Psychological aspects of pain Flashcards
Pain =
unpleasant sensory and emotional experience associated with actual or potential tissue damage and expressed in terms of such damage
What role might acute pain have?
Protective
Self-limiting pain =
Acute
2 broad types of pain:
Nocicpetive
Neuropathic
Nociceptive pain is associated with =
Actual tissue damage
2 types of nocicpetive pain =
Visceral
Somatic
Somatic pain =
Easily localised and describes
Ex of somatic pain =
Fracture
Visceral pain =
Poorly localised and describes. Associated with activation of nociceptive of organs
How might visceral pain be described?
Aching, dull, burning
Neuropathic pain is associated with
Structural neural damage or abnomral processing
How might neuropathic pain be described?
sharp, stabbing, burning, shooting,
Which kind of pain doesn’t respond well to conventional analgesics?
Neuropathic
Time line: acute pain
< 3 months
Time line: chronic pain
> 3 months
Chronic pain:
> 3 months
unpredicatable, unknown circuitry, difficult to treat, not useful
Mechanisms by which a chronic pain state is established =
Peripheral senstisation
Central sensitiasaion
Central reorganisation
Peripheral sensitisation =
Tissue damage leads to release of neuropeptides and inflammatory mediators. This reduces the threshold for activation of peripheral receptors
Central sensitisation =
Increased primary afferent release of glutamate and substance P activated NDMA receptors. Winds up CNS so it is hyperactive
Nociceptive neurotransmitters
Glutamate
Substance P
Pain receptor =
NDMA
Hyperalgesia =
exaggerate pain response
Allodynia =
Pain response to non-painful stimuli
Central reorganisation =
Changes to dorsal spinal cord and cortical sensory matrix
Co-morbidities associated with pain =
Poor appetite Anxiety Depression Difficulty concentrating Lack of energy Difficulty sleeping
Aspects of psychological parts of pain:
Cognitive Behavioural affective Coping strategies Emotions Beliefs Illness behaviour
Affective response to pain =
pain causes anxiety and depression which worsens pain
Behavioural response to pain may include:
Fear-avoidance
Fear-avoidance =
avoidant behaviour based on pain-related fear helps to maintain chronic pain state
Cognitive response to pain may include
Somatisiation
Catastrophising
Positive social aspects
Sympathy
Support
Attention
Negative social aspects
Income
Hobbies
Loss of role in family
Common issues in chronic pain:
- Not often associated with real tissue damage
- Not associated with positve investigations
- Psychosocial
- Impairment and disability
- difficult to manage
- relaistic outcomes
Impairment =
Any loss or abnomrality of psychological, physciological or anatomical structure or function
Disability -
restriction or lack of ability to perform activity in a manner considered normal
Pain red flags =
Hx of cancer recent bacterial infection immunosuppression constitutional symptoms Radicular symptoms (radiates)
Pain yellow flags =
Fear that pain is harmful
Fear avoidance behaviour
Social withdrawl/low mood
Passive rather than active treatment
Chronic pain treatment strategies =
Physcial Self-help Non-pharma Psych Pharma
Psychosocial interventions:
Education Coping CBT Mindfulness Pain management program
Education about chronic pain may come in the form of
Expert patients program
CBT aims to
challenge cognition and negative thoughts. develop strategies (e.g. thought diversion, relaxation, pacing)
Physcial therapies include:
Hydrotherapy Manipulation Acupuncture TENS Exercise/fitness
