Pain perception and management

Question 1

What is the condition in which people feel no pain?

Answer 1

Congenital analgesia (gene SCN9A)
suffer oral cavity damage, bone fractures, unnoticed infections, corneal damage, etc.
At higher risk of more severe diseases
Requires being vigilant to avoiding injury

Question 2

Why study pain?

Answer 2

80 of all doc visits
Most prevalent form of disability: can dominate lives, impair functioning, relationships, employment
Low quality of life & risk of suicide

Enormous economic effects on all societies

Question 3

Define organic pain?

Psychogenic pain?

Answer 3

Organic pain – clearly linked to tissue pressure or damage (burn, sprain, slipped disc)

Psychogenic pain – no tissue damage appears to exist – purely psychological? – still painful

Question 4

Define acute pain?

chronic pain?

Answer 4

Acute
discomfort experienced with temporary painful conditions
lasts < 3mons
Heightened anxiety, but subsides as condition improves

Chronic
lasts > 3 mons or longer than expected
Continued anxiety
Helplessness and hopelessness when treatments ineffective
Interferes with daily activities & world can shrink
Become preoccupied with the pain

Question 5

What are the three types of chronic pain?

Answer 5

intractable benign: present all the time but varies in severity, relatively unresponsive to treatment
ex: lower back pain (tends not to have clear cause, non-threatening, non-malignant)

Chronic progressive: increases in severity, associated with malignancies (deadly or degenerative)

Chronic recurrent: intermittent and intense
ex: trigeminal neuralgia (suicide disorder)
Neuropathic pain: Can result from damage to peripheral nerves – but pain persists & worsens long after healing
no protective action

Question 6

Define neuralgia, causalgia, phantom limb pain

Answer 6

Neuralgia – an extremely painful condition consisting of recurrent episodes of intense shooting or stabbing pain along the course of the nerve (e.g., trigeminal neuralgia)
Causalgia – recurrent episodes of severe burning pain (arm on hot stove).
Phantom limb pain – feelings of pain in a limb that is no longer there

Question 7

Talk to me about the inhibition of pain? What was the Reynolds study?

Answer 7

electrically stimulating a portion of the rat brain produced analgesia during surgery
Called “stimulation produced analgesia” or SPA
Normally: pain fibers -> release substance P -> activates transmission cells

Question 8

What are endorphins?

Answer 8

A form of endogenous (originates from within) opiod (internal pain regulation system)

Question 9

What does pain research suggest about pain behaviors?

Answer 9

part of sick role and often strengthened or maintained by reinforcement – without awareness
Research: pain behaviors often become stable part of habit and lifestyle – even when pain & fear fluctuated

Question 10

Rating pain, define visual analogue scale, box scale or numeric rating scale, verbal rating scale

Answer 10

Visual analogue scale – people rate pain by pointing to a mark on a line – very easy for people as young as 5
Box scale or numeric rating scale – choose one number from a series of numbers
Verbal rating scale – people describe their pain by choosing a word or phrase from several provided

Question 11

What did the McGill pain questionnaire reveal? what are the components (3)?

Answer 11

Pain is only partly described by intensity

1) affective (emotional-motivational) (e.g., fearful, frightening, terrifying);
2) sensory (e.g., hot, burning, scalding, searing);
3) evaluative (e.g., pattern & triggers of pain)

Each word has an assigned value based on the degree of pain it reflects – results in score

Question 12

Three psycho physiological methods of measuring pain

Answer 12

EMG electromyography - activity is MUSCLES reflects tension = stress
Autonomic activity - skin conductance (not useful)
EEG electroencephalograph - voltage signals in brain, sharp surges during intense stimuli (correlated with self report)

Question 13

Opiods and cancer?

Answer 13

non addictive, first line of defense

Question 14

What is neuro-ablation?

Answer 14

radical approach to pain reduction (severely disables) - removes or disconnects part of the PNS or spinal cord; preventing pain signals from reaching the brain

Question 15

What is spinal fusion for?
what is synovectomy?
What is counter irritation?
What are stimulation therapies?

Answer 15

Synovectomy – remove inflamed membranes from arthritic joints
Spinal fusion –severe back pain
Counterirritation: reducing one pain by creating another.
Transcutaneous electrical nerve stimulation (TENS) – electrodes near the skin, stimulate with mild electric current; evidence unclear (anecdotal

Question 16

Is biofeedback effective for pain management?

Answer 16

Migraines example: Learn to control the tension using feedback from EMG
Support: reduce headaches by 40-50%; biofeedback more effective; best when combined with progressive muscle relaxation
Durable long-term effects, but issues with follow-up

Question 17

What are some active coping techniques?

Answer 17

Active coping techniques:
Distraction (changing focus of attention)
Non pain imagery
Pain redefinition
Mindfulness approach