Pain

Question 1

In which groups is chronic pain more prevalent?

Answer 1

Older people

Low income households

Question 2

What is severe pain strongly linked with (69%)?

Answer 2

Depression and anxiety

Question 3

What is congenital analgesia?

Answer 3

Congenital analgesia to pain is a condition that inhibits the ability to perceive physical pain. (like the little girl on Gray’s anatomy)

Question 4

What is the definition of pain?

IASP, 1986

Answer 4

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

Question 5

What are the 5 aspects of pain as a concept?

Answer 5

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

Question 6

What is pain behaviour?

Answer 6

Facial expression
Complaint
Para-vocalisation ("ouch_
Rubbing/holding/guarding
Posture change
Reduced behavioural repertoire
Taking pain relief

Question 7

What is a way of rating pain/

Answer 7

Pain thermometer - 1-10
Visual analogue scales (mark on a line from no pain to extremely painful)
McGill pain questionnaire
Faces test (paediatric)

Question 8

What is the McGill pain questionnaire?

Answer 8

Descriptors: sensory (e.g. sharp), affective (e.g. tiring), evaluative, temporal (e.g. rhythmic).
Looks at body area affected.

Question 9

What is Descarte’s model of pain (the lay view)?

Answer 9

A rope attaches the area of pain to the brain

Sensory, reflex like experience

Question 10

What is the gate control theory of pain? (melzack and wall)

Answer 10

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

Question 11

What is bottom up processing?

Answer 11

Sensory driven

Processes that organise incoming information

Question 12

What is top down processing?

Answer 12

Driven by knowledge, experience and expectations

determines perception in ambiguous situations

Question 13

What is Transcutaneous Electrical Nerve Stimulation (TENS)?

Answer 13

Used for postoperative pain, osteoarthritis, chronic musculoskeletal pain

mild electric stimulation stimulates large nerve fibres - closes gate to stop chronic pain

Question 14

What are the advances of gate control theory?

Answer 14

Shows pain as a perception
Shows individual as active (in terms of changing pain)
Individual variability expected
Multiple causes of pain

Question 15

What are the problems with gate control theory?

Answer 15

Still just a model - no physical evidence of a gate

Assumes organic basis of pain

Question 16

What is phantom limb pain?

Answer 16

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

Question 17

What is virtual walking? Moseley, 2007

Answer 17

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

Question 18

Who did the virtual walking experiment ?

Answer 18

Moseley, 2007

Question 19

What are three ways to describe pain?

Answer 19

Pain threshold
Duration (phasic, acute, chronic)
Quality (superficial, deep, referred)

Question 20

What was the clarke & clarke experiment on Himalayan climbers 1990?

Answer 20

Measured pain in terms of motivated perception, tolerance, motivated tolerance

perception was the same but tolerance and motivated tolerance were much higher

Question 21

What is the stoical patient?

Answer 21

More compassionate care
Positive western cultural value (no pain, no gain)

Difference between cultures

Question 22

What is relative anaesthesia? (for coping with a cute pain)

Answer 22

Mild sedation using N2O or valium - does not reduce the intensity of pain but reduces unpleasantness

Question 23

How does preparation for surgery help with acute pain?

Answer 23

Information, relaxation techniques, importance of expectation and cognitive models
Helps RECOVERY - you have an accurate mental model of what the pain will be like

Question 24

How can behavioural techniques manage acute pain?

Answer 24

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

Question 25

What is the main issue with chronic pain?

Answer 25

Threatens identity - disrupts life, changed sense of body, pain relief becomes the primary goal of life

Question 26

Why is chronic pain a cycle?

Answer 26

Pain leads to anxiety, tension, sleeplessness, irritability which in turn leads to decreased pain tolerance, so you will feel more pain

Question 27

How can multidisciplinary clinics help with chronic pain?

Answer 27

Practical advice
physio
psychological intervention
Less reliance on medical controls
social and family support