Patient Pain

Question 1

Define acute pain

Answer 1

• Intense but time limited, it the result of tissue damage and disease. Usually disappears over time as the injury heals. Lasts less than 6 months and patients are usually highly motivated to seek cause and treatment. It is effectively treated by a number of pain-control treatments

Question 2

Define chronic pain

Answer 2

Often begins as acute pain. Doesn’t resolve after 6 months. High anxiety, hopelessness, helplessness due to lack of treatment success. Interferes with daily life.

Question 3

What are the 3 subcategories of chronic pain and explain them.

Answer 3

• Recurrent acute (caused by benign/harmless condition. Cyclical pain)
• Intractable-benign ( benign but persistent pain)
• Progressive (Caused by malignant condition but with continuing pain that worsens as condition worsens)

Question 4

What are the three theories for pain?

Answer 4

Specificity theory
Pattern theory
The gate control theory.

Question 5

Describe the features and drawbacks of the specificity theory?

Answer 5

• Proposes that there are separate and specific sensory systems for perceiving and detecting pain.
• However the drawbacks are that this is incorrect as there are no specific receptors cells that transmit only pain.

Question 6

Describe some of the features and drawbacks of the pattern theory?

Answer 6

• Proposes that there are no separate system for perceiving pain and that the intensity of the stimulation is key in determining pain.
• Some limitations include the idea that the stimuli triggering pain must be intense which is not true. For example phantom limb

Question 7

What is the Gate Control Theory?

Answer 7

• It suggests that a ‘gate’ exists in the spinal cord, and the gate opens to let through a painful stimuli and closes to reduce pain. It also includes the role of psychological factors in the experience of pain

Question 8

What is the Gate Control influenced by?

Answer 8

• The amount of activity in pain fibres. More activity means the gate opens causing more pain.
• Amount of activity in other peripheral fibres, this includes harmless stimuli or mild irritation. This closes the gate causing less pain
• Messages descending from the brain, e.g. anxiety or excitement. Messages like these can either open or close the gate.

Question 9

Describe in terms of physical conditions that cause the gate to open and close

Answer 9

Open gate - extent of injury

Close gate - Medication, counter stimulation

Question 10

Describe in terms of an emotional condition what causes the gate to open and close

Answer 10

Open - Anxiety, worry, tension, depression

Close - Positive emotions an relaxation

Question 11

Describe in terms of mental condition what causes the gate to open and close

Answer 11

Open - Focus on pain, boredom, little interest in life activities
Close - Intense concentration, distraction, interests in life activities.

Question 12

What does the Gate Control Theory explain?

Answer 12

Why the same event can be interpreted by people as more/or less painful

Question 13

What are the three ways pain is measured? and how many techniques should be used?

Answer 13

1) Physiological
2) Self-report
3) Behavioural
At least two of these techniques should be used.

Question 14

What are physiological measures? and explain why this has limited use

Answer 14

It assumes that pain perception is associated with specific responses (e.g. increase heart rate, BP, resp rate and muscle tension). However the relationship between physiological responses and pain experienced is not consistent.

Question 15

What are the self-report measures?

Answer 15

When patients are asked to describe their pain, this can be done in three ways; interview, pain rating scale/diaries and pain questionnaires (McGill patient questionnaire used very often).

Question 16

Describe some of the limitations self-report methods

Answer 16

They often requires fairly high levels of verbal skills so is not useful for children and non fluent English speakers. Patients can also misrepresent their pain by down playing or exaggerating

Question 17

Describe the behaviour assessment method?

Answer 17

This is where you observe the patients behaviour; physical symptoms, facial expressions and verbal expressions. It is useful but open to misinterpretation.

Question 18

Name and describe some of the psychological influences on pain experience

Answer 18

• Learning. For example, expressing/experiencing pain as a way of receiving gain. To avoid certain activities (P.E or dentist)
• Cognition. For example people beliefs about pain or their expected ability to cope with pain
• Personality. For example there is a positive associated between chronic pain sufferers and anxiety/depression disorders
• Stress. For example major life events.

Question 19

Name some pain management strategies

Answer 19

Physical methods (medical, surgical, physical stimulation therapies, physical therapy or exercise)
Psychological methods (biofeedback, relaxation and distraction, cognitive methods, behaviour therapy, hypnosis)

Question 20

Describe the biofeedback pain management strategy

Answer 20

Patients are asked to engage in different thoughts/behaviours to influence physiological responses. Overtime patients can selectively let go of tension by changes in behaviour.`

Question 21

Describe the relaxation pain management strategy

Answer 21

It involves a systematic and methodical approach to re-learn deep muscle relaxation but it is a skill that needs to be learned and re-learned.

Question 22

Describe the distraction pain management strategy

Answer 22

It encourages patients to take focus away from the pain by using imaginative distraction/ guided imagery. It is effective in; chemotherapy, migraine headaches, dental procedures, low-back pain and in medical procedures such as lumbar punctures.

Question 23

Describe some features of the cognitive pain management strategy

Answer 23

It encourages the understanding of how thoughts and feelings influence pain. It can help people change their perceptions and reactions to pain. Cognitive re-definition can be effectively used too, for example in child birth.

Question 24

Describe some of the features of behavioural therapy in pain management

Answer 24

It encourages the patients change in behaviour and eliminates the perks of pain. The aim is to decrease pain,disability and reliance on medication. It encourages people to stay active.

Question 25

Describe the features of hypnosis in pain management

Answer 25

It only relieves pain in patients that successfully undergo deeply hypnosis. It can provide a high degree of analgesia but only in a minority of patients.