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Pain Psych > Test 1 > Flashcards

Test 1 Flashcards

1
Q

The Problem of Pain

A

pain is the #1 reason to seek health care

pain is the #1 concern of patients with chronic
disease (e.g., cancer, arthritis)

pain can kill

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2
Q

What is pain?

A

Pain is a perception, an emotion, a social communication tool, a motivator of behaviour, affects psychological health and well being.

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3
Q

Pain as perception

A

People experience pain differently, pain depends on context example war vs civilian- Beecher study

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4
Q

Pain as emotion

A

Pain is fueled by social rejection, people feel pain internally not only externally, can have mental pain/ hurt. Social rejection Pain is reduced by Advil- eisenberger

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5
Q

Pain as social tool

A

Shared pain experience- experience pain more. - Martin Crying is used to communicate pain

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6
Q

Pain as motivator

A

Helps us avoid harm, changes our habits and helps us seek deport, pain is one of the largest motivators for behavior and main way we learn to avoid harm

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7
Q

How does pain affect our psychological health and wellbeing

A

Affects functional activities, causes social consequences, socioeconomic consequences and affects emotional functioning

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8
Q

Bedson and Croft

A

Discovered that injury doesn’t always equate with pain, those with arthritis, didn’t always knee pain and those without injury, have knee pain

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9
Q

What is pain

A

Is it a sensation, pain does not habituate, it gets better at responding, is it a drive state- homeostatic

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10
Q

Pain historical perspective

A

Aristotle (384-322 BC): pain is an emotion, in the heart

Galen (130-201): pain is a sensation, in the brain

Avicenna (980-1037): pain is an independent sensation from touch/temperature

Descartes (1596-1650): there exists a
“pain pathway” from the body to the brain; Pain is reflexive (part of lower brain)

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11
Q

Pain and ultilitarianism

A

Principe of Utility
1. Recognizes the fundamental role of Pain and Pleasure in human life.
2. Approves or disapproves of an
2. Ap onese basis of the amount of pain or pleasure brought about (“consequences”).
3. Equates the good with the pleasurable and evil with pain.
Pleasure and pain are capable of “quantification”
- and hence of measure.

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12
Q

Definition of pain

A

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

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13
Q

Duration of pain

A

Acute- seconds to minutes
Tonic- hours to week
Chronic - weeks to years

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14
Q

Pain as protection

A

Pain helps us respond to our environment - withdrawal reflex. Organism interacts with stimulus, which is either neutral or nociceptive(altering pain system) causes pain and action

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15
Q

Pain duration new

A

Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and researchers have placed the transition from acute to
chronic pain at 12 months. Others apply acute pain that lasts less than 30 days, chronic to pain as more than six months duration, and subacute as pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is “pain that extends beyond the expected period of healing.”

“acute-to-chronic pain transitioning”

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16
Q

Pain lumping vs splitting

A

Lumping- duration, classification, location, cause, clinical condition, sensitivity
Splitting- nocioceptive, neuropathic, nociplastic, mixed, visceral

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17
Q

Nocioceptive

A

Nocioceptive pain- neuronal cause, activating these nocioceptors give rise to perception of pain
Clinical conditions can have this pain- example arthritis

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18
Q

Neuropathic

A

Neuropathic- nerve injury- location can be in CNS, driven by a disease, diabetes

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19
Q

Evoked vs spontaneous pain

A

Evoked pain- stimulus causing pain, evoking a pain response
Spontaneous pain- just chilling and have pain- contnous, paroxysmal- specific attacks of pain example migrane, go though periods pf intense pain and no pain, breakthrough- reserved for cancer pain- continuous and spontaneous but have intense attacks, constant low level and then have attack

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20
Q

Paroxysmal vs breakthrough

A

paroxysmal- specific attacks of pain example migrane, go though periods pf intense pain and no pain, breakthrough- reserved for cancer pain- continuous and spontaneous but have intense attacks, constant low level and then have attack

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21
Q

Allodynia

A

Allodynia- painful but not meant to be- hurts when put on tshirt

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22
Q

Hyperalgesia-

A

Hyperalgesia- more pain response than would have to something that is already painfu

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23
Q

Dynamic

A

Dynamic- moving the injured part up and down
Neuropathic- sensitive to soft simulation, dynamic
opiod breakthrouhgh- lowers pain levels

