Psychological Aspects of Pain and Pain Management

Question 1

could pain be a physical sensation?

Answer 1

physical sensation with physical cause (tissue damage, pain is a warning system which tells body something that is wrong)

Question 2

is pain a psychologically mediated SENSATION?

Answer 2

not just because of physical sensation, mediated by other factors: cognitive, motivational + psychological processes

individual differences

• learning
• culture
• past experiences
• conditioning

can influence the transmission of impulses through synapses that recognise and stimulate response of pain

whatever causes pain is mediated by the receptors we use to register that

Question 3

how pain as a subjective experience impacts behaviour:

Answer 3

aversive subjective experience
influenced by cultural learning
disrupts ongoing behaviour
motivates individual to stop the pain

Question 4

pain as an all encompassing body?

Answer 4

not so much what is pain
subjective of how pain is sense
what’s causing the pain, what role the pain has in a person’s life (chronic pain- pain that doesn’t go away is absorbed into every aspect of that life, they have to live with it)

Question 5

*operative definition of pain!

Answer 5

pain is whatever the experiencing person says it is, existing whenever he/ she says it does

Question 6

IASP on pain

Answer 6

• pain can be reported in absence of tissue damage
• direct impact (Physical) + if someone talks about how their chronic pain affects all areas of their life

it is not our place to validate one and not the other, believe when someone says they are in pain

Question 7

what is acute pain?

Answer 7

adaptive + meaningful

fight or flight

cuts, burns, surgery
evolutionary, keeps us away from danger

care + relief is usually likely
suffering is recognised! society empathetic towards it
most people recover from it

Question 8

what is chronic pain?

Answer 8

often without any observable damage
when enough time for normal healing has lapsed (6 months- 1 year) but the pain has not gone away

pain itself is a disease
(you get chronic pain clinics)
we don’t know aetiology of all chronic pain conditions!
no end in sight
no clear care pathway sometimes
care + relief = not likely

psychosomatic- origins are from psychological causes
suffering can be dismissed- people’s compassion + empathy are time limited- runs out

Question 9

differences between acute and chronic pain table:

Answer 9

Question 10

3 early pain theories?

Answer 10

1) organic pain
2) psychogenic pain
3) biomedical framework

Question 11

what is the early pain theory of biomedical framework?

Answer 11

event caused the pain
body’s healing process/ medicine should cure it
doesn’t take into account psychological factors (seen to not have a causal effect)

Question 12

what was the early pain theory of psychogenic pain?

Answer 12

‘we cant see what causes the pain therefore it doesn’t exist’
seen as ‘all in the mind’
when no organic basis could be found

Question 13

what was the early pain theory of organic pain?

Answer 13

‘real pain’ when a clear injury could be seen

Question 14

1956: what did the beecher study in say about trauma being the only cause of pain?

Answer 14

(trauma) tissue damage is not the only cause of pain
because individuals with the same degree of tissue damage reported to feel different amounts of pain

Question 15

are medical treatments for acute pain as effective when treating chronic pain?

Answer 15

no

Question 16

following war, scientists found what % of amputees felt pain years after losing the limb?

Answer 16

65% - 85%

burning + throbbing sensation
(so some part of mind registers pain which isn’t just affected by the physicality)

Question 17

following war, scientists found what % of amputees felt pain years after losing the limb?

Answer 17

65% - 85%

burning + throbbing sensation
(so some part of mind registers pain which isn’t just affected by the physicality)

Question 18

1965: what did the Gate Control Theory Melzack & Wall show?

Answer 18

‘neural’ gate in spinal chord which regulated the experience of pain and it is not the result of a straight- through sensory channel

pain = perceptional experience rather than just sensation
- people don’t just respond passively to painful stimuli
they actively interpret + appraise the stimuli

only when large fibre input goes through- gate is closed = pain
small fibre input-gate is open= pain experience

Question 19

what do large/ small fibres carry in the Gate Control Theory Melzack & Wall?

Answer 19

large fibres- carry sensation for touch, vibration, position perception

small fibres- carry sensation for pain + temperature

Question 20

pain is nerve function of which fibre?

Answer 20

small fibre

Question 21

how does anaesthetic work?

Answer 21

LA- still sensation there, but not painful
can’t feel pain associated with it
turning off gate for small fibres- their inputs not going through
but large fibre input still goes which is why we still have sensation when anaesthetised

Question 22

how does an anaesthetist check that anaesthetic has gone through?

Answer 22

check the temperature on the area which is meant to be numb
large fibre input going through- sensation that something is touching them
can’t recognise difference in temperature- small fibre input not going through

Question 23

which 3 and how do the following have an effect on the information sent to the gate? (3)

Answer 23

1) behavioural state
how much (attention, focus on source of pain) someone is paying to it (dont look at the injection, because attention paid to sensation might be interpreted as pain because of focussing at it)

2) emotional states
- heightened anxiety= heightened sensation rates
fear + depression can have effect on the info sent to the gate

3) previous experience/ self efficacy (trusting your own ability to deal with something) in dealing with pain

Question 24

what is McGill pain questionnaire?

