Musculoskeletal pain Part 1 Flashcards
Definition of pain
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”
What is the modern theory of pain?
Gate control theory of pain
What is the gate control theory of pain
Move from traditional medical model to biopsychosocial model
Pain input to brain is controlled via a ‘gate’ in the spinal cord
Gate controlled by:
pain fibres at site of injury
- pain fibres elsewheredescending messages from brain
What does the gate control theory of pain explain that other models have not?
Variable relationship between pain and injury- pain can be produced by non painful stimuli
Pain produced by innocuous stimuli
Referred pain - when pain is felt in different parts of the body to the tissue damage
Pain in the absence of injury
Persistence of pain after healing
Painless injury
Placebo effect
What are the differences in acute and chronic pain?
Aetiology( cause)
Acute-Result of injury or disease - normal physiological response
Chronic- Can be related or unrelated to tissue damage, can persist beyond normal healing
What are the differences in acute and chronic pain?
Purpose
Acute- Important protective role and be aware of environment
Chronic- No useful biological function
What are the differences in acute and chronic pain?
Duration
Acute- Short
Chronic- Long (>3-6 months)
What are the differences in acute and chronic pain? MSK examples
Acute- Fracture, muscle sprain, acute post-operative pain
Chronic- Chronic back pain, osteoarthritis, chronic post-surgical pain
What is congenital analgesia
Lose the ability to feel pain
What is key about pain assessment?
Multidimensional
What does the pain assessment cover?
Sensory aspects of pain
e.g. intensity, location, frequency, quality
Physical function
e.g activity levels, exercise, daily life
Emotional well-being/psychological impact
e.g. pain-related distress, depression, coping
Role and interpersonal functioning
e.g. work, relationships, social activities
What is important to remember when assessing pain?
Pain is subjective
We can never know someone else’s pain, we can only know our own pain
To assess someone else’s pain, we have to rely on their reports of pain
How do we assess pain?
Doctors need to listen to their patients and try to understand the pain experience
In some situations, you need to collect standardised information about pain e.g. research
How is information about pain collected?
Using patient-reported outcome measures
When is pain assessment quick and efficient
Trauma
Acute post-operative pain
What types of pain assessment is used that are quick and efficient
Verbal Descriptor Scale
Numeric Rating Scale
Visual Analogue Scale
In pain assessment what options are the Verbal Descriptor Scale
No pain
Mild pain
Moderate pain
Severe pain
In pain assessment what options are the Numeric Rating Scale
0- No pain 1 2 3 4 5 6 7 8 9 10- Worst possible pain
In pain assessment what options are the Visual Analogue Scale
Put a marker on a scale between no pain and pain as bad as it could
What is important about assessing acute pain
Repeat assessment of pain important to ensure optimal pain management over time
What is different about assessing chronic than acute pain
have time to conduct a full assessment
patients who have lived with his pain for a long time important to really understand their pain experience
Examples of chronic pain assessment
Disease-specific e.g ICOAP
Generic: Brief Pain Inventory
What does Generic: Brief Pain Inventory assess
used to assess pain in any condition
assesses pain severity and pain interference
such as how much pain interferes with sleep, mood and relationships
What does Disease Specific pain assess?
assessed aspects of pain that a characteristic of a specific condition
What does the Disease-specific: ICOAP assess? What does it stand for?
osteoarthritis
intermittent and constant osteoarthritis pain score
What pain do patients with osteoarthritis experience?
constant dull aching and the shot and unpredictable intermittent pain
Some challenges of using questionnaires to assess pain 4
Pain fluctuates over time because of many factors such activity levels and mood- some questionnaires ask for average pain per month which assumes that pain is static
When asking patients about pain severity over a long period of time like a month = recall bias (more likely to remember severe pain than mild pain)
Impact of co-morbidities and pain elsewhere- people with musculoskeletal pain have this - questionaires ask about particular area, really difficult to differentiate and separate out the different pains that they experience
Adaption and avoidance strategies- people with chronic pain develop this - may underreport amount of pain experienced
When is a non-verbal assesment needed?
Some patients may be unable to self-report their pain: advanced dementia, infants and preverbal toddlers, unconscious, intellectual disabilities, end of life.
What are the hierarchy of pain assessment techniques
Self-report Identify potential causes of pain Observe patient behaviours e_g. behavioural pain assessment tools Surrogate reporting of pain with carer Attempt an analgesic trial
Why are pain assessments important? 4
To understand the pain intensity, qualities and impact
To aid in diagnosis
To help decide on the choice of treatment
To evaluate relative effectiveness of different treatments
