Psychology of Chronic Pain Flashcards
Describe the management of pain
Acute pain: address the cause of the pain
Chronic pain: address the effects of pain and finding ways to maximise function and QOL
Describe the multi-level burden of chronic pain
Starts with patients with chronic pain: trying to find relief, feeling hopeless and can lead to depression.
Significant others/family: sharing frustrations with their loved ones, feeling stressed and worried.
Healthcare providers: share frustration with patients as pain reports continue.
Society: lost productivity and disability benefits.
Describe the Gate-Control Theory of pain
Pain involves both ascending physiological inputs and descending psychological inputs.
‘Gating’ mechanism in dorsal horn of spinal cord that ‘opens’ (permits) or ‘closes’ (inhibits) the transmission of pain impulses.
Things that open the gate: physical (inactivity/poor fitness), behavioural (poor pacing), emotional (anxiety/depression), cognitive (catasrophizing the pain)
Things that close the gate: medication, massage, heat/cold, positive coping strategies, relaxation, exercise etc.
Describe the benefits and disadvantages of the Gate-Control Theory
Benefits:
- Provide physiological explanation for how psychological factors affect pain perception
- Moves away from ‘sensation’ to ‘perception’
Cons:
- Evidence is mixed
- Large amount of evidence showing impact of psychological factors on pain experience by physiological evidence is mixed
- Lack of direct evidence of a ‘gate’
- Does not explain why the same event can be interpreted by different people as more or less painful
Describe the Biopsychosocial Model of pain
More holistic approach than the Gate-Control Theory.
Includes cognitive, affective and behavioural components of pain. Viewing pain as a dynamic and reciprocal interaction with biological, psychological and sociocultural variables that will shape a person’s response to pain (eg. Pain behaviour, past experiences, fear, self-efficacy etc.).
Describe the Cognitive-Behavioural perspective on pain
Emphasises on people’s own unique beliefs, appraisals and coping methods along with sensory, affective and behvioural contributions in the formation of pain perception.
The way the pain is interpreted by the individual (taking in their own patterns of thinking/beliefs) and how they appraise this (focus attention/not focus) can form the pain perception.
Describe methods of pain assessment and their limitations
Can be divided into:
- Pain intensity self-report (most common)
Can be verbal (ranking a set of descriptors), numerical or visual analogue (marks pain as spatial analogue) scales.
Problems include:
- Time, which is limited during a consultation, most patients have to go away and bring it back
- If patient lacks verbal skills or if the person’s first language is not English (visual scales more appropriate)
- Difficulty in identifying chronic pain on verbal/numerical scales
- Can misrepresent patient’s pain if they exaggerate or downplay the pain
- Pain intensity by observational scales
- Pain distress
Describe the Scottish Model in the management of chronic pain
Level 1 (self-management): Advice and information about pain and what to do about it. Advice can be accessed from home/community settings.
Combination of activity/relaxation, non-opioid painkillers and support from 3rd sector organisations.
Level 2 (primary care): Help from GP/therapist needed.
Assessment of pain, advice given, medications, exercise programmes, alternative therapies etc.
Level 3 (secondary care): More specialist help from chronic pain management service.
Hospital based pain clinics/services. MDT of consultants, nurses, physio, psychologists, pharmacists, occupational therapists, psychiatrists etc.
Level 4 (tertiary care): Highly specialised help with intensive pain management programmes
What are the goals of management of chronic pain?
- Improve physical and lifestyle functioning
- Decreasing reliance on drugs
- Increases social support and family life
Describe cognitive-behavioural management of chronic pain
CBT – aims to alter intesnive, frequency or forms of maladaptive unhelpful thinking styles, emotional responses and cooping patterns to improve pain-related functioning.
Describe the functional management of chronic pain
ACT (acceptance and commitment therapy) - focusing on function and workability of behavioural responses to facilitate psychological flexibility and improve QOL in the presence of pain (analysing whether behaviours in response to pain-related fear lead people towards or away from what is important to them)
