Lewandowski: Pain Flashcards
Health and illness to be viewed as a result of interacting mechanisms at the cellular, tissue, organism, interpersonal, and environmental levels.
biopsychosocial model
The biophyschosocial perspective says that pain is influenced by a variety of factors. What are they?
- biological/physical: ex: tissue damage
- psychological/emotional: ex: mood
- social factors
Pain is a (blank) experience. No two people will have the same pain experience. Neither somatic or completely psychological models can explain pain/disability by themselves. Chronic pain is a (blank) response in some individuals.
subjective; learned
Biological/physiological factors that make chronic pain worse
inappropriate medications
non-restorative sleep
physical deconditioning
dysfunctional activity patterns
Psychological/emotional factors that make chronic pain worse
avoidance behaviors
disturbed mood
past learning with pain/injury
cognitions/beliefs about pain
Social factors involved in chronic pain
significant other influence
external disincentives
cultural factors
physician influence
1 reason people will come see you as a physician?
pain
Why is there no respect for pain?
Renee Descarte (mind versus body) Pain historically seen as an epiphenomenon of disease, or a response of secondary importance. Belief that if you eliminate the physical cause, you "cure" the pain.
Serves as a valuable "warning signal" Spans 0 to 12 weeks Lasts a short duration then ceases Symptom of tissue damage Minimal life disruption
acute pain
Treatment of acute pain
correct damage, rest, and take meds
Example of acute pain
broken leg, appendicitis
Cognitive expectation of acute pain
cured/fixed/relieved/eliminated
Pain signal may be the problem and not a sign of tissue damage Spans 13 weeks to many years Long duration, many flare-ups Not a symptom, but IS the problem Significant life disruption
chronic pain
Treatment of chronic pain
movement in a graded fashion
Example of chronic pain
back pain accompanied by depression, anxiety, sleep disturbance
Cognitive expectation of chronic pain
manage, cope, deal with, accept
T/F: It is important to inform your patients of healing times, so that they/you can determine if their pain is chronic or exceeding the normal expectation for healing
true
It is important to recognize that your patient has invisible pain that cannot be seen. What are the concepts of social disbelief and credibility?
Patients believe that their doctor doesn’t realize how bad their pain is, and feel the need to convince the doctor that it is bad
Who was responsible for realizing that the mind and body interact?
Renee Descarte
What are some “Cartesian” ways of thinking today?
If I can't see it on an MRI, it's not real. Organic vs functional labels. Tissue damage = pain intensity Pain ends upon healing Fix, cure, eliminate mindset Hurt means harm
It’s important to know your patient’s history with pain and trauma. What are some factors involved?
Physical abuse
Sexual abuse
Parental abandonment
Parental drug use
It’s important to know your patient’s sleep quality/quantity. Why?
Lack of sleep plays a huge role in chronic pain.
Why is it important to know how pain interacts with your patient’s activity levels?
When patients are unable to do the things they love, secondary problems arise. Inactivity plays a pervasive role in our lack of wellness.
It’s important to know the “meaning” of your patient’s pain. Why?
Important to know if there’s anyone to blame and if they are worried about getting better – these things can affect their prognosis
Which math functions are the most positive predictors for patients?
addition and multiplication
Should you use the term opioid or narcotics?
opioid
T/F: It’s important to know if your patient’s pain is acceptable, but not necessarily optimal.
true
T/F: ~40% of patients believe that they have not received comprehensive care for their pain.
true
Physical therapy aimed at activity increase in a paced manner
CBT
Biofeedback and relaxation training
Medications
Validated treatment approaches for pain
T/F: medications can be useful when treating pain IF integrated with other forms of treatment. Medications = only about half of treated patients respond, and their pain reduction averages only about 30 percent
true
What are the goals of cognitive-behavioral therapy?
problem solving orientation develop a sense of resourcefulness reconceptualize attitudes/beliefs manage rather than cure/fix pacing and modification of activities
Most pain treatments have (blank) as the primary purpose. CBT is a (blank) model (gaining control over your pain). CBT is about changing the (blank) of the thoughts, like reducing non-productive thinking (catastrophizing)
pain reduction; control based; content
How is the third-generation of CBT different?
Places an emphasis on changing awareness of and relationship to thoughts, NOT the content
When referring patients to psychologists, what should you refer to them as?
behavioral medicine specialist
T/F: It’s important to emphasize self-management, not cure.
True
Aspects of controlling pain in primary care setting
assess pain systemically identify comorbid conditions develop an individual treatment plan treat pain early/diligently consider using multiple modalities measure improvement over time reinforce positive/family involvement
Describe the intergrated biobehavioral approach
multidimensional versus interdisciplinary
does not have to take place in a specialized pain clinic
What does symptom magnification really mean?
a loss of control
T/F: Survivors are people who move purposefully towards either resolution or acceptance.
True
T/F: Psychological, social and environmental factors are involved in the maintenance of chronic pain
True
T/F: Addiction to opioids among patients prescribed opioid analgecis for pain is not common
True
