Pain mechanism and management

Question 1

Define pain

Answer 1

An acute sensory or emotional experience that is associated with actual or potential tissue damaging injury

Question 2

Features of acute pain

Answer 2

• Specific injury
• Tissue damage
• Self limiting
• Ceases once healing occurs

Question 3

What is the gate control theory of pain

Answer 3

Pain is a perception rather than sensation

• Opening/ closing of neural gates can control pain
• Gate open- high pain. Gate closed- no pain

Question 4

According to the model, what from the brain can activate gating mechanism

Answer 4

Anxiety, tension, depression, boredom, focus on the pain

Question 5

According to the model, what (other than brain) can activate gating mechanism

Answer 5

Noxious stimulus activating a-delta and c fibres

Question 6

What can inhibit the gating mechanism

Answer 6

Medication, pleasure, distraction, relaxation, analgesia, activation of a-beta fibres (counter stimulation)

Question 7

What % of adults will suffer with chronic pain

Answer 7

25

Question 8

What is the most common site of chronic pain

Answer 8

up to 2 years

Question 9

How does chronic pain affect quality of life

Answer 9

Lose job
Major depressive disorder
Report wish to die
Suicide attempts

Question 10

What is meant by ‘motivation’ in terms of chronic pain

Answer 10

• How do we think about pain
• How do we feel about pain
• What do we do about pain

Question 11

What areas of the brain have sensory/ discriminate roles in pain- what exactly is their role

Answer 11

Lateral thalamic nuclei, S1, S2, SMA

- Localisation of pain in time and space, assesses intensity

Question 12

Whart areas of the brain have affective/ motivational roles in pain

Answer 12

Medial system: BG, medial thalamic nucleus, ACC, insula

Question 13

What areas of the brain are to do with interpreting pain and its meaning

Answer 13

ACC

DLPFC

Question 14

What aspects of pain are primary in

a) acute
b) chronic pain

Answer 14

a) sensory component is primary

b) affective and motivational components are primary

Question 15

What is the triad of chronic pain

Answer 15

Pain
MDD/ anxiety
Addiction

Question 16

How does pain intensity change with major depressive disorder severity

Answer 16

It increased

Question 17

How many sustained pain lead to mental illness

Answer 17

Sustained pain–> increased negative mood states–> more refractory pain–> ultimately MDD

Question 18

Name some systems in the brain that are dysfunctional in both MDD/ anxiety and chronic pain

Answer 18

5-HT
Noradrenaline
Dopamine
Opiod

Question 19

How does the serotonin behave in chronic pain/ MDD

Answer 19

Suppress sensation of normal bodily function

Question 20

How does the noradrenaline system behave in chronic pain/ MDD

Answer 20

Suppress sensation of normal bodily functions

Question 21

How does the dopamine system behave in chronic pain/ MDD

Answer 21

Application of importance, focuses attention and dampens pain

Question 22

Name the 4 types of pain behaviours

Answer 22

1- negative affect
2- facial/ audible expression of distress
3- distorted ambulation/ posture
4- avoidance of activity

Question 23

What is pacing

Answer 23

Combination of pain and activity avoidance- may implicate compromises to patient and suggest greater subjective disability

Question 24

What is biofeedback

Answer 24

Provides biophysiological feedback to patient about some bodily process the patient is unaware of (forehead muscle tension)

Question 25

What is relaxation

Answer 25

Systemic relaxation of the large muscle groups

Question 26

What is hypnosis

Answer 26

Relaxation, suggestion, distraction