Psychological aspects of pain and management Flashcards
What is the definition of pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage and expressed in terms of such damage
Nociceptive vs neuropathic pain
Nociceptive pain is pain arising from the stimulation of nerve cells (as opposed to from damaged or disease in the nerves)
- Nociceptors are receptors that are specifically designed to detect stimuli that may cause harm to the body, they respond well to conventional analgesics
Neuropathic pain is associated with damage to the neurons in the body or abnormal processing
- Responds poorly to conventional analgesics
- Associated with abnormal sensations such as burning, shooting and lancinating
Acute vs chronic pain
Acute pain is a predictable response of a normal sensory system to a defined injurious process
Chronic pain is an unpredictable response of an often abnormal nervous system, where the relationship to injury or tissue damage is unclear
In terms of a time period, what differentiates acute from chronic pain?
Acute = < 3months Chronic = > 3months
What is neuroplasticity?
It is the brains ability to recognise itself by forming new neural connections throughout life. This allows neurons in the brain to compensate for injury and disease, and to adjust their activities in response to new situations or to changes in their environment
What are the different relationships between injury and response to pain?
- Peripheral sensitisation
- Central sensitisation
- Central re-organisation
- Chronic pain states
What is peripheral sensitisation? When does it occur?
Increased sensitivity to an afferent nerve stimuli
- This occurs after there has been an injury or cell damage to the area
What is central sensitisation?
Increased response to stimulation that is mediated by amplification of signalling in the CNS
- Increased primary afferent release of glutamate and substance P
- NMDA receptor activation
What is allodynia?
Pain caused by something that would not usually cause pain
What is hyperalgesia?
Increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves
What is central reorganisation?
- Neuronal sprouting within dorsal spinal cord
- Alteration of cortical sensory matrix
- Established chronic pain state
Give some psychological components associated with pain?
- Behavioural
- Fear avoidance: e.g. stay in bed to avoid pain - Cognitive
- Somatisation: communicate psychological distress in the form of somatic symptoms
- Catastrophising: viewing the situation as worse than it actually is - Affective
- Anxiety
- Depression
Give some different assessment tools for pain
- Visual analogue score
- Verbal rating score
- Brief pain inventory
- HAD score
- McGill pain score
- LANSS score
What are red flags associated with pain?
- History of cancer
- Constitutional symptoms: fever, chills, weight loss
- Radicular symptoms
- Recent bacterial infection
- Immunosuppression
Different physical therapies for pain?
- Exercise/fitness
- Hydrotherapy
- Manipulation
- TENS (transcutaneous electrical nerve stimulation)
- Acupuncture
