Pain

Question 1

perisstent pain cycle

Answer 1

Question 2

Define Pain

Answer 2

• AN unpleaseant sensory and emotional experience assoicated with, or resembling that assoicated with, actual or potential tissue damage
• Lots pain theories

Question 3

Cartesian dualistic pain theory

Answer 3

• In the past: Widely believed pain was a consequence of committing immora, acts thought suffering was a way for people to repent their sins.
• This is where pain was a mutually exclusive phenomenon. COuld be result of physical injury, or psychological injurt but didnt appreciate the two types could combien or influence one another.

Question 5

Specificity theory pain

Answer 5

Brain had different areas responsibel for different things.

Question 6

Pattern theory of pain

Answer 6

Each sensation relays a speciric pattern or sequence of signals to the brain and brain takes patterna dn deciphers it

Question 7

Gate control theory of pain

Answer 7

• Stimulus sent to brain mus travel to lcoations within psinal cord where signal os modulated
• Substantia gelatinosa has signifciant role in modulation of signals acting as a gate for info travelling to the brain
• Percetption of pain is a result of a complex interaction. betweens tructual components of the psinal cord.

Question 8

Nueormatrix theory of pain

Answer 8

• CNS is repsonsibel for leiciting painful sensations rather than periphger
• Neuromatrix ocnsists of multipel ateas in CNS that contirbute to the signal which allow perception of pain
• These include SC, limbic system etc
• Together the areas create signal termed ‘neurosignature’ which is repsonsible for perception of pain
• Inouts from peirphery can intiiate or influence neurosignature but they can not create a neurosignatue.

Question 9

Biopsychosocial model of pain

Answer 9

Pain is a reuslt of complex interactions between bio,psycho and sociological factors and any theory which fails to include all of these 3 constructs of pain, fails to provide an accurate explanation for why an individual is experiencing pain.

Must be multidimensionl to treat pain

Proed to have better outcomes in increase dpatient satsifaction, and better restoration.

Good for those with chronic pain

Question 11

Different types of pain:

Answer 11

• Nueropathic- Pain caused by lesion or disease of somatosensory NS. linical description not diagnostic. Can be from central or peripheral
• Nociceptive - Pain that arises from actual or thretended damage to non neural tissue
• Nociplastic - Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.
• Acute- painful condition with rapid onset or short duration. <12weeks
• Chronic- painful condition persisting beyond normal time of healing. >12wks

Transition from acute to chronic pain: physiological changes take place at various levels from periphery to CNS. If pathophysiological changes take place could be prevented would be really good but not much evidence to support

• Referred
• Rebound

Question 12

RFs for developing pain after surgery

Answer 12

Patient factors

• Psychological vulnerability
• pre op anxiety
• female
• younger age (adult)
• workers compensation
• genetic factors
• depression
• unpleaseant past experience
• social environment

Medical factors

• preop pain moderate/severe more than 1month
• repeat surgery
• radiotherpay to area
• nerve damagr
• chemo
• type of surgery
• operations over 3hours
• sugical technique
• duration of post op pain treatment

Question 13

Psycholgoical management pain

Answer 13

• Acceptance and commitment therpay: type of CBT that teaches people practicla ways to embrace present oment experiencs to enhance day to day quality of life. Differs from CBT in its underlying premise that the normal processes of the human mind are frequently disruptive. Hexaflex model (present, values, comitted action, self as content, defusion, acceptance = all interconnected with physologicla flexibility in the middle. )
• Compassion focued therapy: combiens evolutionary theory with philosophy drawn from buddhism, and may be helpful where traditional CBT fails to omrpov emotional wellbeing. Despite developing ability to recognise unhelpful thoguhts and feleigns some still have shame and guilt. Apparantly developnent of self compassion through warmth and acceptance will reduce ocntributionf rom brains ‘threat’ centers and promot the ability to sooth and comfort oneself. Mindfullness techniqures used in this to promote awareness of painful thoughts and feelings.
• CBT: interplay between situations,thoguhts, feleigns, phsyical sensations and behaviour. Identify and change negative thinking and flase belief about pain. Pacign (activity management) is important. High level evidence of this.