pain Flashcards
types of pain
acute pain
- comes on quickly, lasts for relatively short period of time
- identifaiable source, can be easily treated with pain MEDS and physiotherapy
chronic pain
- lasts for relatively long period of time, resistance to treatment
- has a physical cause, such as physical exertion, cancer
- large impact to quality of life and mental health
example study : maclachlan et al
- a 32 year old male with pantom limb pain in the lower limb was treated by mirror treatment
- in the treatment, 10 repetition of exercises such as straightening, bending leg, clenching, unclenching toes, moving the feet in circles
- initally, the patient needed help from a physiotherapist. But 2 days after, he could carry out the exercise by his own and without the use of a mirror
- after the treatment, his phantom limb pain and stump pain had decreased
- he also reported having higher sense of control in his phantom leg
- in summary, mirror treatment is effective in treating phantom limb pain in lower limb
therories of pain
specificity theory
- proposes that there is a separate snsory system for processing pain
- specialised pain receptors receive stimuli and passes signal to the brain via nerve impulses. the brain processes signal as sensation of brain then quickly respond with a motor response to try to stop the pain
- for example when we touch a hot object, this stimuli is received by pain receptors and sent to the brain. the brain can detect this signal as the sensation of pain then quickly stimulate a motor response to contract muscle.
gate control theory
- proposes that there is a gate in the spinal cord that either prevents signal from reaching the brain or allowing signal to continue
- when there is more large fibre activity compared to small fibre activity , people experience less pain as gates are closed. when there is less fibre activity compared to large fibre activity, people experience sense of pain as gates are opened
- this explains why we rub injuries to reduce the sensation of pain. this is done to activate large fibre activity and inhibit small fibre activity
measures of pain (clinical interviews )
subjective measures (clinical interview )
- clinician ask a range of opened questions which focus on getting a better understanding of patient’s experience of pain
- alao evaluate a range of factors that affects patients report on their experience of pain
ACT-UP guide was used
- activity : how much does the pain affects your daily activities?
- coping : how do you cope with the pain ?
- think : do you think your pain will go away ?
- upset : do you feel upset, depressed?
- people : how does other people reacts when you are in pain ?
- alongside with the questions asked, the alinician also observes the behvaviours of the partient and family members
- clinical interviews allows clinician to get a better indepth understanding on the patient’s experience of pain, it produces qualitative data
- however, it relies soley on the patient’s subjective experience of pain. Some patients may exaggerate their pain, some patients may downplay their pain
measures of pain (mcgill pain questionnaire) MPQ
MPQ
- composed of 78 words, ecah word was assigned a value based on the severity of it
- designed to help patients choose a word that best describe their feelings
- score from 0-78 (0 = no pain, 78 = severe pain)
- MPQ contained several categories including pain descriptors, words such as tender, searing
- affective, words such as terrifying
- miscellaneous, words such as numbness, spreading
- evaluation, words such as annoying, intense
- MPQ also included different factors which increase or decrease the pain such as heat/cold, mild exercise, eating, weather changes
- MPQ eventually asks the strength of pain. Which word best describe your pain now? which word describe your pain at it’s least? which word best describe your pain at it’s most?
MPQ allows measurement of pain over time and the measurement of the effectiveness of pain management. It also produces quantiatitve data which allows satistical analysis to be carried out.
however, MPQ contained close quesitons only. This may cause patients to force to choose words that does not best describe their feelings. It also lacks qualitative data, hence we cannot understand the in depth subjective experience of pain by the patient.
measues of pain (visual analogue scale)
- a instrument to measure pain
- a continuum from no pain to worst thinkable pain
- patients mark along line where they feel best represents their pain
- this is converted to a numerical value by caculating distance from end point to patient’s mark
- this is quick to administer
- produces quantitative data, but lacks qualitative data
measures of pain (key study)
Bruvdik et al
- investigated the level of agreement in pain assessment between parents, doctors, child. Also investigated whether pain assessment affected doctor’s administration of pain relief
- 243 childrens aged 3-15 were used, came from the emergency departement of a norwegian hospital
- 51 physicans with 57% male, 43% female. half of them had over 5 years of medical experience and 30% of them had a speciality in family medicine
- different scales were used to measure the pain by children
- children who aged 3-8 years old completed the face pain rating scale revised, with 6 face of increasing levels of pain.
