Pain Flashcards
Where is pain produced?
In the brain!
What is acute pain?
Pain that persists for days to 3 months
What is chronic pain?
Pain that persists for a minimum of 3 months. Could last after injury has healed due to sensitive nerve endings.
How many people suffer from chronic pain?
1 in 5. 1 in 3 over 65 years
What explains the ongoing nature of chronic pain after the injury has healed?
Nerves remain sensitive and deliver ongoing pain despite healing.
How are sensitive nerves associated with chronic pain addressed?
Re-training brain/nervous system. Meds can help yet limited (short-term option). Address thoughts/emotions and impact on the nervous system.
Reduction from what can calm the nervous system and reduce pain sensed?
Stress
What can be increased to reduce pain?
Emotional well-being
Apart from emotions/stress, what other lifestyle factor can influence the sensation of pain?
Diet, smoking, alcohol, drugs
What psychological factors can influence the sensation of pain?
Individual story around pain - meaning attached to pain. Factors present before the pain started - stress, work pressures, relationship issues, self-efficacy related to pain management etc
What lifestyle factors can help manage pain?
Moderate exercise (walking), eating veggies, gardening
What is pain?
Sensations and emotions produced by the brain in response to injury in the body. Uncomfortable sensation.
What are the physical responses to pain?
Tight muscles, compromised mobility, reduced appetite, reduced energy.
What are the emotional responses to pain?
Depression, anger, anxiety/fear
Cognitive function compromised by pain. Could reduce emotional regulation, increase intensity of emotional expression.
What are typical pain-management strategies?
- medication (reduce dose over time)
- surgery - get 2nd opinion
- Modify lifestyle - exercise, diet, drugs, alcohol, smoking (help nerve sensitivity)
- Evaluate/modify life circumstances (reduce stress, psych support)
- acupuncture/massage
- Connecting with family & friends
- CBT
How could a client be impacted by pain in the healthcare setting?
Trouble concentrating
Trouble with their memory/remembering information
Lowered adherence
Lowered mood/anxiety
What does noiceptive mean?
Pain experienced from the site of injury - most common form of pain.
Who developed the Gate Control Theory of Pain?
Ronald Melzack and Patrick Wall
What is the Gate Control Theory of Pain?
Neurological mechanism of pain
What percentage of aged care residents experience pain?
80%.
Identify and describe the main components that make up the Neuromatrix Theory:
Inputs come into the neuromatrix from different areas of the brain: cognitive-related brain areas, sensory signals, emotional centres from brain. This data goes into the Neuromatric and is processed (around and around the neuromatrix). Outputs are then produced and sent to brain areas that respond to the processed information: pain perception - sensory, affective and cognitive brain areas, action areas (voluntary/involuntary muscle responses) and stress regulation centres, releasing stress hormones and endorphins (reduce pain experienced).
Identify and describe the main components that make up the Neuromatrix Theory:
Inputs come into the neuromatrix from different areas of the brain: cognitive-related brain areas, sensory signals, emotional centres from brain. This data goes into the Neuromatric and is processed (around and around the neuromatrix). Outputs are then produced and sent to brain areas that respond to the processed information: pain perception - sensory, affective and cognitive brain areas, action areas (voluntary/involuntary muscle responses) and stress regulation centres, releasing stress hormones and endorphins (reduce pain experienced).
List medications for acute pain:
- Opioids
- Ketamine
- Peripheral nerve blocks
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Paracetamol
- COX-2 inhibitors
- Alternative therapies: transcutaneous electrical
nerve stimulation (TENS), acupuncture, CBT, massage,
mobilisation
List medications for chronic pain:
- Drug options listed for acute pain
- Social management (family/friends)
- CBT
- Exercise
What are the three psychological dimensions of pain:
- Sensory/discriminative - location/quality of pain
- Cognitive - perception/evaluation of pain
- Emotional/affective - past emotional experiences associated with pain
What is the relationship of chronic pain and depression?
Bidirectional - depression can cause chronic pain and chronic pain can cause depression (30-40%)
What is the impact of chronic pain on cognition?
- Impacts long-term memory
- Selective attention/reduces concentration
- Impacts processing speed
- Impacts executive functioning (including emotional regulation)
Name some social behaviours that can act as reinforcers to pain:
- attention to pain from others
- approval from others
- sympathy from others
- social rewards
All can reinforce/perpetuate pain - reducing coping behaviours and increasing pain behaviours
In the human services setting, which factors does a practitioner need to be aware of in relation to pain and patient outcomes:
- Take a biopsychosocial approach
- Be aware 70% patients don’t adhere to advice
- Attention and memory reduce ability to absorb/retain advice/medical information
- Multidimensional approach required - depression can accompany chronic pain - be aware
- Pain demotivates people
- Be aware of patient locus of control and self-efficacy with pain
- Be aware of drugs/reward center in brain - tolerance/addiction
Describe the pain pathway in four stages:
- Nociceptors in skin, triggered by damage
- Peripheral nerves transport signal to spinal cord
- Neurons in CNS release neurotransmitters into synaptic gap between Peripheral NS and Central NS neurons. Signal crosses into spinal cord and is transferred to brain.
