PAIN Flashcards
An unpleasant sensory and
emotional experience associated with actual or potential tissue damage is known as —
and it can be:
pain
- subjective
- sensation and emotion
- pain without injury
- injury without pain
-pain is associated w the — and lost —- and increased use of — benefits
-cost of pain is — annually in Europe
- pain statistics underestimates human cost as pain often most debilitating and
distressing aspect of a chronic disease
- pain affects – of adult European population
prevalence of chronic pain in Ireland is —
- — of all doctor consultations in US relate to pain
- extended hospital stays
- lost working days
- increased use pf social welfare benefits
- 200 bilion euros
- 20%
- 35.5% and 48% in uk
- 80%
—- a useful biological response provoked by injury or disease, which is of limited duration. Responses are usually adaptive. [Case of Lisa]
—- pain persisting for six months or more and tends not to respond well to pharmacological treatment. Responses are often
maladaptive.
- acute pain
- chronic pain
gate control theory of pain: periphery:
pain sensations transmitted from — to the – by nerves known as –
1- —- are militated pain affronts which have a svery strong noxious stimuli to potential or actual damage to tissue, the expeirence lasts for a short time.
2- —- slow conducting and non myelinated which carry info about dull , throbbing , pain , experienced for a longer period
3- —- is an antipain fibers which is myelinated mechanically ( touch ) sensitive afferents and activation through ( through rubbing , massage and heat ) inhibites perception of pain.
- site of injury
- spinal gate
- nociceptors
- delta fibers
- c polymodal fibers
- beta fiber
these different fibers transmits info at different — which as a result usually pain is experienced in 2 phases:
1- the first is mediated by — involves the expeircne of —-
2- this is followed by more — mediated by —-
- info: couteracted at least in part by —- activation
-speeds
- A delta fibers
- sharp pain
- chronic throbbing pain
- C polymodal fibers
- A beta fiber
gate control theory of pain: psychological influence on pain receptor- conginition and mood:
1- mood:
- anxiety and depression will — pain tolerance and — reporting pain
2- conginiton:
- —- : focusing on pain increases experience of pain
- — of increases or reduction in pain can be self fulfilling
- types of thoughts that infuelnce the pain experience include:
- decrease , increase
- attention
- expectation
types of thoughts include: - Attributions of the cause of pain
- Beliefs about the ability to tolerate pain
- Beliefs about the ability to control pain
- Expectations of relief from pain – the placebo
effect.
gate control theory of pain:
1- A and C fibers send info to — by which some excretory some inhibitory
2- activation of 000 in response to — and — response to pain from brain influenced by distraction attention fear etc
3- transmutation to — in the brain , — of both pains and neural inputs
- gelatinosa substantia
- reticulospinal fibres
- cognitive and emotional
- pain centres
- summation
combined gate control theory inputs:
1- peripheral pain receptors transfers info about —- to series of — in the — , these nerves link to other nerves along the — that transmits info – to — within the brain
2- at the same time as experience pf physical damage , we experience related — and —- , regulars in activation of — taking into from the brain — the spinal column to the – at which the incoming pain signals enter spinal column
- physical damage
- gates
- spinal column
- spinal column
- up
- pain centres
- cognitions and emotions
- CNS nerve fibres
- down
- gate
factors that open and close the pain gate:
- tend to — as:
* -physical
– Injury
– Inactivity/poor physical fitness
– Long-term drug & alcohol use
* behavioral
– Poor or too little pacing of activity,
i.e., doing too much
– Poor Sleep
* emotional
– Anxiety, depression
– Stress distress
– Helplessness/hopelessness
* cognitive
– Focussing on the pain
– Worrying about the pain
– Catastrophising (thinking the worst)
- tend to close the gate:
- tend to — as:
* Physical
– Appropriate medication use
– Heat/cold
– Massage
* Behavioural
– Exercise
– Relaxation training
– Sleep hygiene
* Emotional
– Laughter/humour
– Optimism
– Engaging in enjoyable activities
* Cognitive
– Distraction
– Active coping
- open
- close
pain management:
- historical aim was for —
- moder aim for:
- eliminate pain
- modern:
– Reduce pain perception
– Improve coping ability
– Increase functional ability
– Decrease drug reliance and distress
– Respect for attempts at self-
management
pain management for acute:
1- first line is generally —
2- 2d level is — forms as:
- pharmacological
- psychological intervention
as:
– Increasing patient control - e.g., patient controlled
analgesia (PCA)
– Teaching coping skills, primarily: - Distraction
- Relaxation
– Hypnosis
pain management - chronic:
- causes —- and — which may be influenced by interaction within —
*—- (intrapersonal) gain: expressions of pain
result in cessation of aversive consequence, e.g.,
going to work, household chores
*—- (interpersonal) gain: pain behaviour
yields positive outcome, e.g., expressions of
sympathy, care
*—- gain: feelings of pleasure/satisfaction
experienced by person helping person in pain
- complex and multifactorial
- social environment
- primary
-2ndary - tertiary
chronic pain management results :
- So-called “five D’s”
:
1. Dramatisation of complaints
2. Disuse through inactivity
3. Drug misuse through over-medicating
4. Dependency on others
5. Disability due to inactivity
pain magmenr for chronic:
1- behvaioral strategies as:
2- cognitive strategies as:
1:
– Based on operant learning:
contingency management
– Reinforcement of adaptive
behaviours such as appropriate
levels of exercise and ignoring
pain behaviours
– Withdrawal of attention or other
rewards that were previous
responses to pain behaviours
– Providing analgesic medication
at set times rather than in
response to behaviour
* Rare to use this approach only:
problems with generalization
2- :
– Cognitions are central to the
experience of pain and reactions
to it
– Help patient alter beliefs about
unmanageability of pain
– e.g., address catastrophising or
negatively biased thinking
– Helps identify and challenge
distorted thinking and helps
restructuring of cognitions
* Information provision - reduces
anxiety
* Distraction, re-directing attention
* Relaxation - target muscles in area of
pain
pain management programes ( PMPs) :
- Multidisciplinary Teams (MDT): doctors, nurses,
physiotherapists, psychologists, occupational therapists and
counsellors. - Underpinned by cognitive-behavioural principles (CBT)
- Provide education on pain physiology, pain psychology, healthy
function & self-management of pain problems - Delivered in group format to normalise pain experience &
maximise learning - Patient receive:
– Full assessment
– Education
– Skills training
– Exercise schedules
– Relapse prevention
– Family work
