1
Q
– Clinical pain –
A
2
Q
What is Clinical pain?
A
- refers to any pain that receives or requries professional care
- can be either acute or chronic!
3
Q
What is Clinical pain? - calls for treatment for 2 reasons…
A
Not only because it may be a symptom of progressive disease, but relieving pain is important for humanitarian reasons
4
Q
When/how does acute pain promote survival?
A
- When it serves as a warning of injury (however much of the acute pain experienced today has little value)
- When medical care is available, these pains are not useful
5
Q
What’s common for patients after surgery?
A
- experiences of greater-than-necessary pain
- thus, it’s suggested that practitioners assess pain intensity and satisfaction with pain relief after surgery
6
Q
Inadequately reduced pain after surgery can cause…
A
physiological reactions that can lead to medical complications adn even death (e.g. susceptibility of infection)
7
Q
Canadian women reported more…
+ what does this reveal?
A
- Chronic pain intensity
- Higher incidence of chronic pain
- Chronic pain overall
- reveals important associations among sociocultural variables, health, and pain
8
Q
How do sufferers perceive their acute pain as it progresses into chronic pain?
A
- They expected the acute phase to end and thus, did not see pain as a permanent part of their lives
- As the pain continued longer than expected, they became discouraged and angry
- They might seek care from physicians, but when this isn’t fully successful, hopelessness increases
9
Q
The transition from acute to chronic pain is a critical time where…
A
…many of these people become increasingly disabled - especially if they experience a loss of efficacy for performing activities and a fear that certain behaviour will cause painful episodes or worsen their condition
10
Q
For people transitioning from acute -> chronic pain, avoiding activities can lead to…
A
- reduced muscle strength and increases negative affect, which decreases activity further
- as this happens, these people may develop feelings of helplessness and psychological disorders
11
Q
When people transitioning from acute -> chronic pain develop negative feelings as a result of their worsening condition, what becomes a dominant aspect of their personalities?
A
The neurotic triad
12
Q
What does the neurotic triad consist of?
A
- Hypochondriasis
- Depression
- Hysteria
13
Q
Chronic pain creates what kind of long-term effects? 4
A
- Long-term psychosocial problems
- Impaired interrelationships
- Substance use
- Frequenct sleep disturbance
14
Q
Does treatment for acute vs chronic pain need to be differentiated in clinical settings?
A
YES; differing conditions require different treatment methods
15
Q
– Medical Treatments for Pain –
A
16
Q
How did peasants in Western cultures commonly treat pain?
A
piercing the affected area of the body with a twig, believing it would absorb the pain somehow
17
Q
Pain treatment in the nineteenth century?
A
Alcoholic beverages and “medicines” laced with opium were available
18
Q
Nowadays, physicians try to reduce pain in two ways:
A
- Chemically
- Surgically
19
Q
Treating clinical pain with surgical methods is more effective for…
A
acute pain > chronic pain
20
Q
Are extreme surgical procedures used today?
A
No - seldom provide long-term relief and often have side effects
21
Q
Extreme surgical methods - Neuroablation
A
the surgery removes or disconnects part of the peripheral nervous system or the spinal cord, thereby preventing pain signals from reaching the brain
22
Q
Other surgeries that are less risky - synovectomy (example)
A
surgeon removes the membranes that become inflamed in arthritic joints
23
Q
Other surgeries that are less risky - spinal fusion (example)
A
joins two or more adjacent vertabrea to treat severe back pain
24
Q
Surgery for back pain is often used in North America - is it effective?
A
- Little evidence that it’s better than nonsurgical methods
- Less effective for people with depression and other psychosocial disorders
- Used at a much lower rate in other countries
25
How might physicians choose specific drugs and dosages?
## Footnote
(i.e. what factors are considered)
* How intense the pain is
* Its location
* Its cause
26
What might the efficacy of chemical treatments (for pain) depend on?
1. Characteristics of the drug
2. Patient themselves
3. Sociocultural factors
27
Many hospital patients in pain are _. Who is majorly affected?
