The Puzzle of Pain Flashcards
What’s the biopsychosocial approach to understanding pain
- Cognitive, motivational, judgemental and psychologic processes influence the transmission of nociceptive impulses at the first synapse and all subsequent levels
- Influential factors include learning, personality, past experience, culture, and conditioning
Describe the ‘subjectivity of pain can be due to environmental load’ approach to understanding pain
- An aversive, personal, subjective experience which disrupts ongoing behaviour and motivates the individual to attempt and stop the pain
- Influential factors include cultural learning, the meaning of the situation, attention, and other psychological variables.
What’s the definition of pain
‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’
What are factors affecting pain experience
- Context (placebos)
- Cognitive set
- Injury
- Nociceptive
- Chemical and structure neurodegeneration
- Mood
What can pain trigger?
What are its psychological consequences?
- Triggers help seeking behaviour
- Has psychological consequences and can generate fear and anxiety
Components of the pain experience
- Sensory
- Neurophysiological and biochemical
- Motivational
- Behavioural
- Lifestyle impact
- Information processing
What is acute pain
- ‘Adaptive and meaningful’
- Pain from cuts, burn, surgery etc.
What is chronic pain
When three months for normal healing has lapsed but the pain has not subsided
Whats the gate control theory of pain (Melzack and Wall 1965)
- A neural ‘gate’ in the spinal cord regulates pain experience
- There are physiological and psychological causes to pain (not just sensory)
- Pain is a perception and experience, not just a sensation
- Patients don’t just respond passively to stimuli but actively interprets and assesses
What does information sent to the gate depend on
- Behavioural state
- Emotional state
- The previous experience/self-efficacy in dealing with the pain
Explain what happens after large fibre stimulation
Large fibre stimulation → normal somatosensory input → gate closed
Explain what happens after a small fibre stimulation
Small; fibre stimulation → associated with pain (noxious information) → gate opened
What are endorphins
‘Happy hormones’ that stop pain affecting us
Whats the relationship between pain and anxiety
Bi-directional
Big booty beeeaaaches
What are informal techniques of controlling pain
- Avoiding negatives
- Reframing the sensation
- Relaxation and lowered pain threshold
- Distraction
- Massaging the area
- Apply pressure or stretching mucosa before injection.
Understanding pain: SOCRATES
- Site – where is the pain/maximal site of the pain?
- Onset – when did it start? sudden, gradual progressive, regressive?
- Character – what is it like? ache, stabbing, sharp, dull?
- Radiation – does the pain radiate anywhere?
- Associations – any other signs or symptoms with it?
- Time course – does the pain follow a pattern?
- Exacerbating/relieving factors – does anything change the pain?
- Severity – how bad is the pain (scale of 1 to 10)
Chronic orofacial pain cluster into a single group
- TMJ pain (facial arthromygalgia) – most common
- Atypical facial pain (PIFP)
- Burning mouth syndrome
- Atypical odontalgia
What are the 2 axes in the diagnostic criteria for temporomandibular disorders
- Physical signs and symptoms
- Psychosocial symptoms
What model is best for dealing with chronic pain
- The biophysical model
- Should be a collaborative, problem centred approach that is empathetic
- Should be in a clear and calm manner for the patient
What’s the biomedical framework for understanding pain
- Pain is an automatic response to an external factor
- Tissue damage causes the sensation of pain - sensation has a single cause
- Psychological factors have no influence
- Pain can be organic (injury can be seen) or psychogenic (injury cannot be seen)