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24
Q

paresthesia vs dysethsthia

A

paresthesia- tingling feeling/dysesthesia- tingling that hurts

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25
Q

paradoxical thermal sensations-

A

hot perceived as cold and vice versa

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26
Q

Aftersensation

A

Aftersensations- bang funny bone- have lingering pain

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27
Q

Allodynia and Hyperalgesia

A

Normal pain response- increase stimulus intensity- start to feel pain, increase intesnsity even more to evoke a pain response
When have an injury- normal pain response curve shifted to left- what was not painful is now painful- allodynia- As keep increasing intensity- evoke a pain response quicker
Allpydina- wasn’t painful before but now is
Hyperalgesia- was painful before but now the pain response is more intense

In sunburn Allodynia- put tshirt on and hurts
Hyperalgesia- slapping still hurts but hurts more, or temperature of shower- when sunburned pain response is more intense

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28
Q

Prevelance

A

Back pain most common
What are they dying of?- stress/ immune deficiency making mopre likely to die of cancer and cardiovascular issues

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29
Q

Somatosensation

A

sensory sensation activate perception- ex toucgh vs. pain- driven by nocioceptor
Somatic- skin, muscle, joint, bone- know most about this pain, different than a migraine
Visceral has own pain detecdtion system

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30
Q

Anesthesia vs analgesia

A

anesthesia- local vs general- decrease all sensation vs. analgesia- reduction of pain on

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31
Q

Pain vs nociception

A

pain vs. nociception(detection of danger cues when activate nocioceptor, different than perception of pain

32
Q

Treatment of Pain in Antiquity: Trephination

A

Drilling hole in to skull to relieve pressure and mental illness
Getting rid of the evil spirits

33
Q

Treatment of Pain in Antiquity: Theriac

A

Potions
Theriac- used for pain treatment, works cause has opium poppy- where opiods come from

34
Q

How Was Pain Treated in 1500 A.D.?

A

Willow bark- chew on it or lick the tree, has salicylic acid- natural ingredient of aspirin

Opium poppy- found in theriac and extract opium

35
Q

Analgesia

A

Analgesia – state of reduced awareness to pain

36
Q

Analgesics

A

Analgesics – substances that decrease pain sensation by increasing the threshold for painful stimuli. The do not affect somatosensation or consciousness.

Analegsics- affect pain awarness but not somatosensation

Non-opioids (NSAIDS, paracetamol, asprin)
Analgesics
Opioids (morphine, oxycodone)

37
Q

Anesthesia

A

Anesthesia – medications/drugs used to decrease all sensation (i.e., touch and pain).

Local anethetics- reduce all somatosensation in local area
General= put asleep

38
Q

Co-analgesics/adjuvants

A

Co-analgesics/adjuvants – drugs not originally intended for pain relief but reduce pain either alone or in combination with opioids(analgesics). Ex- ssri, tricyclic antidepressants- help neuropathic pain

39
Q

OPIates

A

Opiates
Class of drugs derived from the opium poppy/plant

Opium poppy: used for the relief of pain for several thousand years

40
Q

Opium

A

Opium
The juice of the opium poppy

Becomes brownish when it dries

Chemical compounds extracted from opium (i.e., alkaloids) used to produce opioid drugs

Opium or morphine- use as basis for building other opiates
Take directly out of poppy plant unmodified= opiates, if take this chemical and start changing it, anything that is synthesized using opiates- opioid (0xycodon)

41
Q

TYPES OF OPIOID DRUGS DERIVED FROM OPIUM

A

Illegal drugs (opium, heroin)- considered illegal because of spike of opium content, works extremely fast, very addicitive, quick onset that quickly fades, making more addictive

Legal drugs
(opioid medications; a.k.a. pain killers)

Natural opioids (i.e.,
opiates)- morphine, codeine
Semi synthetic opioids- oxycodone synthetic opioids- methadone, fentanyl

42
Q

Opioids - classification

A

Fentanly- considered very strong, need very little amount to cause toxicity
Get rid of withdrawal- keep constant stimulation at opiod centre
When inject and ingest opiates- get rid of spike in blood stream
Can use as transdermal patch- the skin slowly absorbs it, have no peaks and valleys- have steady state, but if remove it, can cause withdrawal- become physiologically dependent

Cant just cut cold turkey opiates- there is a specific regimen when over many weeks, slowly decrease the opiod medication, so you don’t cause withdrawal

43
Q

Opiate side effects

A

Designer
Dry mouth
Euphoria
Sedation
Itch
Gastro
Nausea
Eyes
Respiratory depression

Addiction- consequence of opiod use, euphoria leads to the addiction

44
Q

opioid “crisis”

