Week 4 - Coping and Pain Flashcards
1
Q
What is pain, according to the World Health Organisation?
A
An unpleasant sensory and emotional experience which is associated with actual or potential tissue damage, or is described in terms of such damage
2
Q
What is acute pain?
A
- Short term (e.g. burning finger, breaking leg)
- Attracts our attention (warns of tissue damage)
- Pain lasts for as long as there is healing
- There is action to take (rest, see Dr, medication)
3
Q
What is chronic pain?
A
- Pain for >12 weeks
- Long term, persistent, debilitating
- Prolonged rest and medication is not helpful
- Arises from a variety of conditions/diseases, or no known cause
- Levels of pain vary from day to day
4
Q
What is the Gate Control Theory of pain?
A
- Pain is experienced in the brain through complex pathways in the body, from damage/disease source
- Different types of pain fibres have been identified (fast, slow, hot, cold, blunt)
- Pain is a result of a 2-way process of communication between the brain and the tissue damage/nerve messages
- Important neural relays/gates for messages to pass through are located in the dorsal horn of the spinal cord
- The extent that the gate is open/closed affects the number of pain messages that are received
5
Q
What are some examples of things that close the gate that pain messages pass through?
A
- Medication
- Counter stimulation
- Exercise
- Relaxation
- Distraction
- Positive beliefs (control)
- Positive emotions
- Active life
6
Q
What are some examples of things that open the gate that pain messages pass through?
A
- Injury
- Over/under active
- Sensitivity of NS
- Stress and tension
- Focusing on pain (expectation)
- Negative emotions
- Negative beliefs
- Minimal involvement in life
7
Q
What are some psychological factors that affect the experience of pain?
A
- Classical conditioning
- Operant conditioning
- Anxiety
- Fear
- Secondary gains
- Pain behaviour
- Catastrophising
- Attention
- Self-efficacy
- Meaning
8
Q
What are pain management programmes?
A
- Programmes that aim to improve the physical, psychological, emotional and social dimensions of quality of life in people with persistent pain
- Uses a multidisciplinary team
- Works according to behavioural and cognitive principles
- It is about helping the patient to take control of their pain
- 4 main mechanisms:
- – Managing thoughts and feelings (e.g. mindfulness)
- – Active, but pacing self
- – Goal setting
- – Relaxation
9
Q
What is the guided practice for pain management programmes?
A
- Reinforce an acceptance of reality of chronic pain
- Improve fitness, mobility and posture
- Address fear of consequences of movement
- Develop ways to cope with stress, anxiety, depression, danger
- Improve ability to relax
- Graded return to activities of daily living
- Improve communication skills
- Reduce use of unhelpful aids and equipment
10
Q
What are some of the factors that patients with chronic illnesses have to cope with?
A
- Diagnosis:
— Emotional response (e.g. shock, anxiety, depression, denial, anger, fear, etc.) - Physical impact:
— Pain
— Limited mobility
— Other symptoms - Treatment:
— Anxiety
— Discomfort
— Impact on body image - Hospitalisation:
— Loss of autonomy, privacy and status
— Possible removal from usual support network - Adjustment:
— Biographical disruption (e.g. change to your life plan and goals)
— Change in identity
— Chronic nature of illnesses
— With terminal illness, acknowledgement of own mortality - Socioeconomic impact:
— Financial problems (work may be affected)
— Social problems (e.g. housing, childcare)
— Relationship problems - Context of ‘real life’:
— Family
o Bereavement, divorce, marriage, family health, pregnancy, family unemployment
— Personal
o Imprisonment, personal achievement, change in school/residence, sexual difficulties, change in habits, holidays, Christmas
— Workplace
o Dismissal, retirement, job change, change in responsibilities/conditions
— Financial
o Change in financial state, mortgage
11
Q
What is emotion focussed coping?
A
Change the emotion
- Behavioural approach: do something
- – E.g. talking to friends, alcohol, finding a distraction
- Cognitive approach: change how you think about the situation
- -E.g. denial, focus on positive aspect of problem
12
Q
What is problem focussed coping?
A
Change the problem or your resources
- Reduce demands of stressful situation
- – E.g. how to cope with feelings of claustrophobia in a mask for radiotherapy
- Expand resources to deal with it
- – E.g. if mobility is a problem, focus on physiotherapy exercises, buy a motorised wheelchair, etc.
13
Q
How can you aid a patient’s coping?
A
- Increase/mobilise social support
- – Help patients recognise and mobilise support
- – Suggest formal/informal sources of support (e.g. social services, community resources, charities, patient groups)
- Increase personal control
- – Pain management
- – Self-management programmes
- – Involve patients in care-planning
- – Facilitate cognitive control
- Prepare patients for stressful events
14
Q
Explain depression in chronic illnesses
A
- 2-3 times more common in people with a chronic illness
- Response to loss, failure or helplessness
- Emotional state is characterised by persistent low mood, sadness, loss of interest, despair, feelings of worthlessness
- Tends to be long term
15
Q
Explain anxiety in chronic illnesses
A
- More common in people with heart disease, stroke and cancer
- May be a response to a threat (e.g. to identity/wellbeing, or events)
- Sustained anxiety may be associated with unhelpful thinking patterns and physiological effects
