Psychological Aspects of Pain and Pain Management Flashcards
- psychological aspects of the pain experience - physiological effects of acute pain - physiological effects of chronic pain - psychological methods of pain control - mechanisms of pain control - power of placebo
could pain be a physical sensation?
physical sensation with physical cause (tissue damage, pain is a warning system which tells body something that is wrong)
is pain a psychologically mediated SENSATION?
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
how pain as a subjective experience impacts behaviour:
aversive subjective experience
influenced by cultural learning
disrupts ongoing behaviour
motivates individual to stop the pain
pain as an all encompassing body?
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)
*operative definition of pain!
pain is whatever the experiencing person says it is, existing whenever he/ she says it does
IASP on pain
- 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
what is acute pain?
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
what is chronic pain?
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
differences between acute and chronic pain table:
3 early pain theories?
1) organic pain
2) psychogenic pain
3) biomedical framework
what is the early pain theory of biomedical framework?
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)
what was the early pain theory of psychogenic pain?
‘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
what was the early pain theory of organic pain?
‘real pain’ when a clear injury could be seen
1956: what did the beecher study in say about trauma being the only cause of pain?
(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
are medical treatments for acute pain as effective when treating chronic pain?
no
following war, scientists found what % of amputees felt pain years after losing the limb?
65% - 85%
burning + throbbing sensation
(so some part of mind registers pain which isn’t just affected by the physicality)
following war, scientists found what % of amputees felt pain years after losing the limb?
65% - 85%
burning + throbbing sensation
(so some part of mind registers pain which isn’t just affected by the physicality)
1965: what did the Gate Control Theory Melzack & Wall show?
‘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
what do large/ small fibres carry in the Gate Control Theory Melzack & Wall?
large fibres- carry sensation for touch, vibration, position perception
small fibres- carry sensation for pain + temperature
pain is nerve function of which fibre?
small fibre
how does anaesthetic work?
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
how does an anaesthetist check that anaesthetic has gone through?
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
which 3 and how do the following have an effect on the information sent to the gate? (3)
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
what is McGill pain questionnaire?
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?
what is the pain scale?
what is the pain scale?
scales help people quantity
smiley faces used for children- helps us understand how they feel
how can cultural definitions of physical ailments be misleading?
phrases like:
‘butterflies in stomach’
‘ heart skipped a beat’
are all down to individual interpretation
which 2 type of descriptors allow us to differentiate between irreversible and reversible pulpitis?
1) affective descriptors - sickening, how it makes them react
2) temporal descriptors - ‘constant/ rhythmic’ - duration
different types of pain (5)?
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
placebo pain control:
there are responders + responders
no typology to determine who will be which (No tests or examinable personality factors)
what 2 things can affect if someone will have a response/ non response to placebo? (2)
1) expectancy effects (verbal or beliefs, expectations)
2) affected by interaction with clinician
the communication style/ enthusiasm they have received from the clinician
how can patients get more pain control?
manage your own experience of pain much more adequately
via patient controlled analgesia (PCA)
is PCA effective? (3)
- associated with better analgesia
- better patient satisfaction
- at most the same amount of drug is used as conventional administration by clinician so SAFE
hypnosis as pain management?
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
what source showed that hypnotic suggestion relieved pain for the majority of people, REGARDLESS of type of pain?
meta- analysis by Montgomery et al, 2000
indications for hypnotic pain control? (7)
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
how does hypnosis alleviate chronic pain?
draws attention away from pain, reduces sensation experienced
role of acupuncture in management of pain?
- effective in chronic pain
- effective in post op pain
how does acupuncture work? (3)
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)
what is CBT?
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
how does CBT work?
- cognitive restructuring
- reordering their thinkings
- coping skill training
- imagery + relaxation techniques
- reducing anxiety/ fear/ depression which exacerbate pain experience
how can vigilance to pain make treatment of a patient more difficult?
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
how can avoidance of pain make treatment of a patient more difficult?
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
how can pain manifest as anger and make clinical practice difficult?
patients may shout
be hostile
nothing to do with you
they are in a state of intense pain
due to frustration + distress
how can we help reduce the adverse effects of their pain? (2)
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
how can we help reduce the adverse effects of their pain? (2)
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