A

Opioids offer clinical benefits, but come with potential harms
-misuse- ur medication- still using but using different using opiod as not prescribed, abuse-using opioid for things non intended for- ex high and addiction

Contribution of both illegal and/or prescription opioids
- opioid prescribing trends in Canada and USA- has steadly increased

Since 2016 there have been 44,000 opioid related deaths in Canada

In 2020 – 15 people died per day of opioid overdoses in Canada

94% of opioid-related deaths are accidental

Young people aged 15 – 24 have been most affected- steal from their family= abuse
Opiods= greatest tool against pain, especially chronic

45
Q

THE ROLE OF PHARMACEUTICAL INDUSTRY
Opioid crisis

A

Late 1990s, opioid marketing by pharma industry was aggressive
Specific types of opioids were marketed as less addictive than other medications

Opioid sales have quadrupled between 1990 & 2010 Mislead the public & prescribing physicians

Claimed that Oxycontin was less addictive than
other pain medications

In 2023, Sackler family(owned perdue pharmacy) ordered to pay 6 Billion over a decade to compensate families. Protected from civil lawsuits. Any family affected by this couldn’t sue this pharmacy company any further
Oxycontin- promoted as safe alternative
Before 90s- were hesitant
Perdue pharma made oxycontin- slow release oxycodone(strong opioid with lots of peaks and valleys) oxycodone- wrapped in contin(protective) and slow down the oxycodone if crush it up- gets rid of that confirmation, making it act like a drug(get high)

46
Q

OxyContin

A

Purdue taught its sales force that there were fewer “peaks and valleys” in oxycodone levels among patients taking OxyContin.
Fewer highs and lows meant less euphoria and fewer “comedowns.”
The chart showed the drug’s release over 12 hours as a smooth line,
with few ups and downs
Short acting- sharp rise and then comes down critical zone= pain relief- above= eurphoria, below = pain

Long lasting- rises slowly and doesn’t reach euphoria, was supposed to last 12 hours
Purdue used a LogRhythm scale to make it seem like this curve was ”flat”

47
Q

Naloxone

A

Antagonist of Opiates

Medication designed to reverse opioid overdose
Routes of administration: Intranasal or Intramuscular
Naloxone- counteracts opioid overdose, it blocks all recpetors kicking the opioid out and reversing its effects

48
Q

Aspirin

A

Willow bark (salicylic acid)

*mentioned in Dioscorides’ collection of cures – 80 A.D.

Bayer company
Aspirin= alsylic acid- asa- derived from salicylic acid

49
Q

NSAIDs

A

COX-1 and COX-2
Both are involved in increasing PGE2 activity, causing increased inflammation
COX-1 maintains protective layer of stomach
NSAIDs are dual inhibitors of COX- 1 and COX-2
NSAID inhibition of COX-1 contributes to stomach lining and ulcers
NSAIDS- non strodial anti-inflammatory drugs- inhibit cox-1 and cox2 enzymes

Main side effect= stomach issues, can cause ulcers because inhibit cox1( forms protective layer for stomach)
More interested in their ability to reduce cox2- arises when hurt ourselves, causing inflammation
Pge2- important for inflammation, associated with pain
Non selective- ihibit both

50
Q

COX-2 Inhibitor

A

Derived from NSAIDs
Selective inhibitors of COX-2 thought to have less gastrointestinal issues than NSAIDs
Discovered that COX-2 was involved in the synthesis of the prostaglandins that produce inflammation and pain
Controversy: Increased incidence of heart attack, stroke by up to 40%. Most removed from the market (Vioxx
Step function= Kaplan myer graph

51
Q

Common painkiller

A

NSAIDS, opioids analgesics, paracetamol Paracetamol- doesn’t decrease inflamatiion

52
Q

The WHO Analgesic Ladder for Cancer Pain

A

If pain occurs, there should be prompt oral administration of drugs in the following order: non- opioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain. To calm fears and anxiety, additional drugs – “adjuvants” – should be used. To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand”. This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective.
Step approach- start with least drastic then move up if not eorkinh
Ketamine= horse anetshetic

53
Q

Drug development process

A

Phase 0 animal trials, start with 5-20 compounds
Phase 1 small human trials, 2-5 compounds
Phase 2 larger human trial, 2 compounds
Phase 3- 1 compounds, larger human trial
FDA approved and market introduction

54
Q

RCT designs

A

Parallel- start with participants, randomized them and analyze
Crossover- both groups go through each condition, one at a time- carryover affect
Enriched design- screen patients, wield out those who have adverse effects or no effect, ramdomise from the ones that work

