week 11 - pain and pain management Flashcards
What is the commonsense view of pain? (S.5)
- The average person on the street thinks pain is
* A symptom of underling disease or damage
What are some drawbacks of the commonsense view of pain?
does not account for
- phantom limb pain: when indivisuals get their leg amputated they can still feel pain in that area and also feel as though they still have their leg
- disproportionate levels of pain: cannot explain that individuals with the same chronic illness undergo different levels/frequency of pain
- psychological predictors of pain: people who are experiencing depression/anxiety are more likely to experience more pain than others
What is the most common/known definition of pain?
unpleasent sensory and emotional experience that is associated with actual tissue damage, or described in terms of such damage
What are the three components of pain according to IASP?
- Sensory (discriminative) - when you feel pain and do something about it
- Motivational (affective) - emotional component of pain a
- Cognitive (evaluative) - thoughts and thinking of pain affect your experience of pain
What are the classifications of pain?
- nociceptive pain
- pain that is formed from interations of neurons -
- characteristed by short sharp localised pain (somatic) and dull diffused pain (visceral) - neuropathic pain
- pain stimulus that dammages peripheral/CNS
- shingles, diabetic neuropathy, burning, tingling - idiopathic/psychogenic pain (non-nociceptive)
- researchers indicate there is no such thing and it is purely ones perception `
Are women or men more likely to experience pain? Is the highest prevalence age group for the gender the same?
- women more affected by chronic pain
* prevalence peak differs between gender
What are some consequences individuals experience from chronic pain?
- Persistant complaints of pain
- Pain behaviours
- Disrupted daily activities
- Disrupted occupational, social, recreational activities
- Altered sleep patterns
- High anxiety/depression
- High use of drugs/medical procedures
- Loneliness, high risk of suicide
- Does not correspond well with commonsense view of pain
- Chronic pain: theres not really underlying damage but the pain is still there
What were the two early theories of pain - specificity and pattern theory?
- Specificity pain theory:
- theory that pain travels directly from sensory pain receptors, through pathway in spinal cord to brain
- Perception of pain is a different system
- Pattern theory: percetipn and actual pain is from the same system but pain is felt with certain intensity or pattern of stimulation
What are some limitations with the early theories of pain?
Does not account for disproportionate experiences of pain
What is the new theory - the gate control theory of pain?
- Discovered by Patric wall and ronald malzek
- Scientific theory about the psychological perception of pain
- Explains pain as a process of ascending inhibition - i.e. pain experienced as nerve pathways go up from body -> CNS
- Based on touch sensation - if you hurt your arm, automatic reaction is to rub the arm
- Rubbing the arm (touch sensation, afferent impulses) going into CNS
- If there is lots of touch sensation going through particular spinal nerve at the same time, the touch sensation blocks the pain impulses
- This therefore results in pain impulses can’t get through from the periphery to the spinal cord -> LESS PAIN EXPERIENCED
- Pain is function of balance between information travelling into spinal cord through large and small nerve fibres
- Attention plays a BIG ROLE in how you experience pain
what determines if the gate for pain is opened or closed? i.e. experience low or high pain? give an example
Pain fibres + other peripheral fibres (touching, rubbing, putting cold water) +brain ( how much you are focussing on the pain) = ACTUAL PAIN EXPERIENCED
example: * Burn myself - skin pain fibres (+6) + other peripheral fibres - cold water reduces pain (-2) + from brain - not focussing on pain very much due to exam tomorrow (-3) = + 1
* T.F + 1 pain value goes to transmission cells
* + 1 pain from transmission cells goes to brain
* T.F GATE IS CLOSED - i.e. experiences only low pain
How is alpha and C fibre different in terms of myelin, pain sensation, CNS connection, response to impulse?
