Pain

Question 1

Pain

Answer 1

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 2

Acute organic pain

Answer 2

pain that lasts no more than three months, until the underlying cause has healed
Onset: sudden
Quality: sharp
Purpose: to warn of tissue damage
Possible causes: cuts, minor burns

Question 3

Chronic organic pain:

Answer 3

pain that is more persistent than acute pain, lasting for three months or more
Onset: gradual
Physical effects: muscle tension, fatigue
Emotional effects: depression, anxiety
Examples: chronic back pain
Possible causes: physical injury that does not heal

Question 4

Psychogenic pain

Answer 4

a physical pain caused, increased or prolonged by mental, emotional or behavioural factors
Examples: headache, back pain, stomach pain

Question 5

Phantom limb pain

Answer 5

type of psychogenic pain - this refers to the ongoing sensations that seem to come from a part of a limb that is no longer there e.g. an amputee experiencing pain in their amputated limb

Question 6

Specificity theory

Answer 6

Traditional pain theory originating from Descartes (1644)
We have separate physiological sensory system for pain.
A = a noxious event, such as putting you foot in a fire
B = a pain receptor is stimulated by the noxious event
C = the pain signal travels to the pain centre, where it is perceived as pain

Question 7

Ways to measure pain

Answer 7

1. MPQ
2. VAS
3. Behavioural / Observational Measures - UAB
4. self report
5. Pain Measures for Children - PPQ
6. Pain Measures for Children - Wong-Baker Scale

Question 8

Self-report measure

Answer 8

HISTORY: when did the pain start? How has it progressed?
EMOTIONAL adjustment: how did they feel before the pain started? How do they feel now that they are in pain?
LIFESYYLE: do they exercise? What is their diet like? Has their lifestyle had an impact on the pain, or has the pain impacted on their lifestyle?
PAIN MANAGEMENT: how do they typically manage or cope with the pain
Social context: are there specific triggers for the pain? How do family, friends respond

Question 9

What is the MPQ?

Answer 9

4 parts
Where is your pain? marks location on diagram of body
What does your pain feel like? choose from 20 groups of descriptive words
How does your pain change? things relieve and increase pain
How strong is your pain? rating scale 1-5

Question 10

Visual Analogue Scales

Answer 10

A VAS requires the patient to point to or draw a line at any point of a scale from “no pain” at one end to “worst possible pain” at the other

Question 11

Behavioural / Observational Measures - UAB

Answer 11

chronic pain over time using structured observation
The patient is observed performing set activities
A trained health professional observes and rates each of 10 behaviours

Question 12

Pain Measures for Children - PPQ

Answer 12

Includes aspects from MPQ, such as a picture of a person, for locating pain and use of descriptive words, although these have presented in a more child friendly format

Also includes a visual rating scale with faces

Question 13

Pain measures for children-Wong-Baker Scale

Answer 13

Scale shows a series of faces with expressions ranging from 0 (happy face, no hurt) to 10 (crying face, hurts worst).

Question 14

Validity and reliability of pain scale

Answer 14

• inter-rater reliability
• concurrent validity
• construct validity

Question 15

What is concurrent validity?

Answer 15

compare to an established scale, statistical comparison

two psychometric test (measuring the same thing in the same way) to be checked against each other

Question 16

What is construct validity?

Answer 16

concept of interest (pain) is tested by comparison with external variables related to the construct.

e.g. 25 children were observed before and three times after analgesic administration

Question 17

Psychometrics-strengths

Answer 17

REDUCTIONIST - focus on specific quantifying variables, allows statistical analysis

RELIABLE - standardised can be retested, e.g. VAS

VALID - carefully tested to ensure construct validity. They can be compared to similar measures of the same construct to see if they are detecting appropriate characteristics. e.g. MPQ and UAB

Question 18

Psychometrics - weaknesses

Answer 18

They do not provide qualitative data, e.g. MPQ does not provide deeper insight into the history of the patient’s pain, and how or why they are managing their pain.This means they may only provide superficial understanding of the psychological construct being measured - how much rather than how or why.

As psychometric measures are reductionist, because they may only measure one or a limited range of variables, they may miss other important variables that should be considered. E.g. the VAS only measures severity, but does not give any indication of the location of pain, which is important for diagnosis.

Question 19

Types and theories of pain

Answer 19

P1 - definitions of pain: acute+chronic organic pain, psychogenic pain (phantom limb pain)
P2 - theories of pain: specificity theory (Descartes), gate control theory (Melzack)

Question 20

Measuring pain

Answer 20

P1 - self-report
P2 - psychometric measures (MPQ,VAS )
P3 - behavioural/observational measures (UAB)
P4 - pain measures for children (PPQ, Wong-Baker scale)

Question 21

Managing and controlling pain

Answer 21

P1 - medical techniques (biochemical)
P2 - psychological techniques : cognitive strategies (attention diversion, non-pain imagery, cognitive redefinition)
P3 - alternative techniques (acupuncture, TENS)

Question 22

What is the Gate control theory

Answer 22

• Spinal cord contains neurological gate: blocks/ allows pain to continue to brain
• Both physio,psychological factors can open/close the gate
  Opened: pain signals transmitted through small nerve fibres or factors eg. depression/anxiety
  Closed: signals from large nerve fibres or cognitive distraction