55
Q

Odds Ratios (and Relative Risk)

A

Relative risk= risk relative to all events- prob of event occurring compared to all events
Odds that something worked over odds that something didn’t
Looking at odds that something happened to odds that something that didn’t happen

Relative Risk
Relative Risk
Odds Ratio
Probability of Getting
Disease if exposed
Probability of Getting disease if not exposed
Probability of Outcome if on drug
Probability of Outcome if on placebo
Odds that the diseased were exposed
Odds the controls were exposed
Create 2 by 2 contingency table
Cases vs control
Exposed vs unexposed

56
Q

Odds Ratios (and Relative Risk)

A

Odds Ratio = Odds of pain reduction with Botox- include those no effect
Odds of pain reduction with placebo- include no effect
=85/32
21/93
= 85 X 93
21 X 32
= 7,905 672
= 11.76

Botox has an odds of pain reduction that is 12-fold greater than placebo

Note: these are not real data, and the numbers are used just to illustrate calculating the odds ratio
Ratio of 1= no difference, treatment didn’t work
Greater than one- treatment works by that amount
Less than one- treatment is less likely to work than placebo
When dividing 2 frcations- flip the numerator and denominator
Know how to set up table

57
Q

Number-Needed-to-Treat

A

How many ppl you need to treat before one person benefits above and beyond placebo
How to calculate- 1/ portion benefeting from treatment- portion benefiting from control
Lower NNT= works better

An example (acetaminophen against acute postoperative pain):

500/1000 patients taking acetaminophen had at least 50% pain relief 250/1000 patients taking placebo had at least 50% pain relief
NNT = 1

500/1000)  -	(	250//1000 )
58
Q

Number-Needed-To-Harm

A

Number of ppl need to give drug to before having adverse reaction
Can be minor or major

59
Q

Subjectivity vs objectivity of pain

A

Subjective- what the person feels, persons perception of their pain vs objective measures of pain- visual or quantifiable pain- cold water test

Subjective= feeling and perception
Objective- measurement of activity or reduction in ability

Why are objective measures better than subjective measures?- can be compared across participants, more reliable and easier to make conclusions Q2. Why are subjective measures better than objective measures?- can get at individual differences at pain and help us better understand perception of pain, pain itself is subjective
Objective metal- cant focus, slow thinking

60
Q

Subjectivity of Pain

A

Tissue damaging sihnalling- neuroceptors
Neuron and gila- send the signals via the white matter
Sensing pathway ends in cortex- decides what to do
Salience network- what we pay attention to, pain activated this
Brain has to cope with pain- activating motor and modulation pathways- endorphins and calechomines- regukate pain
Sensitivity and efficacy of these circuits- how we respond and feel pain

61
Q

Pain Threshold and Tolerance

A

NSAIDS- bring down at site of inflammation
The drugs make it into bloodstream- circulated through body- where it works_NSAIDS- localized to inflammation

Pain sensitivity measure- use pressure device, apply to localized region, measuee sensitivity, common for fibromyalgia- tender joints through body, sensitivity in the joint points
Cold pressor test- place hand in cold water- leave for amount of time and rate pain, or keep in till cant tiolerate
can do with heat as well- measure latency before they say pain

Start to feel pain= threshold
Can no longer deal with the pain- tolerance

What is time (i.e., latency) a proxy for? How long it takes for them to feel the pain Q2. Why do we need anything else?- yes ppl have different tolerances and thresholds, doesn’t apply to all pain types

Duschek et al., J. Psychophysiol., 2008

62
Q

Rating scales

A

Verbal pain intensity
Visual analogue scale
0-10 pain scale
Faces scale

when? (right now, average in the last week, maximum in the last week, etc.)
-in what context? (at rest, when standing, in the morning, etc.)

When around doctors, your pain usually reduces
These scales are very vague- hard to know what its acc asking

pegs”: worst possible pain”, “worst pain imaginable”,
“pain as bad as it can be”, “unbearable”, “excruciating”, etc.

63
Q

Gracely pain scale

A

Gracely pain scale, log scale
Pain that is milder- easier to make distinctions
When pain is more intense, harder to make distinction

64
Q

Problem with ratings- communication

A

Pain ratings can be used to communicate different things
Can communicate if drug worked based on scale- pain rating gets lower

65
Q

Problem with ratings, pegs

A

One can have more experiences with pain- a more vast scale- the pain ratings would look different than they actually are, hard to compare the ratings

Your pain experiences affect how you deal and rate pain, makes it less painful

Makes pain look different than actually is because the participants have a different worst pain experience, more pain experienced= larger graph

66
Q

Pain Ratings: Real vs. Imagined

A

Imagined pain is often greater than the actual pain except for childbirth- sample is very small for actual rating

67
Q

What’s Driving a Clinical Pain Score?

