Week 7 Flashcards
Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
Classification of pain according to the cause
- Nociceptive pain: due to tissue damage.
- Neuropathic pain: due to damage to the nervous system.
- Mixed pain: nociceptive and neuropathic pain combined.
- Idiopathic pain: pain without a clear organic cause.
Classification of pain according to duration
- Acute pain: pain that lasts for less than 3 to 6 months. Can stop when it’s healed, but can also be recurrent.
- Chronic pain: continues for more than 3 to 6 months.
Allodynia
Experiencing pain because of a stimuli that normally doesn’t cause pain (like a feather)
Hyperalgesia
Experiencing very severe pain due to a very small pain stimulus.
Consequences of chronic pain
- Economical: costs, sickness absence, disability etc.
- Psychological: depression, anxiety, sleep etc.
- Social: social network, partner, children etc.
The biological model of pain
The injury causes the pain receptor to send a signal to the brain. The amount of pain is related to the amount of injury.
Gate control theory (psychobiological model)
There is a ‘gate’ at the spinal cord and an interaction between the gate. This process goes in 2 steps:
1. Biological processes: pain stimulus –> pain receptor–> brain.
2. Interaction between the pain signal and cognitions / emotions: causes a release of chemicals at the gate that open or close the gate, which cause more or less pain.
Importance of the Gate Control Theory
It explains why psychological variables (past experiences, mood) can influence the pain experience (inhibition / facilitation). The also made the influence of psychology upon pain credible.
Learning theory (psychological theory)
Is based on operant conditioning, which is based on the law of effect: when a specific response is followed by regards, the chance of reoccurrence of the response increases. Pain responses are learned and maintained by reinforcement.
Cognitive Behavioural Theory
Includes all different kinds of factors. Pain can be a viscous cycle of cognitions, emotions and behaviour. this is influences by:
- Attention: paying attention to the pain increases the pain.
- Attributions concerning the cause of pain: to what do you ascribe the pain.
- Expectations: about the ability to tolerate or control the pain and engage in other activities.
- Coping.
Differences between Learning Theory and Cognitive Behavioural Theory
Learning theory does not consider the cognitive and emotional aspects of pain and is restricted to behaviour.
Important dimensions of pain to asses
- Pain perception itself: consists of pain intensity, frequency, type of pain, pattern etc.
- Psychological dimension: consists of the emotional dimension (anxiety, depression) and the cognitive dimension (cognitions, coping strategies).
- Behavioural dimension: consists of pain behaviour and functional limitations / quality of life.
Pain assessment focused on pain perception
- Unidimensional assessment of pain: indicating how bad the pain is on a scale or in a daily log. (Ex: 0-10 scale, diary,)
- Multidimensional assessment of pain: where is your pain, what does it feel like, how does it change, how strong is it? (Ex: Mc Gill Pain Questionnaire)
Pain assessment focused the psychological dimension
- Focussed on emotions: anxiety, sleep, depression.
(Ex: symptoms checklist-90, brief symptom inventory, depression scale) - Focused on cognitions: rumination, helplessness, coping, catasrophising.
(Ex: pain catastrophising scale, pain coping strategies questionnaire).
Pain assessment focused on the behavioural dimension
Pain observation scales that look into pain behaviours and functional limitations / quality of life.
(Ex: SF-12, SF-36)
Virtual reality
Entering an immersive virtual environment can serve as a powerful pain control technique (like snow-world and spider-world). Can cause less pain-experience, alsof during painful procedures and wound care. The effectiveness can be explained by the gate-control theory: in order to experience pain, conscious attention to the pain is important.
Medical treatments of pain
- Surgical intervention: severing the nerves that transfer the pain signal. The effects were short-term and nerve pathways rewired themselves. Caused damage to the nervous system and neuropathic pain.
- TENS: transcutaneous electrical nerve stimulation. Electrical signals block other electrical signals in the brain. Effectiveness is not proven and only has short-term effects.
- Pain medication: painkiller, narcotics, anti-inflammatory drugs, anxiolytics, antidepressants.
Psychological treatment of pain
Necessitates an active participation of the patient, because it influences the effectiveness. There often is a lot of reluctance because people think that you undermine their problems. You need to make a clear distinction between factors that caused the pain initially and the factors that maintain or aggravate the pain.
(Ex: relaxation, biofeedback, meditation, hypnosis, behavioural interventions, CBT)
Direct and indirect influences of relaxation on pain
- Direct: muscle tension causes a lack of oxygen in the blood, which causes pain.
- Indirect: feeling more relaxed causes stress to have less impact on the body, better stress coping mechanisms and less pain experience.
Biofeedback
The patient receives information their own biological processes. The combination of relaxation and biofeedback is NOT more effective than just relaxation, and it’s also very expensive.
Mindfulness meditation
Includes focused attention and whole field awareness in the present moment. Observing, without judging, thoughts, emotions, sensations and perceptions as they arise moment by moment. Is effective in chronic pain patients. Positive effects were found on functional limitation, medication intake, anxiety and depression. Doesn’t have an impact on pain itself, but on pain management and pain coping.
Hypnosis
The basis of hypnosis is deep relaxation and suggestion. During hypnosis the patient is instructed to think differently about the pain and makes a reinterpretation of the pain and distraction from the pain.
Behavioural interventions
Increase healthy behaviour and decrease pain behaviour by rewarding the positive health behaviour an ignoring the unhealthy pain behaviour. It’s quite effective for pain itself, limitations and mobility, but the family has to know about it.
Cognitive Behaviour Therapy (CBT)
There is an interaction between cognitions, emotions and behaviour:
- Cognitions: irrational dysfunctional, catastrophic beliefs.
- Emotions: pain related fear and fear of movement.
- Behaviour: avoidance behaviour.
CBT is very effective for treatment of chronic pain.
Rational Emotive Therapy (RET)
Is a form of CBT where you challenge irrational automatic thoughts by means of the ABC scheme:
- A: actual situation
- B: more rational, alternative beliefs
- C: consequences
Group CBT therapy
Proven to be just as effective as individual therapy and is more cost-effective. You can also use the group dynamics for:
- Treatment effects: modelling of adequate pain management.
- Patient satisfaction: social support
But: it’s not a good choice for patients with a history of interpersonal problems or cognitive impairment and the ideal group-size is 5-7.
Self-help CBT programs
Use the same techniques as normal CBT and involves:
- Improvement of problem-solving skills.
- Self- and pain-management
- Perceived control and self-efficacy.
Effects: effective in decreasing pain intensity, functional limitations, anxiety and depression.
Advantages: you can reach a large group of patients and it’s cost effects, but it’s less effective without a physician/ therapist.
Multidisciplinary Pain Rehabilitation Centers / Pain Management Clinics
Different medical / psychological / social disciplines work together to develop and individualised treatment for chronic pain patients. The psychologists also train the other disciplines about CBT.