- Thalamus receives the signal and forwards it to either:
a) somatosensory cortex (sensation)
b) frontal cortex (thinking)
c) limbic system (emotions)
Brain sends out output signals and motor responses, cognitive, emotive, and stress hormone response ensues.
Describe the Gate Control mechanism (Melzak and Wall):
- Nociceptor in skin activated by injury
- Peripheral nerves transport signal to spinal cord
- On dorsal horn of spinal cord, substantial gelatinosa is where the gateway exists. It releases neurotransmitters into the synaptic gap. The type of neurotransmitter released impacts whether the signal from the Peripheral NS can cross into the spinal cord. This impacts whether pain is modified or not.
- Dorsal horn is the gate.
Name the different types of nerve fibres in the Peripheral nervous system:
- A-delta - large, myelinated fibres - fast signal - often first signal to reach the brain (sharp pain) - respond to touch/mechanical, thermal, strong/noxious - danger/damage
- C polymodal fibres - thinner, unmyelinated, slower transfer of signal - often dull pain - pain lasts longer
- A-beta - myelinated fibres, fast signal transfer, reach spinal cord second and can close pain at spinal cord so c fibre impulses are blocked and don’t go to brain. Tactile/gentle touch.
Can nerve signals be altered once they cross into the spinal cord?
Yes. They can be intensified and reduced or blocked.
Why would the brain shut down signals coming into the spinal cord?
If it has a lot of information to process, it will stop signals from entering the CNS, i.e. can keep playing team sport if hurt during the game.
Can you explain referred pain?
Yes, nerves at area of body with injury shares intersect at spine with nerves from other parts of the body. Pain signals can go out to other parts of the body.
Which factors can describe why pain is experienced differently between individuals?
- Psychological/emotional state at time of injury
- History with pain
- Beliefs / expectations around pain
- Upbringing
- Age / gender / social & cultural influences
What is nociceptive pain?
Pain from acute injury - cut, burn, fracture
Pain can vary - sharp, aching, thobing
What is neuropathic pain?
Nerve pain - burning, tingling, shooting, electric, sensitive to hot/cold, light
What is psychogenic pain?
Pain influenced by psychological state
What can happen at the neuron end that can impact the symptoms of chronic pain?
- Pain receptors triggered easily
- Alterations where neurons intersect
- Brain/spinal cord blocked signals
- Inflammation can activate pain receptors that aren’t generally active
- Damaged neurons grow back but lack full functioning
Which two pain relieving/blocking neurotransmitters are produced by the brain?
Seratonin & endorphines (opioids - morphine-like substance)
Endorphines released at dorsal horn can block nerve signals from coming into spinal cord.
What is pain about?
Survival - protective mechanism or warning indicator injury or disease
Name three gains of pain to sufferer and their supporters:
- Primary - intrapersonal - gain in people helping/supporting
- Secondary - interpersonal - people offer sympathy
- Tertiary - others feel pleasure from supporting
What are the 5 x D’s relating to pain response/help from others
- Dramatisation of symptoms
- Disuse - inactivity/muscles
- Drug misuse
- Dependency on others
- Disability through inactivity
How does attention affect pain experienced?
Attention increases pain sensation.
Distraction reduces pain sensation.
How does mood affect thoughts and therefore the experience of pain?
Mood affects the pain level experienced. Thoughts can look to source of pain, beliefs of ability to manage pain, beliefs re how controlled the pain is, expectations relating to managing the pain.
What is the belief in a medication’s ability to help pain/make a difference to health?
Placebo effect
Nerve fibres - blocked signal - explain how A beta nerve fibres can reduce pain experienced:
Injury occurs.
A delta delivers signal to brain, quickly - sharp pain felt.
C polymodal slowly starts transmitting signal.
We rub injury.
A beta transfers touch signal to spinal cord. Beats C polymodal. Can close gate at Dorsal horn.
If all signals go through gate then:
A delta and beta signals go to Thalamus - redirected accordingly.
C signals go to limbic system/hypothalamus/autonomic NS - rear response/motor neurons activated/physical movement from danger.
Which neurotransmitters released from brain/substantia genaltinia close the gate to pain?
Endorphins, other opioid-like chemicals
Why does worry/anxiety open the gate and increase pain experience?
Reduces endorphins/opioid-like chemicals
List methods to reduce pain experienced (coping skills):
- Being in control of pain medication
- Distraction - reduces anxiety/reduces pain
- Relaxation - increases relaxation/reduces pain
- Hypnosis - increases relaxation/reduces pain
- TENS - stimulates A beta (touch) nerve fibres - competes with A delta (sharp pain)
- Behavioural interventions - remove pain reinforcers, analgesic meds given set times, train new behaviour - positive = reduced pain
- CBT
How does CBT help with pain management?
- Improves self-efficacy as normal lifestyle resumes - increases confidence
- Cognitions/emotions and behaviour change - better outcomes
What are goals of CBT?
- Help modify beliefs - from can’t cope to can cope - increase problem-solving
- Help understand connection thoughts-emotions-behaviour
- Help learn coping strategies - distraction, reduce distress, positive adaptive strategies
What are the two stages of CBT?
- Pinpoint unhelpful thoughts
* Reflect time of pain
* Discuss
* Identify unhelpful thoughts
* Patient to become aware of thoughts assoc with pain /mood (diary) - Begin changing thoughts - workshop more helpful thoughts with client.
