Management of stress and pain

Question 1

• Pharmacological agents
• Surgery and medical devices
• Complementary and alternative medicine
• Cognitive-behavioral techniques

Answer 1

Methods of Control

Question 2

• PTSD: benzoadiazepine tranquilizers, antidepressants
• pain: opiates
• nonsteroidal anti inflamm drugs like aspirin
• acetaminophen :act in CNS

Answer 2

Pharmacological Control of

Stress-related Disorders

Question 3

• Cutting pain fibers at various points so pain
sensations can’t be conducted
– Effects are often short-lived
– Regenerative powers of the nervous system mean that blocked pain impulses reach the brain through different neural pathways
– Can worsen problem because surgery damages the nervous system and that damage can cause pain
• Typically a “last resort”

Answer 3

Surgical Control of Pain

Question 4

Counterirritation
– Inhibiting pain in one part of the body by stimulating or mildly irritating another area
– Ex: Scratching a part of the body near the part that hurts
• Dorsal Column Stimulation
– Electrodes near the nerve fibers from the painful area deliver a mild electrical stimulus, thus inhibiting pain
– Short-lived, temporary relief
• Transcutaneous electrical nerve stimulation (TENS)
– Electrodes attach to the skin and provide electrical
stimulation
– Less effective

Answer 4

stimulation sensory control of pain

Question 5

• Dates back to 2000 B.C. and arose in many cultures
• Manual manipulation of soft tissue to produce health benefits
• Not suitable for arthritis or joint problems
• Energy healing

Answer 5

CAM Manipulation:

Massage

Question 6

• Founded in 1895
• Manipulation of the spine to not only cure illness
but also prevent it
• Effects:
– Some benefits for pain relief
– Not more effective than standard care but more
effective than no care
– Most effective for back and neck problems
• May do harm when applied to broken bones or
infection

Answer 6

Chiropractic Manipulation

Question 7

• Technique of healing developed in China over 2,000 years ago
• Long, thin needles are inserted into designated areas of the body
– To reduce discomfort in a target area of the body
• Accupressure
• Effects
– Controlling nausea, low back pain, postoperative pain
• How acupuncture controls pain is unknown

Answer 7

Acupuncture

Question 8

• A method whereby an individual is provided with
– Ongoing specific information about a particular physiological process by a machine
– So that s/he can learn how to modify that process
• Electromyograph (EMG) biofeedback (skeletal muscles)
– Decrease tension for stress; increase for rehabilitation
• Thermal biofeedback (skin temperature)
– Increase temperature to decrease stress and tension

Answer 8

Biofeedback

Question 9

• Why is it effective?
– Uses operant conditioning
– Little evidence due to physiological changes
– May be relaxation, suggestion, enhanced sense of control, placebo effect
• Drawbacks:
– Expensive & complicated
– Not more effective than simpler interventions (like relaxation)

Answer 9

Biofeedback

Question 10

– Transcendental meditation
• Focus on breathing & one sound (“om”)
– Mindfulness meditation
• Increase awareness & objectively assess thoughts
– Yoga
• Physical postures, breathing, & meditation
– Guided imagery

Answer 10

meditation

Question 11

• Acute Pain
– Modest effects
• Chronic Pain
– Valuable effects
– Release endogenous opioids
– Increase immune functioning

Answer 11

relaxation

Question 12

has successfully controlled
– Anxiety
– Irritable bowel syndrome
– Acute pain due to surgery, childbirth, dental procedures,
burns, headaches
– Pain due to laboratory procedures
– Chronic pain, such as pain due to cancer

Answer 12

hypnosis

Question 13

• Shape behavior using operant conditioning
• Secondary gains such as compensation,
attention, and sympathy are positive reinforcers
that promote chronic pain
• Benefits: increase physical activity & decrease medication use

Answer 13

Behavioral Management

Question 14

• Based on the principle that people’s beliefs,
personal standards, and feelings of self-efficacy
strongly affect behavior
– Focus on changing cognitions or thoughts
– Identify and attack irrational beliefs

Answer 14

Cognitive Therapy

Question 15

• Aims to develop beliefs, attitudes, thoughts, and skills to make positive changes in behavior
– Change attitudes
– Change environmental contingencies and build skills to change behavior

Answer 15

Cognitive Behavioral Therapy

CBT

Question 16

• Conceptualization
– Identify & clarify problems
• Skills acquisition and rehearsal stage
– Educational & behavioral components
– Change self-talk
• Application and follow-through
– Practice

Answer 16

Stress Inoculation Program

Question 17

• Reconceptualization
– Accept complexity of pain
– Learn Gate Control Theory
• Acquisition and rehearsal of skills
– Learn relaxation, controlled breathing, and distraction skills
• Follow-through
– Families use operant conditioning
– Patients use skills

Answer 17

Pain Inoculation Program

Question 18

• Increase acceptance of pain

* Focus attention on other goals and activities

Answer 18

Acceptance and Commitment

Therapy (ACT)

Question 19

Is any particular coping technique more effective

for managing pain?

Answer 19

– It depends on how long the patient has had the pain
– Recent Onset: Avoidant styles work
– Chronic Pain: Attending directly to the pain is effective

Question 20

• Multimodal approach
• Assessment of the pain
– Location
– Sensory qualities
– Severity
– Duration
– Onset
– History

Answer 20

Pain Management Programs:

Initial Evaluation

Question 21

Behavioral interventions
– Reduce reports of pain disability
– Reduce reports of psychological distress
• Improvement on psychosocial dimensions
– Commonly found as a result of pain management
• Programs offer the dignity that comes from selfcontrol of one’s pain

Answer 21

pain management programs:an evaluation

Question 22

• patient edu
• training
• group therapy
• target maladaptive cognitions

Answer 22

components of the programs