 7

What is Classified as Acute Pain?

Answer 7

• Three months or less
• Definable cause
• Treatable (usually medical)

Question 8

What is Classified as Chronic Pain?

Answer 8

• Three months or more
• Benign or progressive
• Identifiable or non-identifiable

Question 9

….CHANGE A BIT….What does ‘Pain Experienced’ depend on?

Answer 9

Context
Injury
Cognitive Set
Mood
Chemical & Structure
Genetics

Question 10

Risk Factors for Chronic Pain?

Answer 10

• Older Age
• Being Female
• Poor Housing
• Pathologies

Question 11

What is the Gate Control Theory of Pain?

Answer 11

The gate control theory of pain asserts that non-painful input closes the nerve “gates” to painful input, which prevents pain sensation from traveling to the central nervous system

Question 12

How does Fear of Pain develop?

Answer 12

• Develops as a result of a cognitive interpretation
of pain as threatening (pain catastrophising)
• This fear affects attention processes (hyper-
vigilance)
• Leads to avoidance behaviours, followed by
disability, disuse, and depression

Question 13

What does the Fear-Avoidance Model suggest?

Answer 13

The fear- avoidance model suggests that in the absence of fear-avoidance beliefs about pain, individuals are more likely to confront pain problems head-on and become more engaged in active coping to improve daily function

Question 14

What is Pain Catastrophising? Pros and Cons?

Answer 14

• Common coping strategy
• Rumination about irrational, worst-case
scenarios
• Pros: Prepares for pain, aimed to receive
support/resources from others
• Cons: Increased attention pain, pain intensity
increases, increased analgesic use, depression,
anxiety, maladaptive pain behaviours

Question 15

What is the Placebo Effect?

Answer 15

When a person’s physical or mental health appears to improve after taking a placebo or ‘dummy’ treatment

Question 16

What is the Nocebo Effect?

Answer 16

Occurs when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have

Question 17

Pain Management Drug Types (3)

Answer 17

• Endogenous opioids released naturally
• Exogenous opiate drugs
• Antidepressants

Question 18

Exogenous Opiate Drugs Mechanism

Answer 18

• Bind to opioid receptors at nociceptors
• Act on limbic system (emotion, memories)
• Can reduce affective, emotional aspects of pain – think catastrophising, fear
in fear-avoidance model

Question 19

Antidepressants Mechanism

Answer 19

• Modulate pain via CNS
• Inhibit reuptake of neurotransmitters involved in
the descending (efferent) pathway from CNS

Question 20

What is Relief?

Answer 20

A multifactorial phenomenon that depends upon context, cognition, mood and personality

Question 21

What are the Main Analgesics in clinical use? (5)

Answer 21

• Opioids
• Non-Steroidal Anti-Inflammatory (NSAIDS)
• Simple Analgesics (e.g. paracetamol)
• Local Anaesthetics
• Other Miscellaneous Drugs

Question 22

What is the biggest danger of prescribing Opioids?

Answer 22

• They are addictive
• If taking meds 10 days or longer on regular
basis withdrawal symptoms may occur
• Wean off meds slowly
• Respiratory Depression

Question 23

Signs of Potential Dependence on Drugs [Specifically Pain Meds] (7)

Answer 23

• Hoarding medication
• Rating pain as more than 10 on pain rating scale
• Falsifying symptoms
• Not attending scheduled appointments (but
turning up/calling out of hours/without appt)
• Aggression/threats/manipulation/impatient
• Excessive flattery
• Requesting specific drug

Question 24

Pain Management: Non-Pharmacological Interventions (7)

Answer 24

• Transcutaneous Nerve Stimulation (TENS)
• Biofeedback
• Cognitive Behavioural Therapy
• Physical and Occupational Therapy
• Progressive Muscle Relaxation
• Complimentary Medicine
• Exercise & Lifestyle Changes

Question 25

When should a patient be referred to Pain Management Programs?

Answer 25

• When reaching PMPs, patients have had 5
years of pain
• Exhausted most other options

Refer to PMPs when pain causes:
• Distress
• Disability
• Reduced quality of life
• Isolation
• Workplace absenteeism

Question 26

What is The Descending Pain Modulatory System?

Answer 26

Cortical subcortical-brainstem network with anti- and proinfluences on dorsal horn nociceptive processing