Pain + Chronic Pain management

Question 1

what is the difference between acute and chronic pain

Answer 1

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

Question 2

what is chronic-recurrent pain

Answer 2

stems from benign causes and involves repeated and intense episodes of pain separated by periods without pain (ex. migraines)

Question 3

what is chronic-intractable-benign pain

Answer 3

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

Question 4

what is chronic-progressive pain

Answer 4

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

Question 5

what is the gate control theory of pain

Answer 5

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.

Question 6

what are things that can open and close the “gate” in control theory of pain

Answer 6

Close = medication, rest, relaxation, counter stimulant (heat), distraction

Open = low mood, anxiety, anger/frustration, expectations, thoughts/beliefs (Pain catastrophizing)

Question 7

what is the neuromatrix model

Answer 7

suggest the body is perceived in units of networks of neurons in the brain → possibly explains phantom limb pain

Question 8

what is the fear-avoidance model

Answer 8

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

Question 9

what is the communications model of pain

Answer 9

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

Question 10

what are secondary gains of pain

Answer 10

realizing pain results in special treatment from other –> gets others to do things for them

Question 11

What are the three standard assessments for chronic pain

Answer 11

pain characteristics (duration, internity), pain impact (depression), personal and psychological history

Question 12

how to asses pain in children

Answer 12

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

Question 13

what are the adaptive benefits to pain

Answer 13

beneficial for long term survival, warning signal that motivates behavior and facilitates learning, pain signal no longer adaptive in chronic pain

Question 14

what happens when one develops a fear of movement

Answer 14

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

Question 15

what is quota-based exercise programs

Answer 15

patient progressively increase their activity despite fear of movement

Question 16

what are the consequences of pain catastrophizing

Answer 16

greater bodily pain, more medication, lower quality of life and higher depression, greater work disability an absenteeism

Question 17

what is positive and negative social reinforcements of pain behaviours

Answer 17

negative = avoidance of doing unpleasant tasks, positive = attention from others

Question 18

what were the results of the medical visit study (either told spouse or clerk is behind mirror)

Answer 18

if spouse was behind mirror, displayed more pain behaviours → spouses more likely to discourage patients from participating in physical tasks (enabling pain behaviors)

Question 19

what is solicitous communication

Answer 19

utterances reflecting concern about a pain patients condition or discontinued activity

Question 20

what are the consequences of disability payment

Answer 20

people receiving financial benefits from pain → pain treatment is less effective

Question 21

what is the best way to prescribe medication for chronic pain

Answer 21

Time-contingent medication rather than as needed → when as needed patients can catastrophize pain and take advantage of medication

Question 22

what kind of medication and treatments are prescribed for chronic pain

Answer 22

analgesics and narcotics → not sufficient for chronic pain management however, surgery (severing nerves that transmit pain signals) → only good for short term

Question 23

what are the principles of psychical stimulation for chronic pain

Answer 23

slightly stimulate nociceptors in one region to reduce overall pain (ex. Massage therapy, acupuncture, chiropractic therapy) → effective but effects short lived

Question 24

what is the goal of cognitive behavioral therapy for patients experiencing chronic pain

Answer 24

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