Pain Flashcards
Limitations of the bio-medical theory of pain?
Some report pain after tissue damage heals
Some report pain where there is no physical damage
Some report little plain despite severe injuries
Some amputees experience phantom limb pain
Placebo effect
Variation in pain reports from people with similar injuries
What is the biomedical model of pain?
Physical damage is the only cause of ‘real’ pain and explains the full extent of the pain experience.
The only role of psychology is an aftermath of pain eg anxiety, fear, depression
WHO definition of pain?
An unpleasant sensory and emotional experience which is associated with actual/potential tissue damage or is described in terms of such damage
What is acute pain?
Short term
Attracts our attention
Lasts for as long as there is healing
There is action to take eg rest, see doctor, medication
What is chronic pain?
Pain for >12 weeks
Long term, debilitating
Pain is not useful, does not indicate on-going tissue damage
Prolonged rest and medication is not helpful unlike acute pain
Arises from a variety of conditions/diseases or can have no known cause
How is pain assessed?
Consider self-report Assess behaviour Psychophysiological measures Effect of pain on other areas of life eg mood Clinical assessment is important
What is the gate control theory of pain?
Pain is experienced through complex pathways between the brain and damage/disease source along nerve fibres
Messages pass through two neural relays/gates in the spine
The extent to which the gates are opened or closed affects the number of pain messages that are received
What psychological factors affect how open or closed the gate is?
Thoughts, beliefs, expectations, interpretations, fear, anxiety
What physiological events can affect how open or closed the gate is?
Physical stimuli, tissue damage, nerve messages, medication
What can close the gate?
Medication Counter stimulation Exercise Relaxation Distraction Positive emotions and beliefs
What can open the gate?
Injury Over/under activity Sensitivity of nervous system Focusing on pain expectation Negative emotions and beliefs Minimal involvement in life
How can psychological factors affect the experience of pain?
Operant conditioning Anxiety Fear Secondary gains Pain behaviour Catastrophising Attention Self-efficacy Meaning Classical conditioning
Limitations of the gate control theory of pain?
No physical structure has been identified
Assumption that there is still organic basis of pain
Allows that physical and psychological processes interact but still sees them as separate
Advantage of the gate control theory?
Help to explain how people experience of pain in practice
Aims of pain management programmes? (PMP)
Improve physical, psychological, emotional and social dimensions of quality of life in people with persistent pain
Principles of PMPs?
Use a multidisciplinary team working according to behavioural and cognitive processes
Problems formulated in terms of effects on physical and psychological health (not as disease/damage in biomedical terms or deficits in patient’s mental health/personality)
About patients taking co tell of pain, not about a cure
What do PMPs do for the patient?
Reinforce acceptance of chronic pain Improve fitness, mobility and posture Address fear of consequences of movement Develop ways to cope with stress, anxiety, etc. Improve ability to relax Facilitate appropriate medication use Improve communication skills Reduce use of unhelpful aids and equipment
PMP programme topics?
Managing thoughts and feelings - CBT and mindfulness
Active, but pacing self
Goal setting
Relaxation
How is mindfulness for pain management done?
Focus on present, not past or future
Accept negative thoughts as just thoughts, don’t fight them
Keep returning to present moment
Act with kindness
Can be used to manage stress, which in turn helps with pain
Other important aspects of PMP (patient’s view)?
Being believed that pain is real
Being part of a group that can share experiences of effect of pain on their lives
Social compassion theory - people often judge others as worse off
Which patients are often referred to PMPs?
Had on average 5 years of pain
Exhausted all other medical methods of pain relief
40% have had an accident, 20% unknown cause
Often angry, depressed, anxious, disabled, unemployed, family difficulties, withdrawn from usual social activities due to mood, finances and pain
Inclusion/exclusion criteria for PMPs?
Communication/language Mental health Cognitive ability Willingness to be in a group environment Level of physical functioning
Social or psychological obstacles may need addressing first
Issues with PMPs?
Not all patients can work in groups
How long can people maintain their improved ability to manage pain?
Practicalities of follow-up
PMP approach ideally belongs at the beginning of an episode of pain
Specific training is needed to ensure consistency
