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Medicine Unit 5 > Psychology of pain > Flashcards

Psychology of pain Flashcards

1
Q

what is pain

A

a percept
aversive and unpleasant
sign of actual or potential tissue damage

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2
Q

components of pain

A

sensory
affective
cognitive
motivational

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3
Q

why do we have pain

A

constant feedback about body enabling us to make adjustments
warning sign that something is wrong and results in protective behaviour
triggers help seeking behaviour

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4
Q

3 stages of pain

A

acute
pre-chronic
chronic

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5
Q

acute pain

A

adaptive
typically related to identifiable injury of disease
self-limited and resolves over hours to days or in time frame associated with healing
usually associated with objective autonomic features
heightened sympathetic activity

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6
Q

pre-chronic pain

A

critical time when the person either begins to heal and overcome the pain or lose hope and develop feelings of helplessness that can constitute chronic pain

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7
Q

chronic pain

A

time for normal healing has elapsed but the pain will continue
often in absence of any detectable tissue damage
vague descriptions of pain and inability to describe pains timing and localisation
lacks signs of heightened sympathetic activty
depression and anxiety common

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8
Q

which pathways transmit pain from periphery to brain

A

transduction
transmission
modulation
perception

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9
Q

transduction

A

afferent nerve endings translate noxious stimuli into pain messenger impulses
bee sting

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10
Q

3 types of primary afferents in transduction

A

A-beta
A-delta
C-fibers

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11
Q

A-beta

A

carry information related to touch

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12
Q

A-delta

A

information related to pain and temperature

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13
Q

C-fibers

A

information related to pain, temperature and itch

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14
Q

nociceptors

A

receptors in the kin and organs that sense heat, mechanical and chemical tissue damage

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15
Q

noiception

A

process of perceiving pain

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16
Q

transmission

A

process where impulses are sent to dorsal horn of the spinal cord
along the sensory tracts top the brain

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17
Q

2 finer systems in transmission

A

A-delta fibers: fast,sharp,well localised sensation, first pain
C-fibers: duller,slower onset often poorly localised, second pain

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18
Q

modulation

A

process of dampening or amplifying the pain related neural signal
descending inhibitory input dampens or entirely blocks incoming nociceptive signals at the gate of the dorsal horns

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19
Q

label the image of the descending pain modulation pathway

A
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20
Q

gate control theory

A

Melzack and Wall
neural gate in the spinal cord that regulates the experience of pain
pain isn’t result of straight through sensory channel
physiological and psychological causes

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21
Q

descending central influences from the brain

A

sends information related to the psychological state of the individual to the gate
behavioural state
emotional state
previous experience or self-efficacy in dealing with the pain

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22
Q

early pain theories

A

biomedical framework
pain is automatic response to external factor
tissue damage causes the sensation of pain
pain sensations has a single cause
psychosocial factors have no casual influence

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23
Q

what was pain categorised into

A

psychogenic pain
organic pain

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24
Q

psychogenic pain

A

considered to be all in the patients mind
was a label given to pain when no organic basis could be found

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25
Q

organic pain

A

regarded as real pain
label given to pain when some clear injury could be seen

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26
Q

pain perception

A

conscious awareness of the experience of pain
mediated by small diameter myelinated A-delta and non-myelinated C fibers
chemicals released following injury produce pain by direct stimulation of by sensitisation of nerve endings

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27
Q

what does perception result from

A

interaction of transduction, transmission,modulation, psychological aspects and other individual circumstances

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28
Q

how does GCT differ from earlier pain models

A

pain is a perception
individual actively interprets and appraises the stimuli
variations in pain perceptions is understood in terms of degreee of opening and closing gate
GCT suggests many factors involved not one cause

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29
Q

what opens the gate

A

physical factors
emotional factors
behavioural factors

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30
Q

physical factors for opening the gate

A

injury
activation of large fibers

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31
Q

emotional factors for opening the gate

A

anxiety
worry
depression

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32
Q

behavioural factors for opening the gate

A

focusing on the pain
boredom

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33
Q

what closes the gate

A

physical factors
emotional factors
behavioural factors

34
Q

physical factors for closing the gate

A

medication
stimulation of small fibers

35
Q

emotional factors for closing the gate

A

happiness
optimism
relxation

36
Q

behavioural factors for closing the gate

A

focus
concentration
distraction
involvement in other activities

37
Q

physiological gate open and gate closed

A

C/A delta fibers active

A beta fibers active

38
Q

medical gate open and gate closed

A

extent of injury and insufficient medication

sufficient medication

39
Q

cognitive gate open and gate closed

A

focus on pain

distraction and reinterpretation of pain

40
Q

emotional state gate open gate closed

A

anxiety, fear, stress and depression

happy optimistic relaxed rested prior experience of pain

41
Q

behavioural personality gate open gate closed

A

introvert

extrovert

42
Q

hysteria

A

tendency to exaggerate symptoms and use emotional behaviour to solve problems

43
Q

hypochondriasis

A

tendency to be overly concerned about health and to over report body symptoms

44
Q

what do chronic pain suffers score high in

A

depression

also hysteria and hypochondriasis

45
Q

factors that may affect pain

A

biology of pain pathways
neuroplasticity in these pathways
learning and conditioning
cognitive aspects of pain
emotional aspects of pain
memories of pain
sociocultural milieu in which pain is experiences

