THE BIOPSYCHOSOCIAL MANAGEMENT OF CHRONIC PAIN

Question 1

what is pain?

Answer 1

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 2

what is recurrent pain?

Answer 2

pain which comes and goes

Question 3

what is acute pain?

Answer 3

short-term pain

Question 4

what is chronic pain?

Answer 4

long-term pain

Question 5

what criteria makes pain long term pain?

Answer 5

6 months or more/ extends beyond the expected period of healing

Question 6

what is the pain gate theory?

Answer 6

Nerves from all over the body run to the spinal cord, which is the first main meeting point of the nervous system. In the spinal cord we have a series of gates into which messages about pain arrive from all over the body.
The hypothesis is that these gates can sometimes be more open than at other times. This is important because it is through these gates that messages from your body pass towards your brain.
this is why sometimes we can be more/less aware of pain

Question 7

what can open the pain gates?

Answer 7

emotional states
being tense
lack of activity/reduced fitness
focussing attention on pain
boredom

Question 8

what is central sensitisation?

Answer 8

an increased responsiveness of nociceptors in the central nervous system to either normal or sub-threshold afferent input resulting in hypersensitivity to stimuli.

Question 9

what are the 2 types of central sensitisation?

Answer 9

allodynia

hyperalgesia

Question 10

what is allodynia?

Answer 10

Occurs when an individual experiences pain with things that are not normally painful, nerves in the area are sending messages to a brain which is in a state of heightened reactivity producing a sensation of pain & discomfort

Question 11

what is hyperalgesia?

Answer 11

Occurs when a stimulus that is typically painful is perceived as more painful than it should- heightened reactivity produces pain that is amplified.

Question 12

what could be the possible causes of central sensitisation?

Answer 12

Changes in the dorsal horn of the spinal cord & in the brain, particular at the cellular level, such as at receptor sites.
Strokes & spinal injuries which cause damage to CNS

Question 13

what are some drug treatments for chronic pain management?

Answer 13

paracetemol
NSAIDS
tricyclic antidepressants
opioids if low and intermittent

Question 14

describe the persistent pain cycle?

Answer 14

persistent pain–>being less active –> loss of fitness/weak muscles/joint stiffness –> create a ‘no go’ list of things you think you can’t do –> sleep problems/tiredness –> stress/fear/anxiety/anger –> medication side effects–> weight loss or gain –> negative thinking/fear of future –> depression/mood swings –> time off work/money worries/relationship concerns

Question 15

how does pain affect life?

Answer 15

work chores hobbies mobility weight eating habits sleep relationships children finances housing negative thoughts

Question 16

what is maladaptive behaviour?

Answer 16

negative behaviour like turning to drugs and alcohol

Question 17

do expectations play a part in chronic pain?

Answer 17

People with negative beliefs about their pain can experience greater suffering

Question 18

describe the relationship between pain and depression?

Answer 18

Patients appraisals of the impact of their pain on their lives and their sense of control over their pain determines the pain-depression relationship.
Those patients who believed they could still function despite their pain and those who believed they could maintain some control did not become depressed

Question 19

how can CBT help with chronic pain?

Answer 19

it challenges unhelpful thoughts to develop more helpful thoughts and new behaviours

Question 20

what are some psychological approaches to working with chronic pain?

Answer 20

CBT
mindfulness
acceptance and commitment therapy
compassion-focussed therapy

Question 21

describe the link between childhood trauma and chronic pain?

Answer 21

Research has shown that prolonged anxiety, hyper vigilance, and fearfulness associated with early trauma can lead to pain behaviour
48% of chronic pain patients report childhood physical or sexual abuse.