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26 Cards in this Set
- Front
- Back
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What amount of the population are in chronic pain? |
14 million are in chronic pain (>/=3months of the year) around 1/4 of the population. |
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What percentage of adult women and men are in chronic pain? |
37% adult women and 31% adult men |
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What social groups is chronic pain more common in? |
More prevalent in older people and those of low income households. |
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How much more likely is a person in chronic pain to go to their GP? |
5X more likely |
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How many people in severe pain have clinical anxiety or depression? |
69% |
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What percentage of adults reported 1 pain in the last 12 months? |
87% |
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What percentage of adults reported more than 1 site of pain in the last 12 months? |
75% |
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What is congenital analgesia? |
People who don't feel pain. They often have a larger number of injuries occur to them. Pain is protective, functional and important. |
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Define the term pain |
Pain is an unpleasant and emotional experience associated with an actual or potential tissue damage, or described in terms of such damage. Pain is what the patient says it is and exists when s/he says it does. |
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Describe the case of Claire Phipps |
She spent almost 13 years in constant pain that was often dismissed and overlooked and later diagnosed with joint hypermobility syndrome. |
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Describe pain as a construct |
Physiological - nocioception (the sensory nervous systems response to certain harmful or potentially harmful stimuli) sensory - quality, intensity affective - unpleasantness cognitive - expectations, mental models behaviourhal - vocalising, posture |
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Describe different types of pain behaviour |
Facial expressions, para-vocalisation - 'Ouch' , complaint, rubbing/holding/guarding, posture chages, reduced behavioural repertoire (older people who are in pain are often anxious to go out), taking pain relief |
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How is pain assessed? |
Rating scales - pain thermometer (a fixed point rating scale, vertical orientation) - visual analogue scales - often 100mm long (distance measured of mark out of 100mm is measured and the amount/ percentage of pain is calculated to give a numerical value). McGill pain questionnaire (has image to identify body area affected - sensory, affective, evaluative, temporal - also has global rating scale). Faces pain scale (has been checked and standardised to be robust and reliable. It is just as valid as lab results). |
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What is the gate control theory/ |
Melzack + Wall If the gate is open - pain. If the gate is closed - pain reduces |
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Describe bottom-up and top-down processing of pain |
Bottom-up (sensation) - sensory driven - process that organis incoming information Top-down (perception) - driven by knowledge, experience and expectations - determine perception in ambiguous settings |
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What does TENS stand for? |
Transcutaneous Electrical Nerve Stimulation (TENS) - stimulates large nerve fibres to try and close the gate to reduce the amount of pain that is felt. |
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Describe some advances and problems of the gate control theory |
Advances - pain as a perception - individuals as active - individual variability expected - multiple causes of pain Problems - there is no evidence for the way in which the gate operates it is a theorised concept. - still assumes an organic basis for pain |
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What is phantom limb pain? |
Phantom sensations experienced by almost all amputees - real, normal, same position - persists but vividness often diminishes Phantom limb pain occurs in over 80% of people with an absent/inactive limb - often stronger than above sensations - changes in pain are linked to changes in mood, behaviour and environment It is often related to the last sensation they felt before the accident/amputation. The pain is physchological but feels extremely real. |
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Describe one mechanism used in phantom pain of paraplegia |
Virtual walking - watching a simulated image of themselves walking on a screen. This helps to reduce pain. This is about matching the sensory experience of the body with the physical tissue damage of the individual. |
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What was the Moseley pain experiment 2007? |
15 days of virtual walking task - 10 min/day Addresses a motor output - sensory feedback mismatch. Reduces the amount of pain but also changes the position of pain in some cases. |
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Describe the different descriptions of pain and how they can be useful |
Pain thresholds - sensation, perception, tolerance, encouraged/motivated tolerance (getting through the pain barrier is about moving through tolerance to motivated tolerance) Pain duration - phasic, acute, chronic Pain quality - superficial, deep, referred We can use people's descriptions of pain diagnostically as typically certain types of pain present in chracteristic ways. |
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Describe the Clarke & Clarke experiment |
Himalayan Climbers of different ethnic backgrounds - Occidental (western world) and Nepalise. Neplaise had a higher motivated tolerance, tolerance and a lower perception. |
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Describe cultural difference and how they affect the treatment of pain |
The stoical patient (don't report full intensity of their experiences) - more compassionate care - +ve western cultural value (no pain, no gain) The stoical doctor - response to complaining patient? Cultural competence |
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How can we make coping with acute pain easier? |
Changing the unpleasantness of pain rather than changing the intensity. e.g. preparation for surgery - information, relaxation techniques etc - importance of expectation, cognitive models (saw reduction in requests for medication used as an indicator of pain behaviour) Talking about wellness / having an optimistic tone rather than focusing on pain changes people subjective experiences of pain. |
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How does chronic pain affect an individuals life? |
It threatens their identity - takes over - they feel trapped - changed sense of body - old before my time - pain relief - primary goal in life - maintaining cycle (pain -> anxiety -> tension sleeplessness -> irritability -> decreased pain tolerance->) - psychological distress |
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Describe approaches to management of chronic pain |
Practical advice, physiotherapy, psychological interventions, less reliance on medical controls, social and family support. |
