Pain Flashcards
Define pain
-An unpleasant sensory and affective experience that causes significant discomfort and distress.
What are the different types of pain
Acute pain
Chronic pain
Explain Acute pain
-It is usually in a specific location and has an identifiable cause,
it lasts a relatively short period of time. its easy to treat and does not last after treatment
Explain Chronic pain
-It lasts for a long period of time, it may have an organic cause but its prolonged by psychological factors e,g worries and stress’
-It does not respond to treatment and interferes with daily functioning.
Describe Phantom limb pain
-This is pain that is experienced in a limb that is no longer there.
it can be reported as insatiable itchiness, pressure , cold , crossing fingers or toes. it does not respond well to treatment and sufferes report little benifit from therapy
Describe the study by MacLachlan
Case study of a person with phantom limb pain.
Aim - to investigate the effectiveness of mirror box therapy in the management of phantom limb pain.
sample - 32 year old man named Alan
he had a life saving surgery to remove his leg at the hip. he got extremely unwell immediately following the surgery and only got fully aware of the amputation after 5 weeks.
presenting symptoms,
at the beginning of the day the pain was mild as the day went on the pain worsened
Alan initially felt as if his phantom leg was shorter than his remaining leg
-he felt as if the was stretching backward with his toes pointing downwards
treatment - A 3 weeks mirror box treatment was used. the treatment involved leg movements. the remaining leg was put in a box with a mirror right in the middle. at an angle Alan looked at the mirror and saw a reflection that felt to him that the missing leg was there.
he was asked to perform 10 different exercises and repeat each exercise 10 times with the remaining leg.
the exercises included;
straightening and bending the leg
pointing the foot up and down
clenching and unclenching the toes
moving the foot in circles
-After a few days alan could carry out the exercises alone , and eventually without the mirror.
-the exercises began twice a day and increased to 4 times a day
Results;
What are the two theories of pain
Specificity theory
Gate control theory
Describe the specificity theory
This is the idea that pain just like other sensations such as hearing and visual has a separate sensory system
Specialized pain receptors respond to stimuli by picking up pain signals and sending these signals to the brain for perception
For example if you touch something hot the neurons below the skin will transmit these signals to the brain and the brain will perceive pain. The brain then sends back a message to the muscles in your hand telling them to move your hand away from the source of pain.
Describe the gate control theory
This is a more holistic approach to looking at the experience of pain. This is because it looks at the psychological determinants of pain
- The word ‘gate’ comes from a psychological idea that there exists a psychological gate in the
spinal chord at a specific region called the dorsal horn.
- this psychological gate contains different types of fibers. There are two types which determine whether the signals will reach the brain or not.
- Large diameter neurons
- Small diameter neurons
These are located in the dorsal horn. When the large diameter neurons are activated the gate closes.
The pain signals cannot cross the spinal cord to the brain. However when the small diameter neurons are activated the psychological gate opens and the brain perceives pain.
Activities that activate the small diameter fibers :
Anxiety, depression etc when you’re worried about what would happen as a consequence etc
An activity that activates the large diameter neuron :
A) Painkillers are meant to ractivate, the LDN
at the spinal cord so that the individual cannot percieve pain anymore
b) An array of activities activate the LDN e.g rubbing your elbow after it gets hit on the table
- Evidence for the gating mechanism of pain: Epidurals- given through the spinal cord. The goal is to close the psychological gates, so that the woman does not perceive pain.
- Activities that open the gates:
1. Focusing on the pain: you are consciously aware of the pain. The top down approach to pain perception is that you are telling your brain to process pain. (??). To manage this, you will need distraction.l
2. Inappropriate activity level: putting pressure on the pain.
- Activities that close the gates:
1. Relaxation:
2. Distraction
3. Positive emotions, rest etc.
Reductionist
- The specificity theory of pain is reductionist bcoz it focuses on the biological aspect of pain. It doesn’t tell us how psychological factors such as worries, anxieties can lead to persistence of pain.
Holistic
- Gate control is holistic bcoz it looks at how psychological factors are implicated in the EXP of pain. It tells us about the dentist systems that transmit pain can only be successful if the psychological gates open or closes. It looks at both the psychological and biological factors to pain perception.
Nomothetic
- Both the specifics and gate control theory are nomothetic as they are scientific ways of understanding pain perception. For instance, data from specificity theory and gate control is obtained from a section of the population and was then generalized to the external population not withstanding the uniqueness of pain to individuals.
Idiographic
- The theories ought to take into consideration the uniqueness of individuals’ context with pain. Eg: some ppl worry more than others, some have higher tolerance levels to pain.
Useful application to everyday life.
- The gate control theory has useful applications. Epidurals for labour pain and ethicurals largely explain the existence of the psychological gates at the dorsal horn.
- The specificity also does. Nerve ablation therapy, this is when the neurons that transmit pain signals to the brain are severed for those going through very intense pain.
What are the two types of measures of pain
Subjective measures
Behavioral/observational measures
How can a clinical interview be used as a subjective measure of pain
This involves asking the patient a range of open questions and will focus on getting an understanding of the patient’s experience of their pain
-the interviews are done at the doctors clinic
The data obtained from the interview about the patients pain in terms of the quality/intensity
All the subjective self reports given by the patient
The patients describe how they feel during the interview which helps the doctors rate the quality/intensity of the pain
Evaluation of clinical interviews
strengths ;
- allows clinician to get good understanding of the patient
-
Weaknesses
-Validity problems as people may overstate their pain or understate it
-Subjective because pain is subjective
-Difficult to measure pain in children because children are not able to express themselves
How can psychometrics and rating scales be used as a subjective measure of pain
These at questionnaires given to patients to measure their pain
- These psychometric s contains certain adjectives that the patient circles
- The task is for patient to circle adjectives in various categories that best describes your pain at the time you are completing the questionnaire.
McGill Pain Questionnaire:
- Contains 78 adjectives that describe pain.
- It Covers:
1. Pain descriptors
2. Affective categories
3. Evaluation category of pain: words such as annoying, troublesome, unbearable.
4. Miscellaneous category: includes words such as spreading, numb
- Patients are asked to list any of the activities that they think would increase or decrease their pain. Eating, heat, cold, rest etc. so that the doctor gets an idea about how the patients tries to measure pain on their own.
- Patients are asked to circle an adjective in each of the four categories on how they are feeling at the time of taking the questionnaires
What are the behavioural/observational measures of pain
- the clinician is able to detect any changes of behavior so that they are able to rate the patient’s pain. Ie: when a person groans, their posture etc
UAB;
It’s a scale consisting of ten target behaviors and the person observing the patient (someone who lives with the patient ) records details about each of the target behaviors over a period of time.
-For each of the target behavior the observer reports on the severity , frequency or intensity of each behavior everyday
Each behavior is assigned either 0, 1/2 , or 1 mark and a total score is calculated out of a total of 10
- A higher score reflects a more marked pain associated behavior and a greater level of impairment
Visual rating scale
it’s used to measure pain on a continuum from no pain to an extreme account of pain.
-Patients rate their pain from 0-100
-some of the visual analog scales for children who may struggle with the ordinary rating scale
they have different facial expressions rating from 0-100 etc
What are the biological treatments for pain
What are the psychological treatments for pain
