Midterm 1 Flashcards
What is stress-induced analgesia?
When stress inhibits pain
Study:
- Similar wounds between soldiers and civilians
- The soldiers were much more likely to say there was a little pain vs the civilians who described more pain
- Civilians wanted narcotics more
- Only difference: context
What were the confounds in the study of pain and narcotics between soldiers and civilians?
Confounds: soldiers are young and civilians are middle-aged, levels of stress differ
Explain the osteoarthritis example
MAIN POINT: Injury is not the thing that causes the pain in everyone, only some people
Every participant had knee OA that a rheumatologist diagnosed
- Most didn’t have pain in their knee, even though they all had the injury
- You can have OA but not knee pain and you can have knee pain but not OA
- OA sort of causes this pain
Pain is the #1 _____
- reason to seek healthcare
- concern of patients with chronic disease
What are the top 10 presenting complaints at doctor visits?
Cough*
Back pain*
Abdominal pain*
Sore throat
Dermatitis
Fever*
Headache*
Leg pain
Respiratory
Fatigue
What are the most common and least common pain events?
Most common:
- scratched skin (95.2%)
- paper cut (95.2%)
- pinched skin (94.6%)
Least common
- heart attack (0%)
- advanced cancer (1.1%)
- childbirth (1.1%)
Pain (in some form) is experienced by ___ of the population
100%
Around ___% of the population have had chronic pain in their lifetime
50%
Around __% have chronic pain right now
20%
Explain prevalence vs incidence
prevalence = current cases
incidence = new cases
explain out-patients vs in-patients
- Out-patients: given a prescription that you take home
- In-patients: people being treated in the hospital
Explain the back pain and NHS pyramid
surgery: 24,000
in-patients: 100,000
out-patients: 1.6 mil
consulting GP: 3 mil-7 mil
population prevalence: 16.5 mil
Explain prevalence of pain - headache in children study
- Type of population: schools, general practice, community, girl schools
- Studies had very different sample sizes (1,000-10,000)
- Age ranges are different
- Migraines range from 3%-10.6%
Explain self-reported prevalence of specific CHRONIC CONDITIONS by sex, household, and population aged 15 years and older, Canada 2007-2008 (most and least common)
Most common:
- back pain
- high blood pressure
- arthritis
Least common:
- alzheimer’s/dementia
- stroke
- cancer
Prevalence of pain by body part
Head = 15%
Neck = 8%
Upper back = 5%
Hip = 8%
Lower back = 18%
Shoulder = 9%
Leg = 14%
Hand = 6%
Knee = 16%
Describe the burden of pain
- functional activities (sleep, work, household, leisure, energy)
- social consequences (martial, family, intimacy, social isolation)
- Socioeconomic (healthcare costs, disability, productivity)
- emotional (irritable, angry, anxious, depressed)
Explain types of pain vs difficulty with basic/complex actions (%)
- severe headache or migraine: 31/33.5
- lower back: 51.6/55
- neck pain: 30.2/34.4
- knee pain: 37.7/38.6
- shoulder pain: 17.7/21.4
- finger pain: 14.3/16.3
- hip pain: 15/18.4
What are the most and least common social dislocations among chronic pain patients?
Most common:
- postponed housecleaning (81%)
- postponed household duties/laundry (79%)
Least common
- stayed in bed (18%)
- decline in sexual relations (24%)
What is comorbidity?
the likelihood that one disease is linked with another
Which kind of patients experience significant comorbid symptoms?
Patients with peripheral neuropathic pain
Why does chronic pain costs more than heart disease, cancer, and diabetes?
- Because of scans, x-rays, CTs, etc.
- Biggest economic burden: employment costs (amount lost to the economy because they couldn’t go to work and someone had to leave work to take care of them)
Explain pain in Abrahamic religions
- Pain as punishment for sin (Eve ate the apple)
- Pain as redemption (Jesus)
- Pain as personal atonement/redemption (Muslim)
Aristotle view of pain
pain is an emotion, in the heart
Galen view of pain
pain is a sensation, in the brain