Patient Pain Flashcards
What is pain?
an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
acute pain
intense, but time limited
result of tissue damage or disease
disappears as injury heals
lasts less than 6 months
chronic pain
often begins as acute pain
not dissipate after a min. 6 months
high anxiety, helplessness due to lack of medical treatment
interferes with daily life
three sub categories of chronic pain
recurrent acute
intractable-benign
progressive
recurrent acute
cause by benign or harmless condition
repeated intense episodes separated by period w/out pain
intractable-benign
benign but persistent pain
crying levels of intensity, but never disappears
Progressive
pain often originates from malignant condition
continuing pain and discomfort
Pain worsens over time, as underlying condition worsens
what is pain mediated by
mediated by nociceptors
theories of pain
specificity theory
pattern theory
the gate control theory
specificity theory
separate sensory system for perceiving pain
specific sensory receptors for detecting pain stimuli
specific peripheral nerves and pathway to the brain
specific area within the brain for processing pain signals
pattern theory
no separate system for perceiving pain
pain results from the pattern or type of stimulation received by nerve endings
intensity of the stimulation is key determination of pain
strong and mild stimuli of the same sense modality produce different patterns of neural activity
limitations of ST
incorrect - no specific receptor cells in the body that only transfer information about pain
limitations of PT
- requires stimuli triggering pain must be intense
- pain can be experienced without tissue damage
- tissue damage can exist without pain
- both fail to account for the important role of psychology in the perception of pain
Gate Control Theory
- Psychological factors AND physiological factors
- Explains why the same event can be interpreted by different people as more or less painful
- Explains why sometimes pain is not experienced immediately
- Describes the individual as having some control over the experience of pain
three different methods on the assessment of pain
physiological
self-report
behavioural
USE OF 2 OR MORE TECHNIQUES ADVISED
Physiological
• Assume pain perception is associated with specific physiological responses
• R’ship between physiological responses and experience
of pain not consistent
• Limited use
self-report measures
patient asked to describe their pain
interview
pain rating scales and diaries
pain questionnaires
interview
useful for treating chronic patients
focuses on history of pain problem emotional adjustment etc.
Pain rating scales and diaries
Useful for measuring how strong the pain is (intensity) and provides repeated ratings
three types of pain scale
visual analogue scale
box scale
verbal rating scale
Limitations to self-report
often require fairly high levels of verbal skills
less useful for children
misrepresentation of pain can occur, over/under exaggeration
Behavioral assessment
- Observing behaviour
- Procedures for assessing pain in 2 types situations
- useful, but again open misrepresentation
psychological methods
– biofeedback
– relaxation and distraction
– cognitive methods
– behaviour therapy (operant approach) – hypnosis
biofeedback
- Monitor & change selected physiological functions (heart rate, muscle activity)
- Pts asked to engage in different thoughts/ behaviours to influence physiological response
- Over time, pt learns how to selectively “let go” of tension (e.g. in muscle) by change in behaviour
- Useful for headache, chronic back pain (but drawbacks)
Cognitive methods
- Understanding how thoughts/ feelings influence the experience of pain
- Help people change perceptions of, reactions to, pain
- Information, perceived control over pain (e.g. childbirth programs)
- Cognitive re-definition - re-label the pain (e.g. childbirth)
- Effective in variety types pain (headache, back-pain)
Hypnosis
- Relieves pain only in individuals who can successfully undergo deeply hypnosis
- Provides a high degree of analgesia (minority of pts)
- Cognitive and behavioural techniques generally > effective
