Pain

Question 1

Biomedical view of pain

Answer 1

Pain is a response to external factors
Link is direct causal and automatic
Source of pain via nerve impulses to the brain

Question 2

Biomedical model is it and early or late view

Answer 2

Early

Question 3

What is the link between tissue damage and lain

Answer 3

Tissue damage causes the sensation of pain

Question 4

Are and psychological processes takes into account

Answer 4

No

Question 5

What is said to cause pain

Answer 5

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

Question 6

If patients have little tissue damage but lots of Pain what are they doing

Answer 6

Making a fuss

Question 7

Patients lots of tissue damage but little pain

Answer 7

Brave

Question 8

When no physical cause found

Answer 8

All in the patient mind - psychogenic

Question 9

Clear organic element

Answer 9

Real pain - organic

Question 10

Problems with old views like the biomedical model

Answer 10

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

Question 11

Gate control theory of pain

Answer 11

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

Question 12

What does closing the gate do

Answer 12

Reduces the perception of pain

Question 13

What factors close the gate

Answer 13

Physical - medication, stimulation of the large fibres which are abeta
Emotional - happiness, relaxation
Behavioural - intense distraction

Question 14

What factors open the gate

Answer 14

Physical - activation of small fibres - c fibres
Emotional - worry anxiety
Behavioural- boredom, focusing on pain

Question 15

Chronic pain

Answer 15

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

Question 16

Managing chronic pain - psychological interventions

Answer 16

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

Question 17

Interventions - chronic pain

Answer 17

Thoughts - cognitive 
- distraction 
- imagery
- hypnosis
- counselling
-->
Responses 
- behavioural 
- relaxation exercises 
- biofeedback
- physical activity/exercise

Question 18

How do we measure pain

Answer 18

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

Question 19

Visual analogue scale

Answer 19

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

Question 20

Implications of VaS in practice

Answer 20

Easily administered
Use kids over 5
Can be used to measure severity or improvement
Sensitive to small changes

Question 21

McGill pain questionnaire how is is better than vas

Answer 21

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

Question 22

Pain diaries

Answer 22

Time of pain
What doing when get pain
Look for links

Question 23

Pain diary pros

Answer 23

Help doctor understand causes
Provide detailed daily picture
Help patient to see changes in pain and impact of behaviours on pain

Question 24

Pain diary cons

Answer 24

Permanent record of pain - demoralising
Patients can be lazy/forget so infor is incomplete
Inconvenient - just give me pain killers

Question 25

Measuring pain behaviour

Answer 25

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

Question 26

Understanding children’s pain

Answer 26

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

Question 27

Use with kids

Answer 27

Body maps where is pain in ginger bread man

On dolly

Question 28

Scale use with kid

Answer 28

Wong baker faces
Doesn’t hurt happy
Hurts more than can imagine super sad face

Question 29

Placebos and pain reduction

Answer 29

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

Question 30

Implications for practice

Answer 30

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