Answer 24

uses records to quantity pain experience
asks about diff types of pain

discriminates between:
1) sensory descriptors - throbbing? dull? freezing?
2) affective- how does it make you feel/ react? does it make you feel sick?
3) evaluative- how do they find it? is it the worst pain ever? how does it change over time?

Question 25

what is the pain scale?

Question 26

what is the pain scale?

Answer 26

scales help people quantity
smiley faces used for children- helps us understand how they feel

Question 27

how can cultural definitions of physical ailments be misleading?

Answer 27

phrases like:

‘butterflies in stomach’
‘ heart skipped a beat’
are all down to individual interpretation

Question 28

which 2 type of descriptors allow us to differentiate between irreversible and reversible pulpitis?

Answer 28

1) affective descriptors - sickening, how it makes them react
2) temporal descriptors - ‘constant/ rhythmic’ - duration

Question 29

different types of pain (5)?

Answer 29

1) can be a warning sign
2) procedural pain (telling you you are doing something wrong, moving in a way which is causing you damage)
3) postoperative pain- what is abnormal/ normal pain which indicates if healing is happening correctly?
4) chronic pain- underlying condition, pain itself
5) disease pain

Question 30

placebo pain control:

Answer 30

there are responders + responders

no typology to determine who will be which (No tests or examinable personality factors)

Question 31

what 2 things can affect if someone will have a response/ non response to placebo? (2)

Answer 31

1) expectancy effects (verbal or beliefs, expectations)
2) affected by interaction with clinician
the communication style/ enthusiasm they have received from the clinician

Question 32

how can patients get more pain control?

Answer 32

manage your own experience of pain much more adequately
via patient controlled analgesia (PCA)

Question 33

is PCA effective? (3)

Answer 33

• associated with better analgesia
• better patient satisfaction
• at most the same amount of drug is used as conventional administration by clinician so SAFE

Question 34

hypnosis as pain management?

Answer 34

controlling of pain is one of the oldest applications of hypnosis

your mind is stabilised and so relaxed, that you don’t pay attention to the pain and therefore less sensation of pain is observed

• growing evidence/ in popularity

Question 35

what source showed that hypnotic suggestion relieved pain for the majority of people, REGARDLESS of type of pain?

Answer 35

meta- analysis by Montgomery et al, 2000

Question 36

indications for hypnotic pain control? (7)

Answer 36

1) la allergy
2) history of failed LA in patients
3) needle phobia
4) emergency situations
5) treatment of phobia
6) has a role in managing chronic pain
7) any potentially unpleasant process

Question 37

how does hypnosis alleviate chronic pain?

Answer 37

draws attention away from pain, reduces sensation experienced

Question 38

role of acupuncture in management of pain?

Answer 38

• effective in chronic pain
• effective in post op pain

Question 39

how does acupuncture work? (3)

Answer 39

unsure on exact processes/ mechanisms by which this works could MAYBE be because of:
- contribution of expectancy effects
- via gate control theory
- due to endogenous opioid release (pain reducing chemicals in body, counteract pain sensation)

Question 40

what is CBT?

Answer 40

very effective, established psychological treatment theory

• treatment intensive
• 6 week course
• taught to pay less attention to pain, stop interpreting pain in a way which is causing them more pain in the first place
• identify and challenge some of the distorted cognition
  (pain source, pain length, pain sensation)
  increase patient self efficacy so they believe they are able to deal with the pain they are experiencing

Question 41

how does CBT work?

Answer 41

• cognitive restructuring
• reordering their thinkings
• coping skill training
• imagery + relaxation techniques
• reducing anxiety/ fear/ depression which exacerbate pain experience

Question 42

how can vigilance to pain make treatment of a patient more difficult?

Answer 42

patient in pain has impaired concentration
cant process things properly in a cognitive state
so
- keep communication clear + brief
- their attention will be interrupted by pain

Question 43

how can avoidance of pain make treatment of a patient more difficult?

Answer 43

patient will naturally avoid pain/ painful procedures
- avoidance of appointments
- when they do come in, come in worst oral health state
- avoidance manifests in shifting body posture, hands grasping, moving their legs in dental chair, moving mouth away from you

Question 44

how can pain manifest as anger and make clinical practice difficult?

Answer 44

patients may shout
be hostile
nothing to do with you
they are in a state of intense pain
due to frustration + distress

Question 45

how can we help reduce the adverse effects of their pain? (2)

Answer 45

1) involve the patient:
in decision making
provide them with enough info
PCA- give them power + control

2) make sense of their pain
what matter is the patient’s understanding- this informs their behaviour

Question 45

how can we help reduce the adverse effects of their pain? (2)

Answer 45

1) involve the patient:
in decision making
provide them with enough info
PCA- give them power + control

2) make sense of their pain
what matter is the patient’s understanding- this informs their behaviour