Psychology of Chronic Pain* Flashcards

Question

Describe how fear may affect pain.

Answer 1

* Extensive fear of increased pain or pain reoccurring is v common. * This can lead to avoidance of a range of activities, i.e. fear-avoidance model of pain: The fear of pain --> amplified perception (hypervigilance) --> pain avoidance behaviours --> disability and disuse --> higher pain

Answer 2

``` Pain Anger, Anxiety, Fear, Distress Impoverished mood Depression Increased perception of pain ```

Answer 3

``` Pain Activity Avoidance Progressive deconditioning Pain with decreasing activity Further activity avoidance Further deconditioning ```

Answer 4

CLASSICAL CONDITIONING • We might associate certain environment with the experience of pain. Anxiety plays a role too. An association of pain with going to dentist --> enhanced pain perception OPERANT CONDITIONING We may show ‘pain behaviours’ in response to pain stimuli e.g., grimacing, limping --> positively reinforced by those around us by giving sympathy and attention.

Answer 5

* Facial or audible expression (e.g., clenched teeth and moaning) * Distorted posture or movement (e.g., limping, protecting the pain area) * Negative emotions (e.g., irritability, depression) * Avoidance of activity (e.g., not going to work, lying down) - Pain behaviours are reinforced (doesn’t mean ‘caused’) through attention and acknowledgement they receive (e.g., being let off tasks) - Pain behaviours can lead to lack of activity and disuse through muscle wastage, reduced social contact.

Answer 6

• Discouraging avoidance of physical and social activities, offering assistance by generating multiple solutions to problems, and providing emotional support (e.g., sharing sad and pleasant events) (can lead to less pain and better physical functioning)

Answer 7

- Concise history - Examination - Biopsychosocial assessment - Identifying pain type (neuropathic/nociceptive/mixed), severity, functional impact, and context These will all inform selection of treatment options most likely to be effective (e.g. drugs specifically effective for neuropathic pain are ineffective for nociceptive pain, and vice versa)

Answer 8

MCGILL PAIN QUESTIONNAIRE 78 items in 20 groups: sensory, affective, evaluative, miscellaneous E.g., sensory: throbbing; chrushing; quivering E.g., affective: exhausting; fearful E.g., evaluative: annoying; miserable VERBAL RATING, BOX AND VISUAL ANALOG SCALES E.g. mark the word that best describes your present level of pain (mild, moderate, severe, excruciating) STaRT BACK TOOL Screening tool BEHAVIORAL ASSESSMENT Often not included in self-report measures May include: -Verbal/Vocalisation (moans, complaints) -Motor (grimacing, distorted gait) -Seek help/reduce pain (take med, visit doctor) -Functional limitation (resting, reduced activity)

Answer 9

• They tend to be long measures so limited use during a consultation but the patient may be asked to bring it back (e.g. McGill Questionnaire) • Verbal skills • Limited use of psychological scales when it comes to people whose first language is not English, those who come from diverse cultural backgrounds, people with communication difficulties  Visual analogue scales may be more appropriate. • Misrepresentation of pain: exaggeration or downplay of pain  Chronic pain is difficult to capture using verbal and numerical scales. • Subjective (someone's 8 can be someone else's 4)

Answer 10

-Direct observations are also subject to bias: Setting (clinical vs home), the purpose of assessment (benefit claim vs treatment assessment), the assessor characteristics can influence the assessment.

Answer 11

Malingering: conscious and purposeful faking of a symptom to achieve some benefit, usually financial Learn pain behavior, no suggestion of conscious deception, behaviors are unintended and can result from nociceptive input or environmental reinforcement. Most patients who display this are not aware of doing so, nor are they consciously motivated to obtain positive reinforcements with the behaviors.

Answer 12

MANAGEMENT MUST BE MULTIDIMENSIONAL • Pain management programmes cover pharmacological AND psychological interventions (must also have social, occupational dimensions) • Aims of these revolve around: -Improving physical and lifestyle functioning: e.g., improving muscle tone, self-esteem, addressing pain behaviours and secondary gains -Decreasing reliance on drugs -Increasing social support and family life

Answer 13

Cognitive methods Respondent methods Behavioral methods

Answer 14

-Based on principles of operant conditioning: pacing to break the overactivity-react cycle (Someone with chronic pain may have good days when pain is manageable, in which they feel they need to do anything they couldn't when feeling bad, so overactivity, leading to fatigue/pain next day, leading to rest and frustration, then easing of the symptoms, and again overactivity etc.)

Answer 15

To help individual identify and understand their thoughts/beliefs about pain and modify their ‘cognitions’ that may be exacerbating their pain experience.

Answer 16

Cognitive restructuring: identifying and challenging thoughts through Socratic questioning (“What evidence do you have to support your thoughts?”) Distraction (may have limited use in those with chronic pain); positive self-talk; pain acceptance CBT: relies on interaction between emotions, thoughts (cognitions) and behaviors

Answer 17

To modify the physiological system directly by reducing muscle tension.

Answer 18

* Decreasing stress and anxiety and therefore decreasing pain. * Progressive muscle relaxation (e.g. from head to toe focusing on different parts of body) * Biofeedback

Answer 19

Because oftentimes chronic pain patients may think "it's all in their head" if referred for psychological referral, so helpful to explicitly state the aims of the referral (i.e. increasing coping and improve QOL)

Answer 20

NOT HELPFUL | Patients need help understanding what role pain management plays in chronic pain.