Pain + Chronic Pain management Flashcards
what is the difference between acute and chronic pain
acute pain resolves quickly, can be treated with medication and has a predictable prognosis. Chronic pain lasts 3 months or longer, multimodular treatment, unpredictable prognosis
what is chronic-recurrent pain
stems from benign causes and involves repeated and intense episodes of pain separated by periods without pain (ex. migraines)
what is chronic-intractable-benign pain
refers to discomfort that is typically present all of the time, with varying levels of intensity, and is not related to an underlying malignant condition
what is chronic-progressive pain
characterized by continuous discomfort, is associated with a malignant condition, and becomes increasingly intense as the underlying condition worsens. Two malignant conditions that frequently produce chronic-progressive pain are rheumatoid arthritis and cancer
what is the gate control theory of pain
Nerve impulses are transmitted from afferent fibers to the spinal cord, transmission cells modulated by a gating. Large-diameter fibers tend to “close the gate” by inhibiting transmission of pain signals while small fibers “open the gate” by facilitating transmission.
what are things that can open and close the “gate” in control theory of pain
Close = medication, rest, relaxation, counter stimulant (heat), distraction
Open = low mood, anxiety, anger/frustration, expectations, thoughts/beliefs (Pain catastrophizing)
what is the neuromatrix model
suggest the body is perceived in units of networks of neurons in the brain → possibly explains phantom limb pain
what is the fear-avoidance model
certain movements or behaviours become associated with pain, patients avoid these movement and catastrophize the pain that may be experienced, slowing recovery, develop fear of movement of of anxiety
what is the communications model of pain
suggests there is a chain of pain communication starting with (1) internal pain experience, leading to (2) verbal or non-verbal expression behavior of pain (3) the decoding of these behaviors by observers
what are secondary gains of pain
realizing pain results in special treatment from other –> gets others to do things for them
What are the three standard assessments for chronic pain
pain characteristics (duration, internity), pain impact (depression), personal and psychological history
how to asses pain in children
self reports from age 4, use face pain scales (child clicks the face they believe represents the amount of pain they are experiencing), youth and parental reports
what are the adaptive benefits to pain
beneficial for long term survival, warning signal that motivates behavior and facilitates learning, pain signal no longer adaptive in chronic pain
what happens when one develops a fear of movement
ear becomes associated with a number of daily activities, it elicits physiologic reactive and aggravates pain.
Fear of movement = best predictor of functional limitations than biomedical parameters
what is quota-based exercise programs
patient progressively increase their activity despite fear of movement
what are the consequences of pain catastrophizing
greater bodily pain, more medication, lower quality of life and higher depression, greater work disability an absenteeism
what is positive and negative social reinforcements of pain behaviours
negative = avoidance of doing unpleasant tasks, positive = attention from others
what were the results of the medical visit study (either told spouse or clerk is behind mirror)
if spouse was behind mirror, displayed more pain behaviours → spouses more likely to discourage patients from participating in physical tasks (enabling pain behaviors)
what is solicitous communication
utterances reflecting concern about a pain patients condition or discontinued activity
what are the consequences of disability payment
people receiving financial benefits from pain → pain treatment is less effective
what is the best way to prescribe medication for chronic pain
Time-contingent medication rather than as needed → when as needed patients can catastrophize pain and take advantage of medication
what kind of medication and treatments are prescribed for chronic pain
analgesics and narcotics → not sufficient for chronic pain management however, surgery (severing nerves that transmit pain signals) → only good for short term
what are the principles of psychical stimulation for chronic pain
slightly stimulate nociceptors in one region to reduce overall pain (ex. Massage therapy, acupuncture, chiropractic therapy) → effective but effects short lived
what is the goal of cognitive behavioral therapy for patients experiencing chronic pain
becoming more aware of pain related negative thoughts, more emotion expression (holding in emotion increases pain), teaching family members to reinforce positive behaviours: increased activity and Ignore negative behaviours: complaints of pain
