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18 Cards in this Set
- Front
- Back
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What are some features of acute pain? |
•Specific injury |
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Where is the 'gate' in gate theory? |
Spinal Cord |
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What factors contribute towards/inhibit pain gating? |
Increase - Anxiety
Decrease - Ab signals Rubbing Medication |
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Give some features of chronic pain? = Continued state of suffering that persists past the healing phase following an injury. Involves brains stress network |
25% adults Arthritis most common cause Back most common location Decrease QoL Can be without identifiable cause: fibromyalgia, functional gastrointestinal disorders |
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How long do chronic back pain & post herpetic neuralgia take to heal? |
CB pain = 6m post herpetic = 3m |
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What is the pain triumvirate? |
Sensory/discriminative - lateral system - lateral thalamic nuclei, S1/2, SMA Affective/motivational - emotional/unpleasant aspects, reward in escape, medial system - BG, medial thalamic nuclei, ACC, insula Cognitive/evaluative - interpretation of pain and its meaning, ACC, DLPFC |
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Which components of the pain triumvirate are more active in acute/chronic pain? |
Acute - sensory component dominant, motivational reflexive, affective is secondary.
Chronic - affective + motivational components are primary, these determine sensory component |
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What is the chronic pain triumvirate? |
Pain, MDD & anxiety + addiction |
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Which is the most common mental disorder associated with pain? |
Major depressive disorder: associated w disability, worse response to treatment, somatic symptoms common, pain intensity increases w MDD severity. Genetic association with chronic pain in 1st degrees. |
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Which neurotransmitters are involved in chronic pain/MDD/anxiety? |
5HT - suppress sensation of normal bodily functions NA - " DA - application of importance (salience), focusses attention, dampens pain Opiod system - prevents spread of pain, dampens pain, reinforces behaviour
Dysfunction = chronic pain/MDD |
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What could pain in MDD/anxiety reflect? |
Disturbance in NTs Autonomic NS dysfunction HPA axis dysregulation Genetic association |
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What is the cognitive component to pain? |
Beliefs about pain and cause/meaning Fear of future pain - threat, anticipation, salience, vigilance, catastrophisation Physiological ANS arousal, increased pain, avoidance, reinforcement |
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What are the 4 types of pain behaviour? |
Negative effect Facial/audible expression of distress Distorted ambulation/posture Avoidance of activity |
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What increases dependence on pain behaviours and loss of self efficacy? |
Conditioned reinforcement of sick role - care from others, avoidance unpleasant activity, reliance on medication |
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What is the role of pacing in pain behaviour? |
Combination of pain and avoidance - hidden form of avoidance behaviour - greater subjective disability. Associated with worst disability |
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What can be used in assessment/detection of a) chronic pain, b) MDD/anxiety? |
a) Pain fluctuation, pain diaries, alleviating/exacerbating factors b) Scales, pain scale - McGill, symptoms - low energy, sleep disturbance, worry more common |
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What treatment is available for patients with chronic pain/ MDD? |
CBT - self responsibility of patient Biofeedback, relaxtion, hypnosis. Cognitive - distraction, non-pain imagery, pain redefinition Behavioural - medication scheduling - medication becomes less pain behaviour, behaviour reinforcement - reduce disability/sick role |
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What pharmaceutical treatment is available for chronic pain? Pharmotherapy -> Wean off opiates -> CBT |
Antidepressants - tricyclics - amytriptylline, 5HT with NA Antipsychotics - haloperidol, clozapine, Mood stabilisers |
