Lecture 3.1: Acute and Chronic Pain Flashcards
What is Pain?
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
What is Suffering?
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
What is Empathising Pain?
Women experiencing physical pain activate similar brain regions (affective not sensory) to those involved when feeling empathy to their partner’s suffering
Is Pain Good or Bad: Pros
• 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
Is Pain Good or Bad: Cons
• Unfortunately, pain often outlives usefulness as
warning system
• Instead becomes chronic and debilitating
What is Nociception?
Non-conscious neural traffic originating with trauma or potential trauma tissue
What is Classified as Acute Pain?
• Three months or less
• Definable cause
• Treatable (usually medical)
What is Classified as Chronic Pain?
• Three months or more
• Benign or progressive
• Identifiable or non-identifiable
….CHANGE A BIT….What does ‘Pain Experienced’ depend on?
Context
Injury
Cognitive Set
Mood
Chemical & Structure
Genetics
Risk Factors for Chronic Pain?
• Older Age
• Being Female
• Poor Housing
• Pathologies
What is the Gate Control Theory of Pain?
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
How does Fear of Pain develop?
• 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
What does the Fear-Avoidance Model suggest?
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
What is Pain Catastrophising? Pros and Cons?
• 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
What is the Placebo Effect?
When a person’s physical or mental health appears to improve after taking a placebo or ‘dummy’ treatment
What is the Nocebo Effect?
Occurs when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have
Pain Management Drug Types (3)
• Endogenous opioids released naturally
• Exogenous opiate drugs
• Antidepressants
Exogenous Opiate Drugs Mechanism
• 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
Antidepressants Mechanism
• Modulate pain via CNS
• Inhibit reuptake of neurotransmitters involved in
the descending (efferent) pathway from CNS
What is Relief?
A multifactorial phenomenon that depends upon context, cognition, mood and personality
What are the Main Analgesics in clinical use? (5)
• Opioids
• Non-Steroidal Anti-Inflammatory (NSAIDS)
• Simple Analgesics (e.g. paracetamol)
• Local Anaesthetics
• Other Miscellaneous Drugs
What is the biggest danger of prescribing Opioids?
• They are addictive
• If taking meds 10 days or longer on regular
basis withdrawal symptoms may occur
• Wean off meds slowly
• Respiratory Depression
Signs of Potential Dependence on Drugs [Specifically Pain Meds] (7)
• 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
Pain Management: Non-Pharmacological Interventions (7)
• Transcutaneous Nerve Stimulation (TENS)
• Biofeedback
• Cognitive Behavioural Therapy
• Physical and Occupational Therapy
• Progressive Muscle Relaxation
• Complimentary Medicine
• Exercise & Lifestyle Changes
When should a patient be referred to Pain Management Programs?
• 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
What is The Descending Pain Modulatory System?
Cortical subcortical-brainstem network with anti- and proinfluences on dorsal horn nociceptive processing
