Pain Management and Assessment in Elderly Care
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Questions and Answers

Pain perception is influenced solely by biological factors.

False (B)

GCT provides a good understanding of the complexities of pain.

True (A)

Pain assessment tools are based solely on clinical observations.

False (B)

Multidisciplinary perspectives are important in managing chronic pain.

<p>True (A)</p> Signup and view all the answers

Education on pain psychology is not included in chronic pain management programs.

<p>False (B)</p> Signup and view all the answers

The modern aim of pain management includes increasing drug reliance.

<p>False (B)</p> Signup and view all the answers

Psychological interventions for acute pain management are considered second-level methods.

<p>True (A)</p> Signup and view all the answers

Chronic pain causes are generally simple and one-dimensional.

<p>False (B)</p> Signup and view all the answers

Patient-controlled analgesia (PCA) is an example of increasing patient control in pain management.

<p>True (A)</p> Signup and view all the answers

The 'five D's' in chronic pain management include drama, disuse, drug misuse, dependency on others, and satisfaction.

<p>False (B)</p> Signup and view all the answers

C polymodal fibres are responsible for mediating chronic throbbing pain.

<p>True (A)</p> Signup and view all the answers

A beta fibres are present in the diagram related to pain transmission.

<p>False (B)</p> Signup and view all the answers

Anxiety and depression can decrease pain tolerance.

<p>True (A)</p> Signup and view all the answers

Focusing on pain decreases the experience of pain.

<p>False (B)</p> Signup and view all the answers

Expectations of pain relief can create a placebo effect.

<p>True (A)</p> Signup and view all the answers

The gate control theory of pain suggests that emotional experiences do not affect pain perception.

<p>False (B)</p> Signup and view all the answers

Cognition includes beliefs about the ability to tolerate pain.

<p>True (A)</p> Signup and view all the answers

Transmission of pain information only involves peripheral pain receptors.

<p>False (B)</p> Signup and view all the answers

Pain is defined as a pleasant sensory and emotional experience.

<p>False (B)</p> Signup and view all the answers

The gate-control theory of pain is one of the psychological approaches to managing pain.

<p>True (A)</p> Signup and view all the answers

Approximately 80% of all doctor consultations in the US relate to pain.

<p>True (A)</p> Signup and view all the answers

Pain management programmes (PMPs) involve only doctors and nurses.

<p>False (B)</p> Signup and view all the answers

Cognitive strategies in pain management focus on altering beliefs about unmanageability of pain.

<p>True (A)</p> Signup and view all the answers

Injury always guarantees the presence of pain.

<p>False (B)</p> Signup and view all the answers

Phantom limb pain occurs after healing of an injury.

<p>True (A)</p> Signup and view all the answers

Reinforcement of adaptive behaviours is a key component of behavioural strategies in pain management.

<p>True (A)</p> Signup and view all the answers

According to Peter Gøtzsche, prescription drugs are the leading cause of death.

<p>False (B)</p> Signup and view all the answers

Providing analgesic medication based on pain behaviours is a common approach in pain management.

<p>False (B)</p> Signup and view all the answers

Withdrawing attention from pain behaviours is a part of contingency management.

<p>True (A)</p> Signup and view all the answers

Pain is solely a biological experience.

<p>False (B)</p> Signup and view all the answers

Approximately 20% of the adult European population is affected by pain.

<p>True (A)</p> Signup and view all the answers

Gate-control theory suggests that pain can be influenced by multiple factors.

<p>True (A)</p> Signup and view all the answers

Inactivity and poor physical fitness tend to close the pain gate.

<p>False (B)</p> Signup and view all the answers

Appropriate medication is a factor that can open the pain gate.

<p>False (B)</p> Signup and view all the answers

Emotional factors such as anxiety and depression can contribute to opening the pain gate.

<p>True (A)</p> Signup and view all the answers

The statement 'Pain is what the patient says it is' highlights the subjective nature of pain assessment.

<p>True (A)</p> Signup and view all the answers

Laughter and humor can help close the pain gate.

<p>True (A)</p> Signup and view all the answers

The focus on pain tends to close the pain gate.

<p>False (B)</p> Signup and view all the answers

Distraction is a cognitive factor that can close the pain gate.

<p>True (A)</p> Signup and view all the answers

Chronic pain management requires a multidisciplinary perspective.

<p>True (A)</p> Signup and view all the answers

Pain perception is influenced exclusively by biological factors.

<p>False (B)</p> Signup and view all the answers

Pain assessment tools rely on the clinician's observations alone.

<p>False (B)</p> Signup and view all the answers

Education on pain psychology is an important component of chronic pain management.

<p>True (A)</p> Signup and view all the answers

Relapse prevention is not part of patient education in chronic pain management.

<p>False (B)</p> Signup and view all the answers

C polymodal fibres mediate chronic throbbing pain.

<p>True (A)</p> Signup and view all the answers

Cognition does not include beliefs about the ability to control pain.

