Psychology of chronic pain Flashcards
Define pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described by the patient in terms of such damage
Define chronic pain
Pain which has persisted beyond normal tissue healing time
Describe the difference between acute and chronic pain
• 12 week duration
• Main difference is management:
- acute pain: addressing the cause of the pain
- chronic pain: addressing the effects of pain and finding ways to maximise function and quality of life
Describe the burden of chronic pain
- 20-50% of chronic pain sufferers have co-morbid depression
- 88% of patients with chronic pain have other chronic illnesses: most common is cardiovascular
- patients with chronic pain visit their GP twice as often as those without chronic pain
- Higher level of use of emergency and unscheduled care
Specificity theory
Direct causal relationship between pain stimulus and pain experience
Pattern theory
Stimulation of pain receptors produces a pattern of impulses and only if they pass a certain threshold they are transmitted to the cortex which leads to pain perception
Describe the gate control theory
- Pain is multidimensional and a subjective experience of perception
- Both ascending psychological inputs and descending psychological inputs are involved
- Gating mechanisms in the dorsal horn of the spinal cord open (permits) or close (inhibits) the transmission of pain impulses
What opens the gate?
- Inactivity/poor fitness
- Poor pacing (behavioural)
- Anxiety/ depression/ hopelessness
- Catastrophizing
- Worrying about the pain
What closes the gate?
- Appropriate use of medication
- Massage
- Heat/cold
- Positive coping strategies
- Relaxation
- Exercise
What are the pros of the gate control theory of pain?
• Provides a physiological explanation for how psychological factor affect pain perception
What are the cons of gate control theory?
Evidence is mixed
• Large amount of evidence showing the psychological factors on pain experience
• Physiological evidence is mixed
• lack of evidence of a gate
What are the psychosocial aspects of pain?
- Anxiety
- Pain behaviour
- Meaning
- Secondary gains
- Previous experience and conditioning
- self efficacy
- Fear
What are our cognitions?
Our thoughts, beliefs and the way we think impacting of our experience of pain
What is pain self efficacy?
Refers to one’s confidence regarding one’s ability to function effectively while in pain
What are the three components of catastrophizing?
- Rumination
- Magnification
- helplessness
Rumination
Focus on internal and external information
Magnification
Overestimating the extent of a threat
Helplessness
Underestimating resources
Describe the relationship between anxiety and acute pain
- anxiety increases acute pain but when acute pain is treated, anxiety drops leading to further reduction in pain
- Cycle of pain reduction
Describe the relationship between anxiety and chronic pain
- Therapy has little impact on chronic pain leading to increased anxiety which then leads to increased pain
- Cycle of pain increase
Describe the fear avoidance model of pain
- fear of pain
- Amplified perception (hyper vigilance)
- Pain avoidance behaviours
- Disability and disuse
- Higher pain
Describe classical conditioning and pain
- We might associate certain environments with the experience of pain
- An association of pain with going to the dentist -> enhanced pain perception
- Anxiety plays a role
Describe operant conditioning
- We may show pain behaviours in response to pain stimuli
* Grimacing or limping positively reinforced by those around us by giving sympathy and attention
What are the negative implications of pain behaviours?
• Can lead to lack of activity and disuse through muscle wasting and reduced social contact
Good social support and pain
- Discouraging avoidance of physical and social activities
- Offering assistance by generating multiple solutions to problem
- Providing emotional support
Assessment of pain sign guideline 136
- Biopsychosocial assessment
- Identifying pain type
- Severity
- Functional impact
- Context
McGill pain questionnaire
- 78 items in 20 groups: sensory, affective, evaluative, miscellaneous
- Sensory: is the pain throbbing? crushing?
- Affective: exhausting, fearful
- Evaluative: annoying, miserable
What are the limitations of self report measures?
- Tend to be long - limited use during consultation
- Verbal skills - do they fully understand?
- Limited use of psychological scales when people’s first language is not English or they have communicational difficulties
- Misrepresentation of pain: exaggeration or downplay of pain
Describe the management of chronic pain
• needs to be multidimensional
• Pharmacological and psychological interventions
• Goals of programmes revolve around:
- improving physical and lifestyle functioning
- decreasing reliance on drugs
- increasing social support and family life
What are behavioural strategies of management of chronic pain?
- Based on principles of operant conditioning
* Pacing to break the overactivity-rest cycle
Describe cognitive methods of management of chronic pain
- Aim is to help the individual identify and understand their thoughts/beliefs about pain and modify their cognitions that may be exacerbating the pain
- e.g. cognitive restructuring - identifying and challenging thoughts through socratic questioning (what evidence do you have)
- E.g distraction; positive self talk, pain acceptance
Describe the respondent methods of management of chronic pain
- Aim: to modify the physiological system directly by reducing muscle tension
- Decreasing stress and anxiety therefore reducing pain
- Progressive muscle relaxation
- biofeedback
