Week 11 Flashcards

1
Q

What is pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of tissue damage, or both.

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2
Q

What are the three dimensions of pain?

A

Sensory- discriminative: how intense the pain in, the location and different qualities (likert scale) as well as duration of pain.

Affective-motivational: the unpleasantness; fight/flight response; the affective component; run-away/confront

Cognitive-evaluative: appraisal; catastrophic, benign; interpretation of the pain > the meaning of the pain

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3
Q

Define acute pain.

A

Short duration, elicited by injury that goes away when tissue heals.

Biomedical approaches are most effective i.e. paracetamol/opioids

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4
Q

Define chronic pain.

A

Often brought about by injury but worsened by other factors.

This pain interferes with functioning and cannot be explained by pathology.

Biomedical approaches often not effective but highly sought after.

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5
Q

What are some of the more common categories of chronic pain?

A

Inflammatory diseases e.g. arthritis

Neoplastic diseases (analgesia may help)

Neuropathic pain e.g. nerve damage and neurological disease (does not respond well to pain killers)

Non-specific musculoskeletal back pain

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6
Q

Describe the Specificity Model of Pain.

A

Also knowns as the rope and bell model of pain, this theory suggests that pain follows a linear transmission.

Largely debunked as it cannot explain:

  • why injuries are sometimes noticed later
  • phantom pain
  • why non-pharmacological methods can relieve pain
  • pain during absence of tissue pathology
  • chronic pain

Newer versions of this model consider:
prior experience
attention/expectation
mood/anxiety/depression
neurochemical/structural changes
genetics
sensitisation (peripheral and central)

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7
Q

Describe Gate Control Theory (Melzack & Wall)

A

This model posits that the CNS is not simply the receiver and transmitter of pain signals.

It suggests that there is a gating mechanism in the spinal cord (substantia gelatinosa of dorsal horn) which receives and modulates signals.

Many brain areas are involved; there’s no fixed pain centre.

Both ascending and descending signals can modify pain.

Clear relevance of the biopsychosocial model

Pain can be modified by a variety of psych and physical signals

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8
Q

Describe the Neuromatrix Model of Pain (Melzack; Gatchel)

A

This model posits that the neural network is genetically pre-determined and modified by experience i.e. injury, chronic stress, pathology

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9
Q

What are the ways that pain-related-fear can lead to pain and disability?

A
  1. negative appraisals: misinterpretation of bodily signals (fear<>avoidance) causing ‘disuse’ syndrome
  2. Avoidance can be negatively reinforced and lead to fewer activities
  3. Fewer opportunities to correct wrongful expectancies i.e. that pain is a physical threat
  4. Avoidance <> disuse syndrome leads to deconditioning and detriments to physical systems
  5. Linked with hyper-vigilance > anxiety
  6. Pain related fear may be connected with increased psychophysiological reactivity
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10
Q

What are the predictors of chronic pain?

A

Maladaptive attitudes and beliefs
Social supports
Emotional reactivity
Job dissatisfaction
Substance abuse
Prevalence of pain behaviours
Psychiatric diagnoses

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11
Q

In the context of pain, describe malingering.

A

This is making up or exaggerating pain. Fishbain (1999) suggested that prevalence of this is between 1-10%, however it is very difficult to accurately identify

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12
Q

How is pain treated differently in the DSM5?

A

Prior editions of the DSM referred to Pain Disorder. The DSM5 changed this to Somatic Symptom Disorder with predominant pain.

Chronic pain can occur with or without diagnoses.

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13
Q

Which demographics are most likely to experience pain?

A

Minority groups
The elderly
Low SES
Women (gender roles, bias, sex hormones)
More common in children

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14
Q

Describe pain catastrophisation (Sullivan et al).

A

Exaggerated negative orientation to noxious stimuli comprising three components:

Tendency to magnify negative aspects

Rumination/ability to disengage from thoughts of pain

Helplessness

Accounts for 7-30% of pain

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15
Q

Describe some of the limitations of pain catastrophisation.

A

Relies on memory/self-report
Assumes cognitive and affective reactions are consistent from one situation to another
Chicken + egg issue
Evidence that it is both state and trait
Not only implicated in pain i.e. anxiety/depression

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16
Q

What are the best ways to measure pain?

A

Common assessment methods include:

interview
rating scales
questionnaires
observation
psychological

17
Q

What are the key dimensions of pain?

A

Pain severity-quality
Disability-functioning
Mood-emotion
Cognitive-coping

18
Q

When measuring pain, what is involved in choosing an appropriate measure?

A

Purpose
Fit with conceptualisation
Variable assessed
Population
Method of delivery
Copyright
Costs
Reliability/Validity
Other considerations

19
Q

What are the two main approaches to managing pain?

A

Medication and other technological approaches (ideal for acute pain)

Physical rehabilitation and psychological approaches (ideal for chronic pain)

20
Q

What are the two main medical interventions used to treat pain?

A

Invasive:
- repair/replace tissue i.e. surgery
- interrupt or eliminate pain signal at peripheral nerve
- Deliver analgesic on target organ or brain directly

Non-invasive:
- medications/opioids

21
Q

What is the best psychological approach to managing pain?

A

Ideally a multidisciplinary approach that considers CBT, physical and educational approaches

58% reduction in medical costs post-MDT approach

A meta-analysis (Hoffman et al) found psych treatment on back pain was better than control groups and that CBT and self-regulatory approaches were effective