Pain Flashcards

Question 1

Q

What is the biomedical model of pain?

Answer

A

Pain as a sensation
Pain is a response to external factors
Source of pain via nerve impulses, is interpreted as pain in the brain
The link is direct, causal and automatic
Tissue damage causes the sensation of pain
patients with little tissue damage but lots of pain = ‘making a fuss’
patient with serious injury but no pain = ‘brave’
when no physical cause can be found = psychogenic
when clear physical ailment could not be seen = real pain
psychological processes were not thought to play a role
pain is an automatic response - person is passive
there is no role for interpretatio or appraisal

Question 2

Q

What are some problems with the old view of pain?

Answer

A

patients with the same degree of tissue damage reported different levels of pain - why? e.g. tooth extraction, epidurals
phantom limb pain - amputees experienced pain in absent limb - how?
most common form of pain is headache, yet there is no injury or tissue damage?
how do athletes continue with severe pain?
gross injury’s occur without much pain e.g severely wounded soldiers complained of little pain
Is pain influenced by interpretations and perceptions?

Question 3

Q

What briefly is the gate control theory of pain?

Answer

A

Melzack and Wall, 1982
Pain is a pereception AND an exception
pain is a multidimensional process that is mediated by other factors and is controlled by a ‘gate’ at the spinal cord level

Question 4

Q

What are inputs to the gate?

Answer

A

peripheral nerve fibres - injury sends info about pain, pressure or heat to the gate
descending central influences from the brain - brain sends info about psychological state of the individual to the gate (e.g. past experiences, fear, confidence etc.)
large and small fibres - are part of the physiological input to pain perception (large = good, small = bad)

Question 5

Q

What are the outputs from the gate?

Answer

A

gate integrates the information from sources

- send to an action system, resulting in perception of pain

Question 6

Q

What factors close the gate?

What factors open the gate?

Answer

A

Closed (no pain)
- physical = medication, stimulation of large fibres
- emotional = happiness, relaxation
- behavioural = intense distraction 
Open (pain)
- physical = activation of small fibres
- emotional = anxiety, worry
- behavioural = boredom, focusing on pain

Question 7

Q

How people interpret pain message and tolerate pain can be affected by the following:
x8

Answer

A

emotional/psychological state
upbringing
gender
memories of past
beliefs/values
social/cultural influences
attitude
expectations

Question 8

Q

What chronic about chronic pain?

Answer

A

mild, short living pain typically causes few problems
long lasting, intensive pain is a different matter (6 months often used as cut off)
medication often becomes ineffective over time
may be constant or come and go
due to a chronic condition e.g. arthritis, cancer
depression/anxiety

Question 9

Q

Describe the psychological interventions for managing chronic pain

Answer

A

clinical trials have shown psychological interventions to give significant improvements
do not undermine drugs approaches and not a sign of weakness, reassure patients you believe in them
interventions might include combination of treatments
pain clinics are likely to be multidisciplinary (pharmacology, clinician, physiotherapy, clinical psychology etc)

Question 10

Q

What are the two strands of intervention for chronic pain?

Answer

A

Cognitive 
- distraction
- imagery
- hypnosis 
- counselling 
Behavioural
- relaxation exercises
- biofeedback
- physical activity/exercise

Question 11

Q

How do we measure pain?

Answer

A

Not easy as subjective
- we cannot feel their pain
- can male doctors understand childbirth
Rely on indirect measures
Two frequent measures 
- visual analogue scales (VAS)
- McGill Pain Questionnaire (MPQ)
Diaries 
Pain behaviours via observation

Question 12

Q

Describe the Visual Analogue Scale and its implications for practice

Answer

A

Frequently used, 10cm line
Two ends of scale, no numbers on scale
e.g. no pain at one end and worst possible pain at other
Patient draws a line 
- easily administered
- use with kids of 5yrs
- can be used to measure severity and or improvement 
- sensitive to small changes

Question 13

Q

Describe the McGill Pain Questionnaire

How is it better than VAS?

Answer

A

VAS only measures intensity. Missing is quality of sensation and emotional impact
- MPQ examines different components of pain experience (questions and body map)
A: sensory (e.g. sickening, pulsing, throbbing, pounding)
B: affective (e.g. tiring-exhausting, fearful)
C: evaluative (e.g. annoying, troublesome)

Question 14

Q

What are the pros and cons of pain diaries?

Answer

A

Pros
- help doctor understand ‘causes’
- provide detailed daily picture
- help patient to see changes in pain and impact of behaviours on pain
Cons
- permanent record of pain - demolarising
- patients can be lazy/forget - incomplete info
- inconvenient - ‘just give be painkillers’

Question 15

Q

What is involved in measuring pain behaviour?

Answer

A

patients can be asked to perform simple tasks to asses extent of pain e.g walking, bending
can record and rate how often patient expresses pain
more useful with chronic vs acute pain
examples of behaviours e.g. groaning, grimacing, rubbing, stopping to rest, holding part of the body, distorted picture, irritability