Week 4: Biopsychosocial Approach to Pain Flashcards
What elements make up the biopsychosocial model of pain? Smallest circle to biggest
- Nociception
- Pain perception
- Attitudes and beliefs
- Psychological distress (suffering)
- Pain behaviour (disability)
- Environment
NPAPPE
Naughty penguins ate prominent portions everyday
Who designed the BSP model? Provide an example of how psychological beliefs can influence pain?
George Engel
High self efficacy eg I can move despite my pain = improved prognosis
True or false: acute pain is a result of tissue injury but resolves once homeostatic balance is restored?
True
What system is involved in the stress response?
Autonomic nervous system
What does the HPA axis stand for?
Hypothalamic pituitary adrenal axis
What are the four main hormones involved?
Cortisol
Norepinephrine
Epinephrine
Enkephalins
Goals of the HPA axis?
Reduce threat
Restore homeostatic balance
Where is the hypothalamus and pituitary gland located?
Just above the brainstem
What does the HPA axis do?
The HPA axis coordinates the body’s response to stress by regulating the release of cortisol. This hormone influences various physiological processes eg metabolism & immune function - aiding in stress adaptation. By maintaining this balance, the HPA axis contributes to overall homeostasis, ensuring stability in the internal environment.
What are the two responses to a stressor/nociception?
Pain & Physiological stress response (Ep/NorEpi/Cortisol)
When responded to positively the physiological stress response leads to what event? What components make up this? What does this do?
Adaptive response
- Comprehension, confrontation, understanding
Normal return to baseline = recovery
Chronic pain is a result of …..
Homeostatic imbalance
What do chronic threats result in?
Atrophy of muscle tissue
Impairment of growth and tissue repair
Morphological alterations of brain structures
Weakness
Pro-inflammatory cytokines
Fatigue
MAINTAIN OR INCREASE THREAT = PAIN
AIM W/PF
When responded to negatively the physiological stress response leads to what event? What components make up this? What does this do?
Maladaptive response
- Catastrophising
- Rumination
- Helplessness
- Magnification
= Prolonged or excess HPA axis activation –> cortisol dysfunction –> Chronic inflammation –> Depression (cycle continues…)
The maladaptive response consists of what four key elements? What does this result in?
- Catastrophising, rumination, helplessness & magnification
- Sensitised fear-based memory
True or false? Explicit validation is a helpful approach to discuss pain with a patient because it acknowledges and validates the patient’s experience, emotions, and concerns regarding their pain
True
Outline the cycle of fear avoidance?
High threat
1. Pain
2. Determine threat as high
3. Priority to pain control
4. Fear
5. Avoidance
6. Interference
7. Negative affect
8. Pain (cycle continues)
Low threat
1. Pain
2. Determine threat as low
3. Priority to value life goals
4. Approach
5. Recovery
Describe the relation between fear avoidance and kinesiophobia (fear of movement)
Pain –> rest –> become stiffer –> movement becomes more painful –> move less –> lose fitness –> movement is more painful (cycle continues).
Links in with fear avoidance - catastrophising –> pain-related fear –> avoidance/hypervigilance –> disuse, depression, disability
What are the five stages of self-efficacy?
Pre-contemplation: Unaware of the problem
Contemplation: Aware of the problem and of the desired behaviour change
Preparation: intends to take action
Action: Practices the desired behaviour
Maintenance: Works to sustain the behaviour change
What are the three elements of catastrophising?
Magnification eg becoming afraid the pain will get worse, thinking of other painful events, etc
Rumination eg I can’t seem to get it out of my mind
Helplessness eg I feel I can’t go on, there’s nothing I can do to reduce pain intensity
Define catastrophising?
The tendency to magnify the threat value of a pain stimulus and to feel helpless in the presence of pain, as well as by a relative inability to prevent or inhibit pain-related thoughts in anticipation of, during or following a painful event.
Outline the five steps in the treatment process in healthcare?
Assessment (1)
* Clinical interview
* Physical assessment / observation / tests, imaging etc.
* Psychometric assessment
Case formulation (2)
* Collaborative, comprehensive
Treatment planning (3)
* Goal setting (SMART)
* Problem solving
Treatment delivery (4)
Treatment evaluation (5)
What is the coloured flags assessment guide?
Red flags - serious pathology (biological factors)
Orange flags (mental health)
Yellow flags eg poor coping strategies, unhelpful beliefs about the injury (psychological factors)
Blue flags eg low social support, unpleasant work, non-english (social factors)
Black flags eg threats to financial security, litigation (other factors)
Benefits of self-report questionnaires
Benefits:
1. Efficient data collection – complete them before appointment
2. Norms – can locate patient in population as better/worse than avg Comprehensive – cover more ground than an interview
3. Patient feels supported; clinician is interested in them; easier to disclose on paper
4. Assist with diagnosis
5. Can use as a screening tool for further assessment
6. Confirms clinically significant change when used pre-post treatment
