Pain Flashcards
Biomedical view of pain
Pain is a response to external factors
Link is direct causal and automatic
Source of pain via nerve impulses to the brain
Biomedical model is it and early or late view
Early
What is the link between tissue damage and lain
Tissue damage causes the sensation of pain
Are and psychological processes takes into account
No
What is said to cause pain
Direct result of tissue damage
Pain is automatic as a result of the damage - person is passive
There is no role for interpretation or appraisal
If patients have little tissue damage but lots of Pain what are they doing
Making a fuss
Patients lots of tissue damage but little pain
Brave
When no physical cause found
All in the patient mind - psychogenic
Clear organic element
Real pain - organic
Problems with old views like the biomedical model
Patients with same level of tissue damage report different levels of pain why? Labour some need epidural some do not
Phantom limb pain -how
Most common form of pain is headache yet there is no injury or tissue damage
How do athletes continue with severe pain
Gross injurys occur without much pain
- severely wounded WW2 soldiers complained of little pain why?
Is pain influenced by interpretations and perceptions
Gate control theory of pain
Pain is a multi dimensional process that is mediated by other factors and is controlled by a gate at the spinal cord level
Input to the gate - peripheral nerve fibres input sends info about pain pressure and Heat to the gate
Descending central influences from the brain - brain sends info about psychological state of the individual to the gate - past experiences fear, confidence
Large and small fibres - are part of the the physiological input to pain perception
Output from the gate - gate integrates the information from sources
Sends to an action system, resulting in a perception of pain
What does closing the gate do
Reduces the perception of pain
What factors close the gate
Physical - medication, stimulation of the large fibres which are abeta
Emotional - happiness, relaxation
Behavioural - intense distraction
What factors open the gate
Physical - activation of small fibres - c fibres
Emotional - worry anxiety
Behavioural- boredom, focusing on pain
Chronic pain
Mild short lived pain typically causes few problems
Long lasting, intensive pain is a different matter - 6 months often used as a cut off
Often reliant on large amounts of medication
What other interventions may help
Managing chronic pain - psychological interventions
Clinical trials have shows psychological intervention to give significant improvements
- do not undermine drug approaches and are not a sign of weakness - reassure patient you believe them
Interventions may include a combination of treatment
Pain clinics - are likely to be multidisciplinary - pharmacology, clinician, physiotherapy, clinical psychologist
Interventions - chronic pain
Thoughts - cognitive - distraction - imagery - hypnosis - counselling --> Responses - behavioural - relaxation exercises - biofeedback - physical activity/exercise
How do we measure pain
Not easy cos subjective - we cannot feel their pain - can make doctors understand period cramps and child birth Rely on indirect measures 2 frequent measures - visual analogue scale - McGill pain questionnaire Diaries Pain behaviours via observation
Visual analogue scale
Frequently used usually 10 cm line
VAS for pain
VAS for treatment effects
Not numbers but where on the line would you put your pain without treatment and with treatment
Implications of VaS in practice
Easily administered
Use kids over 5
Can be used to measure severity or improvement
Sensitive to small changes
McGill pain questionnaire how is is better than vas
Vas only measures intensity - what's missing Quality of sensation - feel like Emotional impact - make me feel like MPQ - examine different components of pain experience (questions and body map) Sensory Affective Evaluative
Pain diaries
Time of pain
What doing when get pain
Look for links
Pain diary pros
Help doctor understand causes
Provide detailed daily picture
Help patient to see changes in pain and impact of behaviours on pain
Pain diary cons
Permanent record of pain - demoralising
Patients can be lazy/forget so infor is incomplete
Inconvenient - just give me pain killers
Measuring pain behaviour
Patients can be asked to perform simple tasks to assess extent of pain
Can record and often patient expresses pain
More useful with chronic than with acute
E.g of pain behaviours
Groaning
Grimacing
Rubbing
Stopping to rest
Holding part of body
Determined amount of pain
Understanding children’s pain
Preliterate and or limited vocab Likely to rely on observations What is being measured is it pain or is it distress Questionnaires might work Visual accounts - teddy
Use with kids
Body maps where is pain in ginger bread man
On dolly
Scale use with kid
Wong baker faces
Doesn’t hurt happy
Hurts more than can imagine super sad face
Placebos and pain reduction
Inert substances that cause pain relief
Patients given substances /experiences which they think will help the pain
Approx 30-40% of patients benefit from placebos - why?
- expectations can change perceptions of pain
- explain the role of complementary therapies
Implications for practice
Always believe the patient
Measure pain as it is experienced - pain recall may be unreliable
Ask patients to keep a pain diary that you review with them as or other HCP
Try to measure more than simply pain intensity - be patient centred
Think of pain as an experience not a sensation
