The Puzzle of Pain Flashcards
The pain experience depends on?
Multiple factors:
Context - placebo, expectation, pain beliefs.
Mood - depression, catastrophizing, anxiety
Cognitive set - Hypervigilance, attention, distraction, catastrophizing
Chemical and structure - neurodegeneration, metabolic.
Injury - Peripheral/central sensitisation
Environmental load
An aversive, personal, subjective experience, influenced by cultural learning, the meaning of the situation, attention and other psychological variables, which disrupts ongoing behaviour and motivates the individual to attempt to stop the pain (Melzack & Wall, 1988)
Why do we have pain?
- It provides constant feedback about the body enabling us to make adjustments to how we sit or sleep or eat
- A warning sign that something is wrong resulting in protective behaviour
- It triggers help-seeking behaviour
- It has psychological consequences and can generate fear and anxiety
Types of pain
• Acute.
Adaptive and meaningful (pain from cuts, burns, surgery and other injuries)
Warning system- tissue damage
Short duration and likely to achieve relief
• Chronic.
When enough time for normal healing has lapsed (3mths) but the pain has not subsided. Often without any observable damage
Pain itself is the disease
Relief is not likely
Gate control theory
Melzack & Wall (1965)
- There is a neural “gate” in the spinal cord that regulates the experience of pain
- Pain is not the result of a straight-through sensory channel
- There are both physiological and psychological causes
- Pain is a perception and experience rather than a sensation
- The individual no longer just responds passively to painful stimuli but actively interprets and appraises the stimuli
Information sent to the neural gate (theory)?
Behavioural state (e.g. attention, focus on the source of pain)
Emotional state (e.g. anxiety, fear, depression)
Previous experience or self-efficacy in dealing with the pain (e.g. I have experienced this before and I know it will go away with a lie down and a paracetamol)
Gate Control Theory
Pain is the result of the relative activity in large and small diameter nerve fibres
Large fibres(carry sensory information) = Close the gate (inhibits information flow)
Small fibres (carry noxious information) Open the gate (facilitates information flow)
Pain and anxiety cycle
Pain causes anxiety which bocks the descending pathways = more pain
Fear of pain causes anxiety
Anxiety about potential pain causes pain
Sensory descriptors of orofacial pain? Sensory, affective and evaluative
Associated with the sensory descriptors –
“throbbing, boring, sharp”
Affective descriptor “Sickening”
Temporal descriptors “constant and rhythmic”
Sensory – what the pain physically feels like – location, intensity, duration, quality (e.g., burning, throbbing)
Affective – what the pain feels like emotionally – is it worrying, frightening
Evaluative – what the subjective overall intensity of the pain experience is (e.g., unbearable, distressing)
SOCRATES
- Site - Where is the pain? Or the maximal site of the pain
- Onset - When did the pain start, and was it sudden or gradual? Include also whether if it is progressive or regressive.
- Character - What is the pain like? An ache? Stabbing?
- Radiation - Does the pain radiate anywhere?
- Associations - Any other signs or symptoms associated with the pain?
- Time course - Does the pain follow any pattern?
- Exacerbating/Relieving factors - Does anything change the pain?
- Severity - How bad is the pain?
Chronic Oro-Facial Pain examples:
TMJ pain (facial arthromyalgia) – most common
Atypical facial pain (PIFP)
Burning mouth syndrome
Atypical odontalgia (PDAP)
What is pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