46
Q

types of conditioning

A

classical conditioning
operant conditioning

47
Q

classical conditioning

A

associating dentist with pain due to past experiences

48
Q

operant conditioning

A

pain behaviour may be positively reinforced which may itself increase pain perception

49
Q

role of cognition

A

catastrophising: rumination, magnification, helplessness
meaning: pain has different meanings to different people
attention: attention to pain can increase pain perception and distraction reduces pain

50
Q

role of affect

A

anxiety
fear

51
Q

anxiety in the role of affect

A

worry and anxiety relate to pain perception
acute pain increases anxiety
chronic pain treatment ineffective increases anxiety and increases pain

52
Q

fear in the role of affect

A

fear of pain and fear avoidance beliefs
exacerbate existing pain and turn acute pain to chronic

53
Q

psychological circle of pain

A

untreated pain that persists can cause fear and anxiety
if pain fails to resolve patients will become depressed and lose confidence in themselves and their doctors
sleeplessness may exacerbate the problem

54
Q

age as a psychosocial factor in experience of pain

A

people get older there is a progressive increase in report of pain and decrease tolerance

55
Q

gender as a psychosocial factor in experience of pain

A

women report more frequently
with more migraines, tension headaches, pelvic pain, facial pain and lower back pain
gender differences already apparent by adolescence and in medicines differential response to pain reports of women admen

56
Q

pain as an interpersonal construct

A

pain is experience by the person
response to pain, particularly chronic pain can be influenced by these

57
Q

psychogenic management strategies

A

placebo
hypnosis
stress
cognitive

58
Q

pharmacological management strategies

A

opiates
spinal block
anti-inflammatory drugs
aspirin

59
Q

placebo

A

may activate endorphin mediated pain control
sometimes inhibited by opiate antagonists

60
Q

hypnosis

A

alters brains perception of pain
control infected by opiate antagonists

61
Q

stress

A

both opioid and nonopioid mechanisms
clinically impractical and inappropriate

62
Q

cognitive

A

may activate endorphin mediated pain control system
limited usefulness for severe pain

63
Q

opitates

A

bind to opioid receptors in peri-aqueductal gray and spinal cord
severe side effects due to binding in other brain regions

64
Q

spinal block

A

rugs block pain signals in spinal cord
avoids side effects of systemic administration

65
Q

anti-inflammatory drugs

A

block prostaglandin and leukotriene synthesis at site of injury
major side effects

66
Q

aspirin

A

blocks prostaglandin synthesis at the site of injury
doesn’t block leukotriene synthesis

67
Q

types fo pain relief intervention

A

stimulaiton
surgical
psychogenic
pharmacological

68
Q

types of stimulation

A

TENS/mechnical
acupuncture
central gray

69
Q

types of surgical

A

cut peripheral nerve cord
rhizotomy, cutting dorsal root
frontal lobotomy

70
Q

TENS

A

tactile or electrical stimulation of large offers blocks or alters pain signal to brain
segmental control, must be applied at site of pain

71
Q

acupuncture

A

similar to TENS but sometimes affected by opiate antagonists

72
Q

central gtay

A

electrical stimulation activates endorphin mediated pain control systems blocking pain signal in spinal cord

73
Q

cutting the peripheral cord and rhizotomy

A

create physical break in pain pathway
considerable risk of failure or return of pain

74
Q

frontal lobotomy

A

disrupts affective response to pain
irreversible and risky, severe effects on behaviour

75
Q

4 distinct strands of psychological pain management

A

operant-behavioural therapy
cognitive behavioural therapy
mindfulness based therapy
acceptance and commitment therapy

76
Q

operant behaviour therapy

A

focus on extinguishing maladaptive behavioural responses
fostering adaptive responses
uses reinformcenet or punishment contingencies
alters associations between threat value of pain and physical behaviour
good for: complex regional pain syndromes, chronic lower back pain and mixed chronic pain, whiplash associate disorders

77
Q

cognitive behavioural therapy

A

biopsychosocial approach to behavioural and cognitive repossess to pain
involves psychoeducation, relaxation strategies, behavioural pacing and cognitive restricting
effective in those with chronic pain
negative in those who have pain disorders

78
Q

what is CBT good for

A

cancer pain
complex pain syndromes
pain with HIV and AIDS
fibromyalgia
IBS

79
Q

stress and pain

A

limbic system hypothalamic pituitary adrenal axis involved in stress response have been implicated
dysfunction has been implicated in chronic pain conditions such as rheumatoid arthritis and fibromyalgia

80
Q

stress reduction

A

mindfullness learning
good for arthritis, chronic pain, fibromyalgia and IBS
progressive muscle relaxation, stretch based relaxation, deep breathing and autogenic training are all relaxation techniques to be learned
biofeedback to modify biological aspects of pain that produce changes in physiological parameters

81
Q

ACT

A

acceptance and commitment therapy
developing psychological flexibility
focuses on development of acceptance of mental events and pain and learning to cease avoidance and other problematic behaviours
good for musculoskeletal paonii and whiplash

Medicine Unit 5 (14 decks)

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