Pain Flashcards
Pain
an unpleasant sensory and emotional experience associated with actual or potential tissue damage
Acute organic pain
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
Chronic organic pain:
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
Psychogenic pain
a physical pain caused, increased or prolonged by mental, emotional or behavioural factors
Examples: headache, back pain, stomach pain
Phantom limb pain
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
Specificity theory
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
Ways to measure pain
- MPQ
- VAS
- Behavioural / Observational Measures - UAB
- self report
- Pain Measures for Children - PPQ
- Pain Measures for Children - Wong-Baker Scale
Self-report measure
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
What is the MPQ?
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
Visual Analogue Scales
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
Behavioural / Observational Measures - UAB
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
Pain Measures for Children - PPQ
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
Pain measures for children-Wong-Baker Scale
Scale shows a series of faces with expressions ranging from 0 (happy face, no hurt) to 10 (crying face, hurts worst).
Validity and reliability of pain scale
- inter-rater reliability
- concurrent validity
- construct validity
What is concurrent validity?
compare to an established scale, statistical comparison
two psychometric test (measuring the same thing in the same way) to be checked against each other
What is construct validity?
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
Psychometrics-strengths
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
Psychometrics - weaknesses
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.
Types and theories of pain
P1 - definitions of pain: acute+chronic organic pain, psychogenic pain (phantom limb pain)
P2 - theories of pain: specificity theory (Descartes), gate control theory (Melzack)
Measuring pain
P1 - self-report
P2 - psychometric measures (MPQ,VAS )
P3 - behavioural/observational measures (UAB)
P4 - pain measures for children (PPQ, Wong-Baker scale)
Managing and controlling pain
P1 - medical techniques (biochemical)
P2 - psychological techniques : cognitive strategies (attention diversion, non-pain imagery, cognitive redefinition)
P3 - alternative techniques (acupuncture, TENS)
What is the Gate control theory
- 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