<p>False (B)</p> Signup and view all the answers

The gate control theory of pain emphasizes the role of emotional experiences in pain perception.

<p>True (A)</p> Signup and view all the answers

Focusing on pain tends to increase the experience of pain.

<p>True (A)</p> Signup and view all the answers

Peripheral pain receptors do not transmit information to the brain.

<p>False (B)</p> Signup and view all the answers

Pain management programmes (PMPs) are only designed for doctors and nurses.

<p>False (B)</p> Signup and view all the answers

Cognitive strategies in pain management aim to help patients alter their beliefs about the unmanageability of pain.

<p>True (A)</p> Signup and view all the answers

Withdrawal of attention from pain behaviours is not considered a part of contingency management.

<p>False (B)</p> Signup and view all the answers

Providing analgesic medication at set times is a common approach in pain management.

<p>True (A)</p> Signup and view all the answers

Distraction and re-directing attention are techniques used to reduce anxiety in pain management.

<p>True (A)</p> Signup and view all the answers

The definition of pain includes an emotional experience associated with potential tissue damage.

<p>True (A)</p> Signup and view all the answers

Phantom limb pain occurs only during the healing process.

<p>False (B)</p> Signup and view all the answers

Cognitive strategies in pain management ignore beliefs about pain.

<p>False (B)</p> Signup and view all the answers

The gate-control theory suggests that emotional experiences can influence pain perception.

<p>True (A)</p> Signup and view all the answers

Pain assessment tools are entirely based on psychological factors.

<p>False (B)</p> Signup and view all the answers

Proper sleep hygiene is a factor that can help close the pain gate.

<p>True (A)</p> Signup and view all the answers

Anxiety and stress tend to close the pain gate.

<p>False (B)</p> Signup and view all the answers

Laughter and humor can contribute to opening the pain gate.

<p>False (B)</p> Signup and view all the answers

Poor pacing of activities can open the pain gate.

<p>True (A)</p> Signup and view all the answers

Appropriate use of medication can help close the pain gate.

<p>True (A)</p> Signup and view all the answers

Cognitive factors have no effect on pain perception.

<p>False (B)</p> Signup and view all the answers

Chronic pain is defined as pain that lasts for less than six months.

<p>False (B)</p> Signup and view all the answers

A delta fibres are responsible for transmitting sharp pain sensations.

<p>True (A)</p> Signup and view all the answers

C polymodal fibres transmit information about acute pain.

<p>False (B)</p> Signup and view all the answers

The gate control theory suggests that 'anti-pain' fibres can inhibit the perception of pain.

<p>True (A)</p> Signup and view all the answers

The cost of pain in Europe is estimated to be around €200 million annually.

<p>False (B)</p> Signup and view all the answers

Chronic pain tends to respond well to pharmacological treatments.

<p>False (B)</p> Signup and view all the answers

Pain can be experienced in two phases according to the gate control theory.

<p>True (A)</p> Signup and view all the answers

About 48% of the population in the UK experiences chronic pain.

<p>True (A)</p> Signup and view all the answers

Flashcards

Pain Definition

Pain is a subjective experience involving unpleasant sensations and emotions, linked to actual or potential tissue damage.

Complex Perceptual Phenomenon

Pain arises from the interplay of biological, psychological, and social factors, meaning it's not solely a physical response.

Gate-Control Theory

A theory proposing that pain signals are modulated by a 'gate' in the spinal cord, influenced by both physical and psychological factors. This gate can be opened or closed.

Pain Assessment

Assessing pain involves methods for evaluating its intensity, location, and characteristics to determine the best course of action for treatment.

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Psychological Pain Management

Various psychological approaches, like cognitive behavioral therapy (CBT) and relaxation techniques, are used to help manage and reduce pain perception and impact.

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Pain without injury

Experiencing pain without any obvious tissue damage; an example could be phantom limb pain.

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Injury without pain

Experiencing no pain despite having an injury.

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Pain disproportionate to injury

When the intensity of pain is surprisingly greater or less than would be expected based on the extent of injury.

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Gate Control Theory of Pain

A theory proposing that pain signals are modulated by a 'gate' in the spinal cord, influenced not only by physical input but also by psychological factors.

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A-beta fibers

Sensory nerves that can counteract pain signals.

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C fibers

Sensory nerves transmitting chronic throbbing pain signals.

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Substantia gelatinosa

A region in the spinal cord involved in pain processing

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Cognitive influences on pain

Thoughts, emotions, and expectations can modify how much pain is felt.

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Pain Perception

How one experiences pain, influenced by physical stimuli and psychological factors.

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Pain signals "gate"

Neurological structures in the spinal cord that regulate the transmission and reception of pain signals.

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Mood influence on pain

Anxiety or depression changes pain tolerance and increases how much pain is reported.

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Pain Management Goals

Modern pain management aims to reduce pain perception, improve coping skills, increase functional ability, decrease drug reliance and distress, and respect self-management attempts.

