Pain Flashcards
In which groups is chronic pain more prevalent?
Older people
Low income households
What is severe pain strongly linked with (69%)?
Depression and anxiety
What is congenital analgesia?
Congenital analgesia to pain is a condition that inhibits the ability to perceive physical pain. (like the little girl on Gray’s anatomy)
What is the definition of pain?
IASP, 1986
An unpleasant and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
OR
pain is what the patient says it is and exists when s/he says it does
What are the 5 aspects of pain as a concept?
Physiological - nocioception (sensory nervous system's response to certain harmful or potentially harmful stimuli) Sensory - quality, intensity Affective - unpleasantness Cognitive - expectations, mental models Behavioural - vocalising, posture
What is pain behaviour?
Facial expression
Complaint
Para-vocalisation ("ouch_
Rubbing/holding/guarding
Posture change
Reduced behavioural repertoire
Taking pain reliefWhat is a way of rating pain/
Pain thermometer - 1-10
Visual analogue scales (mark on a line from no pain to extremely painful)
McGill pain questionnaire
Faces test (paediatric)
What is the McGill pain questionnaire?
Descriptors: sensory (e.g. sharp), affective (e.g. tiring), evaluative, temporal (e.g. rhythmic).
Looks at body area affected.
What is Descarte’s model of pain (the lay view)?
A rope attaches the area of pain to the brain
Sensory, reflex like experience
What is the gate control theory of pain? (melzack and wall)
Specialised fibres (C fibres) in the skin are mediated through the spinal cord to the brain Specific to pain
Other fibres (A fibres) are sensitive to touch and vibration which closes a gate at the level of the spinal cord (so you rub your arm after you hit it)
When the gate is open = pain
When the gate is closed = pain reduces
What is bottom up processing?
Sensory driven
Processes that organise incoming information
What is top down processing?
Driven by knowledge, experience and expectations
determines perception in ambiguous situations
What is Transcutaneous Electrical Nerve Stimulation (TENS)?
Used for postoperative pain, osteoarthritis, chronic musculoskeletal pain
mild electric stimulation stimulates large nerve fibres - closes gate to stop chronic pain
What are the advances of gate control theory?
Shows pain as a perception
Shows individual as active (in terms of changing pain)
Individual variability expected
Multiple causes of pain
What are the problems with gate control theory?
Still just a model - no physical evidence of a gate
Assumes organic basis of pain
What is phantom limb pain?
Phantom sensations experience by almost all amputees
real, normal, same position
persists but vividness often diminishes
Pain is often stronger than other sensations, linked to changes in mood, behaviour, environment
What is virtual walking? Moseley, 2007
Paraplegic patients (who have phantom leg limb pain) are shown top half of mirror to see themselves, and bottom half of person walking
Areas of pain reduce dramatically
It addresses a motor output-sensory feedback mismatch
Who did the virtual walking experiment ?
Moseley, 2007
What are three ways to describe pain?
Pain threshold
Duration (phasic, acute, chronic)
Quality (superficial, deep, referred)
What was the clarke & clarke experiment on Himalayan climbers 1990?
Measured pain in terms of motivated perception, tolerance, motivated tolerance
perception was the same but tolerance and motivated tolerance were much higher
What is the stoical patient?
More compassionate care
Positive western cultural value (no pain, no gain)
Difference between cultures
What is relative anaesthesia? (for coping with a cute pain)
Mild sedation using N2O or valium - does not reduce the intensity of pain but reduces unpleasantness
How does preparation for surgery help with acute pain?
Information, relaxation techniques, importance of expectation and cognitive models
Helps RECOVERY - you have an accurate mental model of what the pain will be like
How can behavioural techniques manage acute pain?
If nurses respond to patients positively when they talk about feeling well, they will start to feel less pain
If nurses respond positively to patients when they talk about pain, they will be positively reinforced for pain talk and will feel more pain
What is the main issue with chronic pain?
Threatens identity - disrupts life, changed sense of body, pain relief becomes the primary goal of life
Why is chronic pain a cycle?
Pain leads to anxiety, tension, sleeplessness, irritability which in turn leads to decreased pain tolerance, so you will feel more pain
How can multidisciplinary clinics help with chronic pain?
Practical advice physio psychological intervention Less reliance on medical controls social and family support
