Wedding and Stuber: Chronic Pain

Question 1

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Basic biological warning mechanism, signals physiological harm, increases awareness, and calls for an action or response (withdrawing a hand from a flame). Subjective nature since there is no reliable tests or biomarkers of chronic pain. Has sensory and emotional dimensions.

Answer 1

Pain

Question 2

Brief duration, generally has a known etiology, most cases associated with tissue damage, resolves when healing is complete, minimal impact on individual’s life. Fear and anxiety are initial emotional responses (serves to motivate care-seeking and limitation of movement). Examples: bone fractures, sprains, puncture wounds, childbirth, various acute disease states, post-surgical pain

Answer 2

Acute pain

Question 3

Pain lasting 6 months or longer or pain that persists beyond the expected time of healing. Persistent, resistant to treatment, many cases last for entire lifetime. Often does not signal tissue damage or physical harm. Associated with changes in the CNS and has a significant impact on physical and emotional well-being. Examples: low back pain, postherpetic neuralgia after shingles, osteoarthritic pain, fibromyalgia.

Answer 3

chronic pain

Question 4

Since pathophysiology is unknown, goal of treatment is to (blank) pain severity and (blank) function (not “fix” the pain). Bedrest, cessation of usual activities, care seeking, and use of analgesics appropriate adaptive responses to acute pain.

Answer 4

reduce; improve

Question 5

Avoidance of activities and care seeking are maintained by (blank) factors. As pain transitions from acute to chronic, physiological, social, and environmental factors come to play a more prominent role in the maintenance of pain behaviors.

Answer 5

nociceptive

Question 6

The process of detection and transmission of pain signals from the site of injury to the CNS.

Answer 6

nociception

Question 7

Noxious stimulus (thermal, mechanical, or chemical) is converted to nerve impulses by receptors called (blank). These are specifically sensitive to pain-enhancing substances associated with inflammation.

Answer 7

nociceptors

Question 8

results from tissue damage (caused by mechanical, thermal, or chemical distress). Examples: burns, cuts, bruises, bone fractures, appendicitis, pancreatitis.

Answer 8

nociceptive pain

Question 9

results from damage to a peripheral nerve or to from a dysfunction in the CNS, occurs in the absence of tissue damage. Can result from direct damage to nerves (cutting, stretching, or crushing injuries), from inflammation, from pressure (tumor infiltration), compression or entrapment by damaged spinal disks, join disorders, or scar tissue. Described as sharp, shooting, burning, lancinating. Often associated with abnormal sensations such as “electric shocks” or “pins and needles.”

Answer 9

neuropathic pain

Question 10

• Pain has direct 1:1 relationship with degree of injury.
• Pain intensity is determined by both physiological AND psychological variables.
• Transmission of pain-related nerve impulses is modulated by a gating mechanism in the dorsal horn of the spinal cord.
• Central and peripheral factors could open and close the gate (facilitate or inhibit transmission of pain-related nerve impulses).
• Large diameter nerve fibers inhibit transmission, small diameter fibers facilitate transmission.
• Central factors such as attention, mood, attributions, and expectations were proposed as modulators of pain perception. Example: attention directed toward pain → opens gate; attention directed away from pain → closes gate.

Answer 10

Gate control model

Question 11

• Emphasizes dynamic interactions between biological, psychological, and social variables in chronic pain which are continuous and reciprocal.

Answer 11

BPSS model

Question 12

• Acute pain behaviors (although initiated by traumatic injury or disease) are reinforced by interpersonal and environmental factors.
• Continuous reinforcement over time leads to patient developing pain (or illness) behaviors.
• Treatment paradigm based on extinguishing specific pain behaviors (e.g. excessive rest or requests for medications) and positively reinforcing adaptive behaviors (e.g. resumption of normal daily activities).

Answer 12

operant conditioning model

Question 13

• Integrated principles of operant behavior modification with cognitive theory and therapy.
• Premise is that perceptions of the world are filtered through personal history, beliefs, expectations, and attributions.
• Cognitions influence perceptions, emotions, and behavioral responses of experiencing pain

Answer 13

cognitive behavioral model

Question 14

List the biological, psychological, and social components of pain according to the BPSS model:
Biological components:
Psychological components:
Social components:

Answer 14

ascending and descending neural pathways and biochemical processes.

attention, thoughts, emotions, expectations, beliefs, and attributions.

sociocultural expectations, interpersonal interactions that shape responses to pain

Question 15

Describe the components of treatment suggested by the cognitive-behavioral model of pain

Answer 15

Develop techniques for redirecting attention away from pain, help patients learn coping skills for managing pain, integrate coping skills into everyday life, and formulate plans for relapse.

Question 16

Emotional problems that are often comorbid with chronic pain

Answer 16

depression

alcohol/substance abuse

Question 17

Addiction to opioids among patients prescribed opioid analgesics for pain is (blank). “Drug-seeking” behaviors (pseudoaddiction) such as taking pain medications faster than prescribed, requesting an increase in dosage, or obtaining pain medication from more than one doctor may reflect nothing more than (blank) pain. Pseudoaddiction commonly resolves when pain is adequately managed.

Answer 17

uncommon; poorly controlled

Question 18

state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time

Answer 18

tolerance

Question 19

state of adaptation manifested by a drug-class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, or administration of an antagonist.

Answer 19

physical dependence

Question 20

primary, chronic neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving

Answer 20

addiction

Question 21

address the consequences of living with pain and teach techniques and strategies for managing pain and improving daily function. Primary interventions include: behavioral (operant) therapy, cognitive-behavioral therapy (CBT), and self-regulatory therapies such as biofeedback, meditation, and self-hypnosis.

Answer 21

psychological interventions

Question 22

• Premise is that frequency of behavior could be increased or decreased by modifying environmental contingencies.
• Behavior frequency increased by positive or negative reinforcement.
o Positive reinforcement works by providing a reward when (and only when) a particular behavior occurs.
o Negative reinforcement works by contingently withdrawing an aversive stimulus when and only when the behavior occurs.
• Behavior frequency decreased by punishment or extinction procedures.
o Punishment works by contingently administering a negative stimulus when and only when a behavior occurs.
o Extinction decreases the frequency of a behavior by discontinuing whatever was reinforcing it.

Answer 22

behavioral therapy

Question 23

• Techniques that patients learn for self-management of pain.
• Include: diaphragmatic breathing, progressive and passive relaxation, imagery, meditation, autogenic phrases, hypnosis and self-hypnosis, and biofeedback.
• All techniques aim to reduce stress, increase physical relaxation, and focus attention.

Answer 23

self-regulatory techniques

Question 24

addresses how patients perceive and understand their pain and what expectations and hopes they hold for treatment, control of pain, and for the future.
• Also addresses the personal losses that co-occur with chronic pain, and patients’ emotional responses to pain and loss.

Answer 24

CBT

Question 25

addresses musculo-skeletal contributions to pain and promotes general conditioning for strength and endurance.

Answer 25

physical therapy

Question 26

include adjuvant analgesics, neurolytic techniques, spinal steroid injections, spinal facet joint injections, medial branch nerve blocks, spinal cord and peripheral nerve stimulators, and spinal analgesic infusion pumps.

Answer 26

medical management therapies