- alpha A fibre:
- myleinated
- pain sensation: sharp and localised
- CNS connection : thalamus and motor sensory cortex
- reposnse to impulse: fast - C fibre
- unmyleinated - slow
- dull, unlocalised, burning, throbbing
- CNS connection: brainstem, limbic system, thalamus, hypothalamus
- reponse to impulse: effects on mood, emotion motivation
Which fibre is associated with chronic pain?
- C fibre associated with chronic pain
- C fibre produces more diffuse pain
- this explains why people experienceing chronic pain experiences alterations in mood, depression, loss in motivation
What is the neuropathic theory?
- Developed my Melzack
- Developed theory from gate theory
- CNS (brain and spinal cord) where pain is produced
- multiple parts of brain and spinal cord work together in response to stimuli from the body or enviro
- 2 main assumptions
- CNS ( brain and spinal cord) is what produces pain NOT tissue damage
- Various parts of the CNS work together to produce pain
Is neuromatrix or the gate theory more supported by research?
- Gate theory more supported
- Theory that is currently used
- Neuromatrix very complex and still not yet proven
Give an example of how the gate control theory has been put to practise?
- Virtual reality and pain distraction
- Attention plays a big role in experience of pain
- Patients use VR to distract themselves from pain/anxeity during medical procedures
- Believes that VR actually changes the way brain processes pain - not just during the procedures
What is the fear avoidance model of pain?
- Pain originates from injury/strain -> painful experience
- The ongoing impact is going to depend on how your going to deal with the painful experience
- Are you going to catastrophes about it or not?
using the fear avoidance model (see notes) provide an example of someone taking the catotrophising route when interpreting their pain
injury on leg -> painful experieence -> catrophosiing (because i hurt my leg this is the end of the world because i wont be able to go anywhere -> fear of movement (fear of moving my leg incase i hurt it) -> avoidance (avoid doing anything involving my leg like going to places, moving around) -> disability and depression (further injury on my other leg as i avoided using my njured one so all the weight has been put on the other leg that caused it to be injured)
using the fear avoidance model (see notes) provide an example of someone taking the non-catotrophising route when interpreting their pain
injury-> painful experiences -> non-catrophising (ill be okay, this isnt too serious) -> confrontation (im going to go to the physio to get some exercises and get better) -> recovery
What is fear-avoidance model of pain usually used for?
Used to explain how acute pain leads to chronic pain
What are the three cognitive factors that influence the process of how acute pain -> chronic pain?
- Attitudes and beliefs about CAUSE and MEANING of pain
- Expectancies of the OUTCOME
- Self-efficacy about the ability to deal and control with pain
Gives some examples of MALADAPTIVE ATTIUDES/BELIEFS that lead to the onset of chronic pain?
- My pain won’t get better
- Uncontrollable
- Pain comes from permanent tissue damage
- Pain is warning that I should not engage in normal activities
catotrophising pain: i.e. there is nothing i can do about it
What specific pain problem does this theory strongly support?
- Ppl with lower back pain
- Decreased pain/disability for people with lower back pain that goes to intervention/seek help LESS 6 months of experiencing onset of pain
- Less evidence of success for decrease pain for ppl who seek help/intervention MORE 6 months of experiencing pain
- This is because thoughts/habits about pain are very strongly ingrained
Does gender influence the amount of pain reported? what factors influence these findings?
- overall men less likely to report pain than women
- male researchers: men more likely to report pain
- female researchers: men less likely to report pain
How does age influence perception of pain? - which age group experiences chronic pain more and why?
- Older people more diagnosed with chronic pain
- Older people have stronger threshold to pain - more likely to have C fibre input (NON-myleinated fibre -> diffuse slow reaction to pain) T.F associated with more diagnosed chronic pain
- Younger adults use BOTH C and A fibre input
What is the pain perception usually seen within children? Do we know?
- Difficult to understand as researchers usually do self-report
- Difficult to get accurate self-report results from children
How does culture influence the perception of pain - in particular the way they express pain?
