Week 11 Flashcards
What is pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of tissue damage, or both.
What are the three dimensions of pain?
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
Define acute pain.
Short duration, elicited by injury that goes away when tissue heals.
Biomedical approaches are most effective i.e. paracetamol/opioids
Define chronic pain.
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.
What are some of the more common categories of chronic pain?
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
Describe the Specificity Model of Pain.
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)
Describe Gate Control Theory (Melzack & Wall)
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
Describe the Neuromatrix Model of Pain (Melzack; Gatchel)
This model posits that the neural network is genetically pre-determined and modified by experience i.e. injury, chronic stress, pathology
What are the ways that pain-related-fear can lead to pain and disability?
- negative appraisals: misinterpretation of bodily signals (fear<>avoidance) causing ‘disuse’ syndrome
- Avoidance can be negatively reinforced and lead to fewer activities
- Fewer opportunities to correct wrongful expectancies i.e. that pain is a physical threat
- Avoidance <> disuse syndrome leads to deconditioning and detriments to physical systems
- Linked with hyper-vigilance > anxiety
- Pain related fear may be connected with increased psychophysiological reactivity
What are the predictors of chronic pain?
Maladaptive attitudes and beliefs
Social supports
Emotional reactivity
Job dissatisfaction
Substance abuse
Prevalence of pain behaviours
Psychiatric diagnoses
In the context of pain, describe malingering.
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
How is pain treated differently in the DSM5?
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.
Which demographics are most likely to experience pain?
Minority groups
The elderly
Low SES
Women (gender roles, bias, sex hormones)
More common in children
Describe pain catastrophisation (Sullivan et al).
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
Describe some of the limitations of pain catastrophisation.
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
What are the best ways to measure pain?
Common assessment methods include:
interview
rating scales
questionnaires
observation
psychological
What are the key dimensions of pain?
Pain severity-quality
Disability-functioning
Mood-emotion
Cognitive-coping
When measuring pain, what is involved in choosing an appropriate measure?
Purpose
Fit with conceptualisation
Variable assessed
Population
Method of delivery
Copyright
Costs
Reliability/Validity
Other considerations
What are the two main approaches to managing pain?
Medication and other technological approaches (ideal for acute pain)
Physical rehabilitation and psychological approaches (ideal for chronic pain)
What are the two main medical interventions used to treat pain?
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
What is the best psychological approach to managing pain?
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
