The puzzle of pain Flashcards
Define pain
An unpleasant SENSORY AND EMOTIONAL experience associated with actual or potential tissue damage or described in terms of such damage
What is the most common cause of dental pain?
Tooth ache
Chronic dental pain
What can heighten the pain response?
Anxiety Depression Mood Previous bad experiences Genetics Neurochemical and structural changes Sensitisation
How does the biomedical framework describe pain?
Describes Pain as an automatic response to an external factor
Tissue damage causes the sensation of pain
The pain sensation has a single cause
Psychological factors have no causal influence
In the biomedical framework what was organic pain?
regarded as “real pain” when some clear injury could be seen
In the biomedical framework what was Psychogenic pain?
“all in the mind” when no organic basis could be found
How did Melzack & Wall define pain?
As 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
How did Broome & Llewelyn define pain?
There is now compelling evidence that cognitive, motivational, judgemental and psychologic processes … from learning, personality, past experience, culture and conditioning among other factors influence the transmission of nociceptive impulses at the very first synapse and at all subsequent levels
How did Crossley define pain?
His body, taken over by pain, comes to have agency. ‘It is a demon, a monster … Pain is an “it”’. In this way, severe pain and illness leads the individual to lose their ‘normal occupancy of everyday reality, producing ‘alienation’ and an ‘existential vacuum’ in which s/he feels ‘cut off from the outer world’, isolated and disintegrating.
How did McCaffrey define pain?
“Pain is whatever the experiencing person says it is, existing whenever he/she says it does”
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
It is essentially a defence mechanism
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
What is a key way of managing pain?
Creating a distraction
What are the 2 types of pain?
Acute
Chronic
Define acute pain
Adaptive and meaningful pain from cuts, burns, surgery and other injuries
Define chronic pain
When enough time for normal healing has lapsed (3mths) but the pain has not subsided. Often without any observable damage
Describe some features of acute pain
A warning system Represents tissue damage Message – do something about this! Short duration Care and relief likely Suffering recognised
Describe some features of chronic pain
May or may not be associated with tissue damage – pain itself is disease
Long duration
No end in sight
Care and relief not likely
‘Psychosomatic’
Suffering may be dismissed – it’s all in your head!
Is pain only induced physically?
No it can be phycologically induced or even imaginery
Are medical treatments used to treat pain effective for chronic pain?
No they are usually only effective again acute pain
How many amputees suffer from phantom limb pain?
65% - 85%
Name the theory Melzack & Wall introduced in 1965
The gate control theory
Describe the gate control theory
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
What information is sent to the gates in the gate control 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
What do large diameter nerve fibres sense?
Sensation of pressure
What can we do to block the pain experience?
Massage the area so that the mechanoreceptors are stimulated
What does the gate control theory say?
Pain is the result of the relative activity in large and small diameter nerve fibres
What does the gate control theory say large fibres do?
They carry sensory information and close the gates which inhibits the flow of information
What does the gate control theory say small fibres do?
Carry noxious information and open the gates to facilitate the flow of information
Where does the descending inhibitory pathway come from?
Your limbic system that controls your emotions
Why does a well functioning psychologically functioning patient not experience pain?
Because their descending pathways inhibits the pain response
Why might an anxious patient experience pain?
Because their descending pathway is impaired
Describe some informal techniques we can use to control pain
Avoid negatives ‘Reframing’ sensation NEVER say you won’t feel anything! Relaxation and lowered pain threshold Distraction Massage the area – chronic pain Apply pressure or stretch mucosa prior to injection
What does Lautch’s research say
He says the phycological factors work together with your pain amplification states and environmental factors to produce pain
What are some chronic oro facial pain?
TMJ pain (facial arthromyalgia) – most common
Atypical facial pain (PIFP)
Burning mouth syndrome
Atypical odontalgia (PDAP)
What mnemonic do we use to make a pain diagnosis?
SOCRATES
What does SOCRATES stand for?
Site Onset Character Radiation Association Time course Exacerbating/Relieving factors Severity
what are the components affect the pain experience?
Sensory-discriminative Neurophysiological/biochemical Motivational-affective Behavioural Lifestyle impact Information processing
