Patient Pain Flashcards
Pain (IASP)
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
Burden of chronic pain
Common problem causing people to seek healthcare
Poses major consequences for individuals and society
Warning sign - motivates behavioural change
What is pain according to the people ?
Pain is whatever the experiencing person says it is, existing whenever they say it does.
Multidimensional views of pain
Biological element
Drug use patterns
Genetic predisposition
Subjective perception
What are the 2 types of pain ?
Acute pain
Chronic pain
Describe acute pain
Intense, time-limited
Result of tissue damage or disease
Typically disappears after injury heals
Sufferers are highly motivated to seek-out its causes, treat it
How long does acute pain last ?
3-6 months
Describe chronic pain
Often begins with acute pain
Persists > 12 weeks despite medication/treatment or beyond normal tissue healing time
High anxiety, feelings of hopelessness and helplessness
Interferes with daily life
How long does chronic pain last ?
> 12 weeks
What are the 3 sub-categories of chronic pain ?
Recurrent acute
Intractable -benign
Progressive
Recurrent acute
Caused by benign or harmless condition
Repeated, intense episodes separated by period w/out pain
Intractable benign
Benign but persistent pain
Varying levels of intensity, but never disappears
Progressive
Pain often originates from a malignant condition
Continuing pain, and discomfort
Pain worsens over time, as underlying condition worsens
How do we perceive pain ?
Mediated by ‘nociceptors’ (nerve endings)
Complexity interplay of physiological and psychological processes
Pain mediated by nerve endings
Receptor cells associated with pain are not entirely or specifically devoted to pain transmission.
The body senses pain in response to many types of noxious stimuli
Always includes a strong emotional component
3 Theories/Approaches to pain
Gate control theory
Biopsychosocial
Cognitive-Behavioural perspective
Describe the gate control theory
Nerve endings in damaged area transmit impulses to the spinal cord.
A gate exists in the spinal cord - ‘neural gate’
- OPEN : to let the pain signal through
- CLOSED : to reduce the pain experience
Gating mechanism modulates incoming pain signals before they reach the brain.
What is the gate control theory influenced by ?
Amount of activity in pain fibres
Amount of activity in other peripheral fibres
Messages descending form the brain
Amount of activity in pain fibres
More activity
Gate opens
More pain
Describe when the gate is open or closed for a PHYSICAL condition
Gate open : Extent of injury, Inappropriate activity level
Gate closed : Medication, Counter stimulation
Describe when the gate is open or closed for a EMOTIONAL condition
Gate open : Anxiety, worry, tension, depression
Gate closed : +ve emotions, relaxation, rest
Describe when the gate is open or closed for a MENTAL condition
Gate open : Focus on the pain, Little interest in life activities
Gate closed : Intense concentration or distraction, involvement and interest in life activities
What does the gate control theory do ?
Explains why the same event can be interpreted by different people as more/less painful
Explains why sometimes pain is not experienced immediately
Describes the individual as having some control over the experience of pain
Biopsychosocial model
Includes cognitive, affective and behavioural components of pain
Views illness as a dynamic reciprocal interaction among biological, psychosocial and sociocultural variables that shape a persons response to pain.
Cognitive-Behavioural perspective
Emphasis on :
- Peoples idiosyncratic beliefs
- Appraisals and coping repertoires
- Sensory, affective and behavioural contributions
- Formation of pain perceptions
Pain interpreted as significant life-threatening illness
Focus on pain
Catastrophising
Pain interpreted as the result of minor injury
Focus on other things
Realistic appraisal
Assessment of pain
Self-report
Behavioural
Physiological
Self report measures
Interview
Pain rating scales and diaries
Pain questionnaires
Example of a pain questionnaire
McGill Pain Questionnaire
-evaluative
-sensorial
-affective
Limitations of self report
Misinterpretation of pain
Less useful for children; those not fluent in English; communication difficulties
Behavioural assessment
Everyday activities
Structured clinical sessions
Psychological factors influencing the experience of pain
Learning
Cognition
Personality
Stress
Management of chronic pain
Physical methods : medical treatment
Psychological methods : relaxation; distraction
Pain management
Biofeedback
Relaxation
Distraction
Cognitive methods
Behaviour therapy
Cognitive methods
Change perceptions of, reactions to pain
Cognitive re-definition
Behaviour therapy
Changing the patient’s pain behaviour
Enhance social reinforcement