- White/european cultures more likely to report pain than non-european cultures
- Traditional ABO cultures less likely report lower back pain -> they believe that LBP is just a process of aging and they believe they should just deal with it
How does personality influence perception of pain? Which traits associated with high report of pain?
- High lvls Neuroticism and introversion more likely to report high lvls pain
Relationship between ppl with depression and chronic pain?
- Ppl with depression more likely report chronic pain
* May be due to less engagement in PA and loss of personal control
What other disorders/symptoms are associated with high reports of chronic pain?
- anxiety
- substance use disorder
- psychiatric disrders
Why do we need to assess the type of pain someone is experiencing? Slide 31
- Differnential diagnosis - determine what type of treatment you will have (rehabilitation, surgery)
- Determine what type of pain control you will go under
- Treatment success
What technique of pain assessment is the most commonly used?
self report questionaires
What is the most frequently used pain questionnaire today?
- Mccill questoniare
- mcgill - gives indication what neural pathway is involved and thus type of pain individual is experiencing
- e.g. when individual chooses sharp cutting pain -> A fibre input -> acute pain
- e.g. when individual chooses dull aching pain -> C fibre input -> chronic pain
what different parts are included within the mcgill questionaire?
part 1: where the pain is located
part 2: what type of pain it is
part 3: how the pain changes overtime
part 4: how strong the intesnity pain is
What are the two types of observational methods for assessing pain?
- Observation in everyday activities -> parents/family reports lvl of activity done by the individual
- Pain related facial expressions - individuals facial expression is observed to determine whether or not he/she is being genuine or exaggurating about their pain
- Only used for acute pain
What are the two types of pain inventions used?
- Pharamalogical
- Analgesics - opioids (morphine), non-opioids
- Opioids only used for cancer patients as high chance of addiction
- Non-opiods includes ibuprofen, aspirin -
- risk of tolerance and additicton , long term effects to stomach
- Non-opioids includes drugs that control pain indirectly - antidepressants, sedatives -
- risk of functional capacity and physical dependance - can also reach ceiling effect (where individual has reached maximum levels and the drug is no longer affective)
- Because depression influences/increases perception of painn - targeting emotions can indirectly improve pain experience
- Placebo effects
- Analgesics - opioids (morphine), non-opioids
- Psychological treatments (slide 43)
- CBT - theory that cognitions affect feelings -> cognitive restructuring to alter feelings towards pain -> improve pain experience
- Main intervention used
- Studies show people who do CBT -> pain perception is reduced, get back to normal activities
- Supportive therapy for acute pain
- When ppl reach ceiling point when using drugs -> i.e. when medication no longer has affect
- Person sees therapist -> expresses how they feel and get support
- Biofeedback
- Therapist monitors patients bodily reactions (muscle tension, breathing patterns, heart rate, skin temperature)
- Provide info back to patient
- Having this feedback helps client gain control of their physiological processes
- Client gain control by combining biofeedback with relaxation therapy
- Commonly used for LBP, chronic tension and vascular headache
- No research shows biofeedback + relaxation therapy is more effective than biofeedback OR relaxation therapy alone
- CBT - theory that cognitions affect feelings -> cognitive restructuring to alter feelings towards pain -> improve pain experience
Out of all psychological interventions, which one is mostly used?
- CBT out of all psychological treatments is the most widely used
What are some challenges with psycholiogical interventions?
- Patients resistant in doing psychological interventions
- When you tell someone to see psychologist about their pain -> people think you are insinuating that pain is not real and they are just imagining it
- Some people don’t see the benefits of psychologist intervention -> due to common sense view majority of people have
- High attrition rate - people can’t see the effectiveness of psychological interventions
What are some potential soluituons to these challenges?
- Incorporate multi-disinplinary interventions -> psychology interventions with physiotherapy
- Sell the intervention as focused on rehabilitation -> i.e. this will help you cope wiht the pain as you get better
- There is ALOT of evidence showing that multi-displinary intervention is more effective than single
- e.g. physiotherapy + CBT
