Pain and Pain Management Flashcards
What are 2 reasons pain is necessary?
- Protects an individual from harm
2. Helps healing
Name 4 types of pain
- Neuroplastic
- Neuropathic
- Inflammatory
- Nociceptive
What is neuroplatic pain?
Nervous system sensitisation pain
What is neuropathic pain?
Nerve injury pain
What is inflammatory pain?
Tissue injury pain
What is nociceptive pain?
Early warning of pain
Name 2 theories of pain
- Gate Control Theory (Melzack and Wall, 1965)
2. Neuromatrix Theory (Melzack, 2001)
Describe the gate control theory of pain
- Spinal central sensitisation and CNS plasticity
- Pain is processed in integrated matrix throughout neuroaxis
- Pain controlled by gate at spinal cord and brain by interference with perception of pain
Describe the neuromatrix theory of pain
- Pain is multidimensional experience produced by the “body-self neuromatrix” in the brain
- May be set of by sensory inputs or independent of them
- Useful in understanding chronic pain
- Neuromatrix is genetically determined by also modified by sensory experienced
Describe the gate in the gate control theory of pain
- Neural gate through which pain signals pass
- Gate can be opened or closed in response to pain
- Gate responds to nerve signals from site, brain and peripheral neural activity
What are nociceptors?
Specialized receptors in skin and internal organs sensitive to painful stimuli
What is nociception?
Response of the nervous system to painful stimuli
What size are nociceptive fibres?
Small
What is the main advantageous evolution of nociceptive pain reception?
- The system can block pain from an injury so delay onset when it is advantageous e.g. attack / accident
- Cognitive mechanisms can inhibit reflex loop
What are 3 features of the psychology of the gate control theory of pain?
- Pain is perception and experience rather than simple physical sensation
- Role of the individual is reflected in the degree of pain experienced
- The individual does not passively respond to painful stimuli but interprets and appraises stimuli
Name 2 physical conditions which open the neural gate
- Extent of the injury
2. Inappropriate activity levels
Name 2 physical conditions which close the neural gate
- Medication
2. Counter-stimulation e.g. massage
Name 3 emotional conditions which open the neural gate
- Anxiety
- Tension
- Depression
Name 3 emotional conditions which close the neural gate
- Positive emotions
- Relaxation
- Rest
Name 2 mental conditions which open the neural gate
- Focusing on pain
2. Boredom
Name 2 mental conditions which close the neural gate
- Intense concentration / distraction
2. Involvement in life activities
Name 3 signals which affect the neural gate’s ability to open or close
- Nociceptor activity opens gate
- Large sensory nerves cause gate to be closed
- Messages from the brain
What 4 variables can affect a person’s perception of pain?
- Genetic
- Environmental
- Psychological
- Cognitive
What is the difference between psychological and cognitive variables?
Emotion is a psychological variable whereas attention, beliefs and expectations are cognitive variables
How can pain expectations influence pain felt?
Pain is influenced by expectations of both pain intensity of stimuli and effect of treatments
What is the definition of pain?
Unpleasant sensory and emotional experience associated with actual or potential tissue damage or describes in terms of such damage
What are 3 types of pain, classified by their duration?
- Acute (short term)
- Recurrent / Intermittent (comes and goes)
- Persistent / Chronic (long term)
What are 3 characteristics of acute pain?
- Results from disease, inflammation or injury to tissues
- Comes on suddenly and may be accompanied by anxiety or emotional distress
- Usually diagnosed and treated, and self-limiting
What are 4 characteristics of chronic pain?
- Persists over a longer period of time than acute pain
- Can be made worse by environmental and psychological factors
- Often resistant to medical treatments
- Can cause severe problems for patients
What are 4 new problems that can be caused by chronic pain?
- Change of posture
- Reduced mobility
- Anxiety / depression
- Unresolved pain re-wires brain causing more pain
What is the alternative to pain being immeasurable?
- Use patient’s own description
- Word definitions e.g. sharp / dull may give best clues to cause
- Pain history
- Observational skills
What are 5 parts of a pain history?
- Site, quality and radiation
- Factors aggravating / relieving pain
- Frequency of pain throughout the day
- Impact of pain on function / mood
- Patient’s understanding of pain
What is the pain stress cycle?
- An event is associated with pain
- Perception of pain creates anxiety
- Anxiety increases actual pain experience
- Pain experience increases future anxiety
- Higher anxiety increases pain experience further
Describe pain hyper vigilance
- People with vigilant tendencies tend to experience more pain
- Inability to disengage from pain experience amplifies intensity
- Focusing on pain, pain levels will get worse
- Distracting someone’s attention away from pain is difficult
Name 5 things which experience of pain depends on
- Context
- Attention
- Anxiety
- Learned pain
- Expectations
What are 5 types of dental pain?
- Toothache
- Gum infection
- Jaw disorders
- Burning Mouth Syndrome
- Orofacial Neuropathy
What are 3 characteristics of TMJ disorder?
- Painful jaw
- Clicking noises
- Facial pain
Name 4 methods of pain relief in the dental surgery
- Pharmacological pain relief
- Sedation
- Reduced anxiety
- Distraction
What may happen if a patient presents with persistent severe pain with no clinical or radiographic abnormalities?
The patient can be referred for psychological assessment or specialist