* **UNDERMEDICATED**
* Those most affected: **children** and **minority group members**
28
Children are among the most in pain who go undermedicated - **WHY?**
* Practitioners believe **children feel less pain than adults** or are **more likely to become addicted to a drug**
* Children may simply request less medication, possibly because they dislike injections or taking pills more than adults do
29
-- Highlight: Types of pain-relieving chemicals --
30
4 types of chemicals are commonly used in treating pain:
1. **Peripherally active** analgesics
2. **Centrally acting** analgesics
3. **Local anaesthetics**
4. **Indirectly acting drugs**
31
**Peripherally active** analgesics
**Reduce pain** by their action in the **peripheral nervous system**
32
**Centrally acting** analgesics
**narcotics (opioids) that bind to opiate receptors in the central nervous system** and **inhibit nociceptor transmission** or **alter the perception of pain stimuli**
## Footnote
nociceptor transmission = pain signal transmission
33
**Local anaesthetics**
* E.g. novacaine, lidocaine, bupivacaine
* Can be applied topically, but most effective when injected at the site of pain origin (like how dentists freeze a tooth they're about to pull)
34
**Indirectly acting drugs**
affect nonpain conditions, such as emotions, that produce or contribute to pain
35
2 conventional ways for administering painkilling chemicals:
giving **injections** or **pills**
36
Painkilling chemicals are given under one of two schedules/arrangements:
1. Prescribed schedule
2. "As needed"
37
Painkilling chemicals are given under one of two schedules/arrangements: **what 2 other methods are available today? FIRST**
* **Epidural block** - practitioners inject narcotics or local anaesthetics epidurally (around the spinal cord)
* Prevents sigals from being transmitted to the brain
38
Painkilling chemicals are given under one of two schedules/arrangements: **what 2 other methods are available today? SECOND**
* Patient-controlled analgesia: patient pushes a button to activate a computerized pump that dispenses a pre-set dose of the chemical through a needle that remains inserted
* Practitioners monitor the patient's use of the drug and set limits on the rate and amount of its use
39
Do people who use patient-controlled analgesia get sufficient pain relief, and do they abuse the opportunity to control their use of narcotics?
## Footnote
(answers from research)
* **Pain relief** with patient-controlled analgesia is somewhat **greater in women** than men
* Patients **in the days after surgery use somewhat more medication** but get better pain relief with patient-controlled than conventional methods; patients with acute pain use narcotic drugs only for a short time, the risk of abuse is low
40
Using chemicals for chronic pain?
* Chronic pain can still occur with cancer
* Thus, using opioids for managing moderate to severe cancer pain is widely accepted today
(however some patients may still receive inadequate analgesic drugs, perhaps out of feat that they'll become addicted if the drug is a narcotic and believe that "good" patients don't complain)
41
Should narcotics be used in treating chronic non-cancer pain?
* Practitioners first consider other treatment methods
* BUT if those don't provide enough relief, they can consider long-term opioid treatment with careful monitoring (which has been proven to help most, but not all, non-cancer chronic pain conditions)
42
Increases in using narcotics for chronic pain are ***occuring cautiously*** for at least 4 reasons: **1**
**Some patients *do* become addicted to narcotics used to treat chronic pain**, and those with depressive or anxiety disorders are at higher risk for addiction than others are
## Footnote
remember: important to note as people suffering from chronic pain often develop depression and anxiety
43
Increases in using narcotics for chronic pain are ***occuring cautiously*** for at least 4 reasons: **2**
Studies still need to **determine specifically how taking *daily doses of narcotics* alters patients' lives and functioning**
44
Increases in using narcotics for chronic pain are ***occuring cautiously*** for at least 4 reasons: **3**
* **Researchers need to find out why tolerance and *addiction to narcotics are less likely when taken to relieve pain***, at least for some conditions
* Is it because the doses are so small, or that the practitioners monitor?
45
Increases in using narcotics for chronic pain are ***occuring cautiously*** for at least 4 reasons: **4**
Evidence indicates that marijuana is an effective alternative chemical for relieving chronic pain for certain medical conditions
46
Are chemical methods sufficient enough for controlling pain?
NO; needs other approaches too!
47
How might (a physician) collaborating with other professionals be an effective approach?
As people transitioning from acute -> chronic pain have a difficult time with anxiety and depresison, it's important to detect and treat psychosocial problems EARLY
48
Advantages of group psychotherapy over individual therapy in treating pain - **1**
**Efficiency**
* Patients can face the same, common difficulties - and they might thus need similar advice and information
* Is more time-efficient for practitioners
49
Advantages of group psychotherapy over individual therapy in treating pain - **2**
**Reduced isolation**
* Chronic pain sufferers are typically isolated from social contaxt. Group meetings can help minimize this!