A

Factors affecting thr rating
Allpodynia painful when not usually
Hyperalgesia- pain greater than usual
Pain patients- one thing they wish to solve= sleep

Ongoing pain burning, stabbing
Allodynia
Hyper Algeria
Functioning

68
Q

FLACC Scale for Babies

A

Category
Scoring

Face
No particular expression or smile
Occasional grimace or frown, withdrawn, disinterested
Frequent to constant quivering chin, clenched jaw
Legs
Normal position or relaxed
Uneasy, restless, tense
Kicking, or legs drawn up
Activity
Lying quietly, normal position, moves easily
Squirming, shifting back Arched, rigid or jerking and forth, tense

Cry
No cry (awake or asleep)
Moans or whimpers; occasional complaint
Crying steadily, screams or sobs, frequent complaints
Consolability
Content, relaxed
Reassured by occasional touching, hugging or being talked to,
Difficult to console or comfort
Rating by Others: FLACC Scale for Babies
distractible
Each of the five categories (F) Face; (L) Legs; (A) Activity; (C) Cry;
(C) Consolability is scored from 0-2, which results in a total score between 0 and 10.
Designed by nurses for babies

69
Q

Facial Pain Scale

A

Facial Action Coding System (FACS)
-Paul Ekman
Facial action coding system- looks at face and codes for motions- muscle movement predicts the emotion, developed for emotions

70
Q

Pain descriptive

A

Sensory- sore hurting, heavy, affective- tiring, suffocating, vicious , evaluative- mild, annoying, distressing
Melzack- medial pain questionnaire and control gate theory
Found pain descriptors- ppl use similar words
Categorized the words – sensory, affective and evaluative
More sensory- how much and where
Affective= more emotional, psych

71
Q

McGill Pain Questionnaire

A

Pick 1 word from each category that best describes their pain or leave blank if no word
PPI- PARTIAL pain index- how is pain being described overall
Has outdated words, and cant use for all ages, also long
Short form May be more helpful for diagnosing and understanding similarities between conditions

72
Q

DN4 Neuropathic Pain Questionnaire

A

Neuropathic pain only
4 questions and interview
Hypoesthesia- reduced sensitivity
Brushing- aggravates area in neuropathic pain
Why is this so short?- used cinically

73
Q

Oswestry Disability Index

A

Subscales:
Pain Intensity
Personal Care ((walking, Dressing)
Lifting
Walking
Sitting
Standing
Sleeping
Social Life
Travelling
Employment / Homemaking

Measures function\
How much does pain interfere with functioning
Can be used clinically or research- use to see efficacy of drug

74
Q

Pain Catastrophizing Scale

A

Used primarily for research
How does person think and feel of pain
Helplessness- no hope, nothing they can do

Magnification-pain is worse than actually is
Rumination- obsessive thinking abt pain
Gives ideas into how anxiouys/ fearful about pain

75
Q

WOMAC Questionnaire

A

For osteoarthritis
How much pain do you have?
1. On walking over even ground
4. When seated or lying down
2. On going up or down stairs
5. When standing
3. At night in bed
SECTION B: How much stiffness do you have?
1. After waking up in the morning
2. During the rest of the day after sitting, lying down or resting
SECTION C: What degree of difficulty do you have…?
1. Walking down stairs
10. Getting out of bed
2. Walking up stairs
11. Removing stockings or socks
3. Getting up after sitting
12. Lying in bed
4. Standing
13. Getting in/out of the shower/bath
5. Picking up something from the floor
14. Sitting
6. Walking over even ground
15. Sitting/getting up from the toilet
7. Getting in and out of a car
16. Doing heavy domestic chores
8. Going shopping
17. Doing light domestic chores
9. Putting on stockings or socks
Answer_
marking one of the following options

76
Q

Psychophysics and QST

A

Quantitative sensory asseement- best way to quantify pain

Use machine- vary intensity and see how u feel it, lowers it then increases it again
Want to hone in on what pain threshold is
Looking at average of responses across trials

QST and Heat Hyperalgesia Change pain stimulus to find threshold
There us sine sensitization
The line= base temp/ skin temp

Pain Psych (5 decks)

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