Patient Pain

Question 1

Pain (IASP)

Answer 1

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.

Question 2

Burden of chronic pain

Answer 2

Common problem causing people to seek healthcare

Poses major consequences for individuals and society

Warning sign - motivates behavioural change

Question 3

What is pain according to the people ?

Answer 3

Pain is whatever the experiencing person says it is, existing whenever they say it does.

Question 4

Multidimensional views of pain

Answer 4

Biological element
Drug use patterns
Genetic predisposition
Subjective perception

Question 5

What are the 2 types of pain ?

Answer 5

Acute pain
Chronic pain

Question 6

Describe acute pain

Answer 6

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

Question 7

How long does acute pain last ?

Answer 7

3-6 months

Question 8

Describe chronic pain

Answer 8

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

Question 9

How long does chronic pain last ?

Answer 9

> 12 weeks

Question 10

What are the 3 sub-categories of chronic pain ?

Answer 10

Recurrent acute
Intractable -benign
Progressive

Question 11

Recurrent acute

Answer 11

Caused by benign or harmless condition
Repeated, intense episodes separated by period w/out pain

Question 12

Intractable benign

Answer 12

Benign but persistent pain
Varying levels of intensity, but never disappears

Question 13

Progressive

Answer 13

Pain often originates from a malignant condition
Continuing pain, and discomfort
Pain worsens over time, as underlying condition worsens

Question 14

How do we perceive pain ?

Answer 14

Mediated by ‘nociceptors’ (nerve endings)

Complexity interplay of physiological and psychological processes

Question 15

Pain mediated by nerve endings

Answer 15

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

Question 16

3 Theories/Approaches to pain

Answer 16

Gate control theory
Biopsychosocial
Cognitive-Behavioural perspective

Question 17

Describe the gate control theory

Answer 17

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.

Question 18

What is the gate control theory influenced by ?

Answer 18

Amount of activity in pain fibres
Amount of activity in other peripheral fibres
Messages descending form the brain

Question 19

Amount of activity in pain fibres

Answer 19

More activity
Gate opens
More pain

Question 20

Describe when the gate is open or closed for a PHYSICAL condition

Answer 20

Gate open : Extent of injury, Inappropriate activity level

Gate closed : Medication, Counter stimulation

Question 21

Describe when the gate is open or closed for a EMOTIONAL condition

Answer 21

Gate open : Anxiety, worry, tension, depression

Gate closed : +ve emotions, relaxation, rest

Question 22

Describe when the gate is open or closed for a MENTAL condition

Answer 22

Gate open : Focus on the pain, Little interest in life activities

Gate closed : Intense concentration or distraction, involvement and interest in life activities

Question 23

What does the gate control theory do ?

Answer 23

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

Question 24

Biopsychosocial model

Answer 24

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.

Question 25

Cognitive-Behavioural perspective

Answer 25

Emphasis on :

• Peoples idiosyncratic beliefs
• Appraisals and coping repertoires
• Sensory, affective and behavioural contributions
• Formation of pain perceptions

Question 26

Pain interpreted as significant life-threatening illness

Answer 26

Focus on pain
Catastrophising

Question 27

Pain interpreted as the result of minor injury

Answer 27

Focus on other things
Realistic appraisal

Question 28

Assessment of pain

Answer 28

Self-report
Behavioural
Physiological

Question 29

Self report measures

Answer 29

Interview
Pain rating scales and diaries
Pain questionnaires

Question 30

Example of a pain questionnaire

Answer 30

McGill Pain Questionnaire

-evaluative
-sensorial
-affective

Question 31

Limitations of self report

Answer 31

Misinterpretation of pain
Less useful for children; those not fluent in English; communication difficulties

Question 32

Behavioural assessment

Answer 32

Everyday activities
Structured clinical sessions

Question 33

Psychological factors influencing the experience of pain

Answer 33

Learning
Cognition
Personality
Stress

Question 34

Management of chronic pain

Answer 34

Physical methods : medical treatment
Psychological methods : relaxation; distraction

Question 35

Pain management

Answer 35

Biofeedback
Relaxation
Distraction
Cognitive methods
Behaviour therapy

Question 36

Cognitive methods

Answer 36

Change perceptions of, reactions to pain
Cognitive re-definition

Question 37

Behaviour therapy

Answer 37

Changing the patient’s pain behaviour
Enhance social reinforcement