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After the MSA > Psychology of chronic pain > Flashcards

Psychology of chronic pain Flashcards

1
Q

Define pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described by the patient in terms of such damage

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2
Q

Define chronic pain

A

Pain which has persisted beyond normal tissue healing time

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3
Q

Describe the difference between acute and chronic pain

A

• 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

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4
Q

Describe the burden of chronic pain

A
  • 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
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5
Q

Specificity theory

A

Direct causal relationship between pain stimulus and pain experience

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6
Q

Pattern theory

A

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

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7
Q

Describe the gate control theory

A
  • 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
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8
Q

What opens the gate?

A
  • Inactivity/poor fitness
  • Poor pacing (behavioural)
  • Anxiety/ depression/ hopelessness
  • Catastrophizing
  • Worrying about the pain
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9
Q

What closes the gate?

A
  • Appropriate use of medication
  • Massage
  • Heat/cold
  • Positive coping strategies
  • Relaxation
  • Exercise
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10
Q

What are the pros of the gate control theory of pain?

A

• Provides a physiological explanation for how psychological factor affect pain perception

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11
Q

What are the cons of gate control theory?

A

Evidence is mixed
• Large amount of evidence showing the psychological factors on pain experience
• Physiological evidence is mixed
• lack of evidence of a gate

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12
Q

What are the psychosocial aspects of pain?

A
  • Anxiety
  • Pain behaviour
  • Meaning
  • Secondary gains
  • Previous experience and conditioning
  • self efficacy
  • Fear
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13
Q

What are our cognitions?

A

Our thoughts, beliefs and the way we think impacting of our experience of pain

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14
Q

What is pain self efficacy?

A

Refers to one’s confidence regarding one’s ability to function effectively while in pain

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15
Q

What are the three components of catastrophizing?

A
  • Rumination
  • Magnification
  • helplessness
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16
Q

Rumination

A

Focus on internal and external information

17
Q

Magnification

A

Overestimating the extent of a threat

18
Q

Helplessness

A

Underestimating resources

19
Q

Describe the relationship between anxiety and acute pain

A
  • anxiety increases acute pain but when acute pain is treated, anxiety drops leading to further reduction in pain
  • Cycle of pain reduction
20
Q

Describe the relationship between anxiety and chronic pain

A
  • Therapy has little impact on chronic pain leading to increased anxiety which then leads to increased pain
  • Cycle of pain increase
21
Q

Describe the fear avoidance model of pain

A
  • fear of pain
  • Amplified perception (hyper vigilance)
  • Pain avoidance behaviours
  • Disability and disuse
  • Higher pain
22
Q

Describe classical conditioning and pain

A
  • 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
23
Q

Describe operant conditioning

A
  • We may show pain behaviours in response to pain stimuli

* Grimacing or limping positively reinforced by those around us by giving sympathy and attention

24
Q

What are the negative implications of pain behaviours?

A

• Can lead to lack of activity and disuse through muscle wasting and reduced social contact

25
Q

Good social support and pain

A
  • Discouraging avoidance of physical and social activities
  • Offering assistance by generating multiple solutions to problem
  • Providing emotional support
26
Q

Assessment of pain sign guideline 136

A
  • Biopsychosocial assessment
  • Identifying pain type
  • Severity
  • Functional impact
  • Context
27
Q

McGill pain questionnaire

A
  • 78 items in 20 groups: sensory, affective, evaluative, miscellaneous
  • Sensory: is the pain throbbing? crushing?
  • Affective: exhausting, fearful
  • Evaluative: annoying, miserable
28
Q

What are the limitations of self report measures?

A
  • 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
29
Q

Describe the management of chronic pain

A

• 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

30
Q

What are behavioural strategies of management of chronic pain?

A
  • Based on principles of operant conditioning

* Pacing to break the overactivity-rest cycle

31
Q

Describe cognitive methods of management of chronic pain

A
  • 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
32
Q

Describe the respondent methods of management of chronic pain

A
  • Aim: to modify the physiological system directly by reducing muscle tension
  • Decreasing stress and anxiety therefore reducing pain
  • Progressive muscle relaxation
  • biofeedback

After the MSA (22 decks)

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