50
Advantages of group psychotherapy over individual therapy in treating pain - **3**
**Credible feedback for patients**
* Pain patients often resist advice from therapists. But in group settings, they can hear this advice from people in their position - making it more believable
51
Advantages of group psychotherapy over individual therapy in treating pain - **4**
**A new reference group for patients**
* Patients can develop a new social network of individuals comparable to themselves and who can provide social pressure to conform to the realities and constructive "rules" of living with pain and physical limitations
52
Advantages of group psychotherapy over individual therapy in treating pain - **5**
**A different perspective for the therapist**
* Watching a patient relate to others in the group provides the therapist with certain kinds of information that may aid in identifying specific problems therapy should address, such as maladaptive coping syles
53
When introducing a team approach to chronic pain patients, physicians need to describe... (2)
..the **rationale** for it and **functions each professional can provide**
54
When introducing a team approach to chronic pain patients, physicians should state clearly... **3**
1. It is understood that the **patient is "obviously in a great deal of pain"**
2. patients can help themselves **control their pain by working with these other professionals**
3. **the physician will be an active part of the team**
55
Benefits of psychologists conducting group therapy?
* Group members can say things to each other that others could not, without seeming cruel
* Can also disconfirm each other's misconceptions, share their own ways, give support, etc.
56
The goals of psychological treatments for pain include... (**4**)
1. Helping clients **reduce their *frequency* and *intensity* of pain**
2. Improve their **emotional adjustment** to the pain they have
3. Increase their **social and physical activity**
4. Reduce their use of **analgesic (for relief) drugs**
57
-- Behavioural and Cognitive Methods for Treating Pain --
58
How did the gate-control theory change the way healthcare workers conceptualize pain?
* By proposing that pain can be controlled not only biochemically/sensory-wise, but by modifying motivation and cognitive processes too
* **Provides a more complex view of pain for psychologists** to develop techniques to help patients ***cope more effectively*** with the pain and other stressors they experience and ***reduce their reliance on drugs for pain control***
59
Therapists use what kind of approach?
**operant approach**: applying operant conditioning methods to modifying patients' behaviour (can be used for all ages)
60
What might an operant approach look like? (3)
* Ignore certain pain behaviours; **extinction**
* Provide rewards or positive reinforcement
* Constant praise/positive feedback
61
Treatment programs that typically implement an operant approach apply to patients...
whose chronic pain has already produced serious difficulties
62
Goals of operant approaches: **1**
To reduce the patient's reliance on medication
63
Goals of operant approaches: **reduce the patient's reliance on medication - "pain cocktail" example**
* Mixing the painkiller with a flavoured syrup and giving it on a fixed schedule, rather than the patient requesting it
* Because receiving the painkiller is not tied to requesting it, any reinforcing effect on the drug that may have on that pain behaviour is eliminated
64
Goals of operant approaches: **2**
to reduce the disability that generally accompanies chronic pain conditions
65
Goals of operant approaches: **to reduce the disability that generally accompanies chronic pain conditions - how?**
* Altering the consequences for behaviour so that they promote "well" behaviour and discourage "pain" behaviour
66
Main feature of the operant approach?
That the therapist trains people in the patient's social environment to monitor and keep a record of pain behaviours, try to reinforce them, and systematically reward physical activity
67
Is the operant approach effective?
Studies have shown successful decreases in patient's pain reports
68
Limitations of the **operant approach?** **1**
After the operant intervention ends and rewards are discontinued, some patients revert to their old pattern of inactivity and pain behaviour
69
Limitations of the **operant approach?** **2**
Not all chronic pain patients are likely to benefit from operant methods
70
The goals of operant approaches seem to be appropriate for who?
Patients with **chronic-recurrent** or **chronic-intractable-benign** than for those with **chronic-progressive**
71
Many people might also experience chronic episodes of pain because...
## Footnote
+ how do we combat this?
* of underlying physiological processes that can be exacerbated by fears and stress
* can be adjusted through fear reduction
72
Fear exacerbating pain example
* People with back pain might fear "moving the wrong way" and bringing on an episode of pain
* This fear causes avoidance of activities, and each time they avoid an activity that they receive negative reinforcement, they don't experience the pain they feared would occur - THIS REINFORCEMENT MAKING THEM PERSIST AND LEAD THEM TO ENGAGE IN LESS AND LESS ACTIVITY
73
Solution to exacerbated fears?
