Pain mechanism and management Flashcards
Define pain
An acute sensory or emotional experience that is associated with actual or potential tissue damaging injury
Features of acute pain
- Specific injury
- Tissue damage
- Self limiting
- Ceases once healing occurs
What is the gate control theory of pain
Pain is a perception rather than sensation
- Opening/ closing of neural gates can control pain
- Gate open- high pain. Gate closed- no pain
According to the model, what from the brain can activate gating mechanism
Anxiety, tension, depression, boredom, focus on the pain
According to the model, what (other than brain) can activate gating mechanism
Noxious stimulus activating a-delta and c fibres
What can inhibit the gating mechanism
Medication, pleasure, distraction, relaxation, analgesia, activation of a-beta fibres (counter stimulation)
What % of adults will suffer with chronic pain
25
What is the most common site of chronic pain
up to 2 years
How does chronic pain affect quality of life
Lose job
Major depressive disorder
Report wish to die
Suicide attempts
What is meant by ‘motivation’ in terms of chronic pain
- How do we think about pain
- How do we feel about pain
- What do we do about pain
What areas of the brain have sensory/ discriminate roles in pain- what exactly is their role
Lateral thalamic nuclei, S1, S2, SMA
- Localisation of pain in time and space, assesses intensity
Whart areas of the brain have affective/ motivational roles in pain
Medial system: BG, medial thalamic nucleus, ACC, insula
What areas of the brain are to do with interpreting pain and its meaning
ACC
DLPFC
What aspects of pain are primary in
a) acute
b) chronic pain
a) sensory component is primary
b) affective and motivational components are primary
What is the triad of chronic pain
Pain
MDD/ anxiety
Addiction
How does pain intensity change with major depressive disorder severity
It increased
How many sustained pain lead to mental illness
Sustained pain–> increased negative mood states–> more refractory pain–> ultimately MDD
Name some systems in the brain that are dysfunctional in both MDD/ anxiety and chronic pain
5-HT
Noradrenaline
Dopamine
Opiod
How does the serotonin behave in chronic pain/ MDD
Suppress sensation of normal bodily function
How does the noradrenaline system behave in chronic pain/ MDD
Suppress sensation of normal bodily functions
How does the dopamine system behave in chronic pain/ MDD
Application of importance, focuses attention and dampens pain
Name the 4 types of pain behaviours
1- negative affect
2- facial/ audible expression of distress
3- distorted ambulation/ posture
4- avoidance of activity
What is pacing
Combination of pain and activity avoidance- may implicate compromises to patient and suggest greater subjective disability
What is biofeedback
Provides biophysiological feedback to patient about some bodily process the patient is unaware of (forehead muscle tension)
What is relaxation
Systemic relaxation of the large muscle groups
What is hypnosis
Relaxation, suggestion, distraction