- children who aged 9-15 years old completed the visual analogue scale and colour analogue scale, line from no pain to worst thinkable pain
- parents and physicians completed the numerical rating scale, on a scale from 0 to 10 predicting the level od pain by childrens
- parents and children were told not to tell their ratings to the physicans but their ratings are were completely blind to each other.
- results showed that children’s NRS was the highest, with 5.5. parent’s NRS was = 4.8. physician’s NRS was 3.2
- difference between pain assessment was not associated with the mean waiting time, child’s age, gender or whether the physician had a child or not.
- only 14.3 % of children with severe pain was given painkillers based on the ratings by childrens
- highest level of agreement was parents and children, with 40.1%. compared to 14.6 % between the physician and the children.
measures of pain (behavioural)
UAB pain behavioural scale
- UAB consists of 10 targets behaviours
- observer records details of each target behaviour over a period of time
- for each behaviour, observer records on the frequency, severity, and intensity
- each behaviour was assigned a value of 0, 0,5 or 1
- a total score out of 10 was calculated
- observer may not truely witness the extent of the pain experienced by the patients
- the ratings of UAB behavioural scale does not correlate with MPQ, suggesting that a outward display of pain does not show the subjective experience of pain by patients.
management of pain
biological : biochemical
- analgesics is a group of drugs that reduces pain, often referred as painkillers
- there are two main kinds of painkillers including opiates and non steriodal - antiin flammatory drugs
- N-SAID works by reducing the production of a hormone that causes pain. side effects including drowsiness, headaches, indigestion
- opiates works by binding to opiate receptors in the brain, cells releases signals that reduces the perception of pain, increasing the levels of serotonin and the feelings of pleasure . side effects including lowered heart rate, drowsiness and addiction.
psychological : attention diversion
- reduces the attention from pain to something else
- this does not reduces the pain, but reduces the attention of pain
- this works because it involves competition for attention between pain and the activity
- activities include puzzle, deep breathing, stress ball, massage, music.
- needed to be practiced in order for it to work. more effective in treating mild, moderate pain then severe pain
psychological : non pain imagery
- involves thinking about a calm, relaxing situation to reduce pain
- as a result, the patient is more likely to reduce their heart rate, breathing rate and lower their blood pressure. This creates a feeling of calm and relax which is beneficial in managing the pain
- audio recording can be used to talk the patient through the relaxing scene and methods to focus on different aspects of the imagery
- more effective in treating mild, moderate pain
cognitive : cognitive redefinition
- involves strategy to replace irrational thoughts about the pain with rational thought
- 2 coping statements
- coping statement : emphasise on the patient’s ability to tolerate the pain for example : it’s hurts but you are in control.
- reinterpretive statement : removes the negative association with pain for example : it’s hurts but it is not at it’s worst.
- more effective in treating severe pain
alternative treatments : acupuncture
- ancient asian method to reduce pain
- involves inserting very fine needles to specific points at the skin
- 4 to 10 needles at a time, leave for 10 to 30 minutes
- it is believed that this stimulates the release of endorphins, increasing the levels of serotonin
- limited evidence in proofing the effectiveness of this treatment. Do not know whether it is placebo effect or truely effective
alternative treatments : TENs, stimulation therapy
- delivers a small electrical current to the pinful area
- electrical impulses reduces the pain signals that reaches the brain and spinal cord, reliving pain and relaxing muscles
- this also stimulates the release of endorphins
- limited evidence proofing the effectiveness of TENS, only offers temporal relief