* Systemic desensitization
* In vivo exposure: similar, pain patient engages in each feared pain activity repeatedly (ex: exercising, sitting/standing up)
74
Biofeedback - treatments are conducted how often?
weekly sessions that span about 2-3 months
75
Methods for relazation and biofeedback: **1**
Progressive muscle relaxation - person focuses on specific muscle groups while alternately tightening and relaxing these muscles
76
Methods for relazation and biofeedback: **2**
Meditation - individual focuses on meditation stimulus, such as an object, event, or sound; person attends to pain and tries to become detached from thoughts and feelings about it
77
Methods for relazation and biofeedback: **3**
Biofeedback - the person learns to exert voluntary control over a bodily function, such as heart rate, by monitoring its status with information from electronic devices
78
Broad answer: do relaxation and biofeedback help relieve pain?
yes - from reviews and meta-analyses of studies
79
Do relaxation and biofeedback help relieve pain? LIMITATIONS TO SUPPORTING EVIDENCE
* Most of these studies have **solely focused on headache and back pain** (not capturing the whole scope)
* **Biofeedback is somewhat more effective** than relaxation
* **Patients vary greatly in the amount of benefit** they get from these treatments
* **Other psychological factors might be at play**
80
Are the improvements from relaxation and biofeedback durable?
Interventions do not always last, such as in cases of alcohol abuse, and relapse often occurs
81
Relaxation and biofeedback - overall pros/cons
helpful in reducing the discomfort many chronic pain patients experience, but these treatments do not provide all the pain relief most patients
82
What do people think about when they experience pain?
* Some people on the ordeal and how uncomfortable and miserable they are, others do not
* Someone might use cognitive strategies to modify their experience ("it's not that bad! be brave!")
83
When people experience acute or chronic pain, they might use two types of coping:
1. **passive coping**: such as taking to bed or avoiding activities, which puts them at risk for disability
2. **active coping**: try to keep functioning by ignoring the pain or keeping busy with an interesting activity
84
Cognitive techniques for treating pain include active coping strategies, **which can be classified into three basic types:**
1. Distraction
2. Imagery
3. Redefinition
85
Cognitive coping strategies for pain - **distraction**
* the technique of focusing on a nonpainful stimulus in the immediate environment to divert one's attention from discomfort
* e.g. dentist's offices having a fish tank
86
Cognitive coping strategies for pain - **distraction: does it always work? when?**
* Not always likely to work
* Distraction is more effective if the pain is mild or moderate than strong
87
Cognitive coping strategies for pain - **distraction: efficacy depends on three factors**
1. The **amount of attention** the task requires (higher distraction = lower the pain levels)
2. How **interesting** the task is
3. The tasks **credibility** to the person (does it make sense? e.g. having someone listen to a sound that isn't there, it's not believable)
88
Cognitive coping strategies for pain - **distraction: role of credibility + therapists**
* Because of the role of credibility in using distraction methods, therapists may need to help patients understand how the technique works
* **BY PROVIDING EXPLANATION, therapists can increase its effectiveness and likelihood that the patient will adhere to it (basically just making things clear)**
89
Cognitive coping strategies for pain - **distraction: useful for acute or chronic pain?**
both! (but this depends on the person)
90
Cognitive coping strategies for pain - **imagery**
* nonpain or guided imagery, whereby the person tries to alleviate discomfort by conjuring up a mental scene that is unrelated to or incompatible with the pain
* e.g. when children receive injections, their parents will say something like "think of something fun or nice!"
91
Cognitive coping strategies for pain - **imagery: how's it different from distraction?**
* Imagery is **based on the person's imagination** (thus, they don't need to depend on the environment to provide a suitably distracting stimulus - they can develop a scene that works reliably which they "carry" around in their heads"
* Distraction is **based on real objects or events in the environment**
92
Cognitive coping strategies for pain - **pain redefinition**
where the person substitutes constructive or realistic thoughts about the pain experience for ones that arouse feelings of threat or harm
93
Cognitive coping strategies for pain - **pain redefinition: how can therapists help people redefine their pain experiences?**
Teaching clients to engage in an internal dialogue, using positive self-statements that come in two forms:
* **Coping statements: emphasize the person's ability to tolerate the discomfort**, as when people say to themselves "be brave - you can take it"
* **Reinterpretive statements: negate the unpleasant aspects of the discomfort**, e.g. "it's not so bad!"
