Pain

Question 0

Limitations of the bio-medical theory of pain?

Answer 0

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

Question 1

What is the biomedical model of pain?

Answer 1

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

Question 2

WHO definition of pain?

Answer 2

An unpleasant sensory and emotional experience which is associated with actual/potential tissue damage or is described in terms of such damage

Question 3

What is acute pain?

Answer 3

Short term
Attracts our attention
Lasts for as long as there is healing
There is action to take eg rest, see doctor, medication

Question 4

What is chronic pain?

Answer 4

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

Question 5

How is pain assessed?

Answer 5

Consider self-report
Assess behaviour
Psychophysiological measures
Effect of pain on other areas of life eg mood
Clinical assessment is important

Question 6

What is the gate control theory of pain?

Answer 6

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

Question 7

What psychological factors affect how open or closed the gate is?

Answer 7

Thoughts, beliefs, expectations, interpretations, fear, anxiety

Question 8

What physiological events can affect how open or closed the gate is?

Answer 8

Physical stimuli, tissue damage, nerve messages, medication

Question 9

What can close the gate?

Answer 9

Medication
Counter stimulation
Exercise
Relaxation
Distraction
Positive emotions and beliefs

Question 10

What can open the gate?

Answer 10

Injury
Over/under activity
Sensitivity of nervous system
Focusing on pain expectation
Negative emotions and beliefs
Minimal involvement in life

Question 11

How can psychological factors affect the experience of pain?

Answer 11

Operant conditioning
Anxiety
Fear
Secondary gains
Pain behaviour
Catastrophising
Attention
Self-efficacy
Meaning
Classical conditioning

Question 12

Limitations of the gate control theory of pain?

Answer 12

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

Question 13

Advantage of the gate control theory?

Answer 13

Help to explain how people experience of pain in practice

Question 14

Aims of pain management programmes? (PMP)

Answer 14

Improve physical, psychological, emotional and social dimensions of quality of life in people with persistent pain

Question 15

Principles of PMPs?

Answer 15

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

Question 16

What do PMPs do for the patient?

Answer 16

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

Question 17

PMP programme topics?

Answer 17

Managing thoughts and feelings - CBT and mindfulness
Active, but pacing self
Goal setting
Relaxation

Question 18

How is mindfulness for pain management done?

Answer 18

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

Question 19

Other important aspects of PMP (patient’s view)?

Answer 19

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

Question 20

Which patients are often referred to PMPs?

Answer 20

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

Question 21

Inclusion/exclusion criteria for PMPs?

Answer 21

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

Question 22

Issues with PMPs?

Answer 22

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