Psychological aspects of pain

Question 1

Pain =

Answer 1

unpleasant sensory and emotional experience associated with actual or potential tissue damage and expressed in terms of such damage

Question 2

What role might acute pain have?

Answer 2

Protective

Question 3

Self-limiting pain =

Answer 3

Acute

Question 4

2 broad types of pain:

Answer 4

Nocicpetive

Neuropathic

Question 5

Nociceptive pain is associated with =

Answer 5

Actual tissue damage

Question 6

2 types of nocicpetive pain =

Answer 6

Visceral

Somatic

Question 7

Somatic pain =

Answer 7

Easily localised and describes

Question 8

Ex of somatic pain =

Answer 8

Fracture

Question 9

Visceral pain =

Answer 9

Poorly localised and describes. Associated with activation of nociceptive of organs

Question 10

How might visceral pain be described?

Answer 10

Aching, dull, burning

Question 11

Neuropathic pain is associated with

Answer 11

Structural neural damage or abnomral processing

Question 12

How might neuropathic pain be described?

Answer 12

sharp, stabbing, burning, shooting,

Question 13

Which kind of pain doesn’t respond well to conventional analgesics?

Answer 13

Neuropathic

Question 14

Time line: acute pain

Answer 14

< 3 months

Question 15

Time line: chronic pain

Answer 15

> 3 months

Question 16

Chronic pain:

Answer 16

> 3 months

unpredicatable, unknown circuitry, difficult to treat, not useful

Question 17

Mechanisms by which a chronic pain state is established =

Answer 17

Peripheral senstisation
Central sensitiasaion
Central reorganisation

Question 18

Peripheral sensitisation =

Answer 18

Tissue damage leads to release of neuropeptides and inflammatory mediators. This reduces the threshold for activation of peripheral receptors

Question 19

Central sensitisation =

Answer 19

Increased primary afferent release of glutamate and substance P activated NDMA receptors. Winds up CNS so it is hyperactive

Question 20

Nociceptive neurotransmitters

Answer 20

Glutamate

Substance P

Question 21

Pain receptor =

Answer 21

NDMA

Question 22

Hyperalgesia =

Answer 22

exaggerate pain response

Question 23

Allodynia =

Answer 23

Pain response to non-painful stimuli

Question 24

Central reorganisation =

Answer 24

Changes to dorsal spinal cord and cortical sensory matrix

Question 25

Co-morbidities associated with pain =

Answer 25

``` Poor appetite Anxiety Depression Difficulty concentrating Lack of energy Difficulty sleeping ```

Question 26

Aspects of psychological parts of pain:

Answer 26

``` Cognitive Behavioural affective Coping strategies Emotions Beliefs Illness behaviour ```

Question 27

Affective response to pain =

Answer 27

pain causes anxiety and depression which worsens pain

Question 28

Behavioural response to pain may include:

Answer 28

Fear-avoidance

Question 29

Fear-avoidance =

Answer 29

avoidant behaviour based on pain-related fear helps to maintain chronic pain state

Question 30

Cognitive response to pain may include

Answer 30

Somatisiation | Catastrophising

Question 31

Positive social aspects

Answer 31

Sympathy Support Attention

Question 32

Negative social aspects

Answer 32

Income Hobbies Loss of role in family

Question 33

Common issues in chronic pain:

Answer 33

- Not often associated with real tissue damage - Not associated with positve investigations - Psychosocial - Impairment and disability - difficult to manage - relaistic outcomes

Question 34

Impairment =

Answer 34

Any loss or abnomrality of psychological, physciological or anatomical structure or function

Question 35

Disability -

Answer 35

restriction or lack of ability to perform activity in a manner considered normal

Question 36

Pain red flags =

Answer 36

``` Hx of cancer recent bacterial infection immunosuppression constitutional symptoms Radicular symptoms (radiates) ```

Question 37

Pain yellow flags =

Answer 37

Fear that pain is harmful Fear avoidance behaviour Social withdrawl/low mood Passive rather than active treatment

Question 38

Chronic pain treatment strategies =

Answer 38

``` Physcial Self-help Non-pharma Psych Pharma ```

Question 39

Psychosocial interventions:

Answer 39

``` Education Coping CBT Mindfulness Pain management program ```

Question 40

Education about chronic pain may come in the form of

Answer 40

Expert patients program

Question 41

CBT aims to

Answer 41

challenge cognition and negative thoughts. develop strategies (e.g. thought diversion, relaxation, pacing)

Question 42

Physcial therapies include:

Answer 42

``` Hydrotherapy Manipulation Acupuncture TENS Exercise/fitness ```