94
The impact of chronic also depends on...
the way patients view their conditions
95
The impact of chronic also depends on the way people view their conditions: when will coping strategies **not** work?
* those who believe their pain will last a long
* signs of disabling injury
* poor coping
96
The impact of chronic also depends on the way people view their conditions: when will coping strategies **will** work?
* patients who believe that they understand the nature of their pain
* that their conditions will improve
97
Pain therapists can promote active coping and pain acceptance with a cognitive behavioural approach called...
acceptance and commitment therapy (ACT): teaches clients to experience their condition and emotions directly, without the negative implications that have usually accompanied them
98
Studies have found that _ coping strategies effectively reduce _ pain
Studies have found that **active** coping strategies effectively reduce **acute** pain
99
Distraction and imagery are particularly useful with...
* mild or moderate pain
* not so much chronic pain
100
Redefinition is more effective with...
* strong pain
* also chronic pain
101
How effective are cognitive behavioural programs in treating a variety of chronic pain conditions?
At least as effective as chemical methods in reducing chronic tension-type headache and also effective when delivered via the internet
102
-- Hypnosis and Interpersonal Therapy --
103
How might hypnosis affect pain levels?
* Can reduce the intensity of acute pain, but is not highly effective for all people
* Those who can be hypnotized very easily and deeply seem to gain more pain relief
104
How does hypnosis reduce pain?
* Unclear, but part of the answer seems to involve physiological changes that occur in the brain and spinal cord of people who are highly suggestible when hypnotized
* Other factors involve the deep relaxation people experience when hypnotized and cognitive factors
105
Can hypnosis reduce chronic pain?
Yes - about as effectively as relaxation therapy and interestingly, regardless of which therapy they receive, their pain relief is greatest if they're high in hypnotic suggestibility
106
Interpersonal Therapy for pain
uses psychoanalytic and cognitive-behavioural perspectives to help people deal with emotional difficulties, such as adjusting to chronic pain, by changing the way they interact with their social environments
107
Interpersonal Therapy for pain - underlying theory
* that people's emotional difficulties arise from the way they relate to others, particularly family members
* therapy sessions involve discussions to help clients gain insight into their own motivations and how their behaviour toward other people affects their own emotional adjustment
* insights often relate to the feelings they and their families have about the pain condition and how they deal with pain behaviour, and the relationship changes they have developed among these people
PSYC 314
flashcards
Decks in class (36)
# Cards
-
Lecture 1-224
-
Lecture 329
-
Lecture 428
-
Lecture 530
-
Lecture 639
-
Lecture 727
-
Lecture 825
-
Chapter 1105
-
Chapter 3101
-
Chapter 4117
-
Chapter 588
-
-------------------------- MIDTERM 1 --------------------------0
-
Lecture 9 - Health Behaviours and Promotions23
-
Lecture 10 - Health Behaviours and Promotions28
-
Lecture 11 - Health Behaviours and Promotions, Substance Use11
-
Chapter 6158
-
Lecture 12 - Substance Use & Addiction32
-
Chapter 70
-
Lecture 13 - Diet, Exercise, & Weight Control19
-
Chapter 8140
-
Lecture 14 - Using Health Services & Patient-Practitioner Interaction27
-
Chapter 9128
-
Lecture 1520
-
Chapter 1068
-
-------------------------- MIDTERM 2 --------------------------0
-
Lecture 16 - Pain and its Symptoms and Management22
-
Chapter 11 lol119
-
Lecture 17 - Pain and its Symptoms and Management29
-
Chapter 12107
-
Lecture 18 - Managing Chronic Illness and Family Involvement0
-
Chapter 130
-
Lecture 19 - Managing Chronic Illness and Family Involvement0
-
Chapter 140
-
Lecture 20 - Psychosocial Aspects of Chronic Illness and Aging; End-of-Life Care and Bereavement0
-
Lecture 21 - Psychosocial Aspects of Chronic Illness and Aging; End-of-Life Care and Bereavement0
-
Chapter 150