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PCA (Patient Controlled Analgesia)

A method that gives patients control over their pain medication dosage, allowing them to administer doses as needed.

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Chronic Pain: Primary Gain

When pain behaviors are reinforced by avoiding unpleasant consequences (e.g., avoiding work).

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Chronic Pain: Secondary Gain

When pain behaviors lead to positive social outcomes (e.g., sympathy, care).

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Chronic Pain: Tertiary Gain

When the person helping the person in pain experiences satisfaction or pleasure.

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Pain gate opening factors

Factors that increase the perception of pain, such as injury, inactivity, long-term drug use, poor sleep, anxiety, and focusing on pain.

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Pain gate closing factors

Factors that decrease the perception of pain, such as appropriate medication, heat/cold, massage, exercise, relaxation, sleep hygiene, laughter, optimism, and distraction.

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Subjective pain

Pain as experienced and reported by the individual.

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Objective pain measurement

Difficult to measure pain based on physical signs/processes alone; patient's reporting is critical.

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Pain indicator

Patient reports of pain are an essential indicator of pathological processes or bodily injury, but aren't the sole source of information.

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Pain assessment mnemonics

Memory aids to help remember steps/factors to consider in evaluating pain.

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Operant learning for pain

Using rewards and consequences to change pain behaviors. It's like training a pet, but for pain management.

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Cognitive strategies for pain

Changing how you think about pain to reduce its impact. It's about challenging negative thoughts and beliefs.

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Catastrophizing pain

Exaggerating the negative aspects of pain and making it seem worse than it is.

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Multidisciplinary pain management

A team of experts from different fields working together to manage pain. Like a puzzle, each piece contributes to the whole picture.

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What is a PMP?

A Pain Management Programme is a structured approach using various strategies to help people cope with chronic pain. It's like a roadmap towards better pain management.

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Pain and the Puzzle

The complexity of understanding pain arises from the interplay of multiple factors, making it challenging to pinpoint the cause and find a single solution.

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Chronic Pain Management

Managing chronic pain requires a multidisciplinary approach, integrating physical, psychological, and social aspects.

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Cognitive-Behavioral Therapy (CBT)

CBT is a therapy approach that focuses on changing negative thought patterns and behaviors related to pain.

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What is pain?

An unpleasant sensory and emotional experience associated with actual or potential tissue damage. It's subjective, meaning everyone experiences it differently.

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Psychological Approaches to Pain Management

Using methods like cognitive behavioral therapy (CBT) and relaxation techniques to help manage and reduce pain perception and impact.

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Pain: A Social Issue

Pain affects a large population and often leads to significant economic and social burden.

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Multimodal Pain Management

Combining different approaches, like medication, physical therapy, and psychological therapies, to manage chronic pain.

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Chronic Pain Prevalence

A significant portion of the population experiences chronic pain lasting for six months or more, with rates varying across countries.

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Chronic Pain's Impact

Living with chronic pain can significantly impact a person's life, leading to longer hospital stays, work absences, and increased reliance on social welfare.

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Chronic Pain Cost

The financial burden of managing chronic pain is substantial, both for individuals and society, with billions of dollars spent annually on healthcare and lost productivity.

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What is Acute Pain?

Acute pain is a short-term, protective response to injury or illness, signaling the need for healing. It usually resolves quickly with treatment.

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What is Chronic Pain?

Chronic pain persists for six months or longer, often resisting typical treatments and causing ongoing suffering.

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Gate-Control Theory - Who?

Ron Melzack and Pat Wall developed the Gate-Control Theory of pain.

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Gate-Control Theory - Where?

The 'gate' in the Gate-Control Theory is located in the spinal cord, acting like a regulator for pain signals.

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Gate-Control Theory - How?

The gate can be influenced by multiple factors, including physical sensations (touch, pressure, heat) and psychological factors (thoughts, emotions), impacting how much pain is felt.

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How do cognitions influence pain?

Our thoughts, emotions, and expectations can significantly influence how we experience pain.

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What is the placebo effect?

A positive expectation of relief from pain, even if the treatment is inactive, can actually reduce pain perception.

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How does mood affect pain?

Anxiety and depression can worsen both pain tolerance and the reporting of pain.

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What are pain gate opening factors?

These factors increase the perception of pain, such as injury, inactivity, long-term drug use, poor sleep, anxiety, and focusing on pain.

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Contingency Management

This behavioral strategy for pain management focuses on reinforcing healthy behaviors, like exercise, and reducing attention paid to pain behaviors.

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Cognitive Restructuring

This cognitive strategy helps patients challenge negative thoughts about their pain and learn to reframe their beliefs.

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MDT for Pain Management

This refers to a multidisciplinary team (MDT) made up of doctors, nurses, therapists, and counselors, all working together to manage a patient's pain.

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Pain Management Programme (PMP)

This is a structured program that combines various approaches to help people manage their chronic pain. It's like a personalized roadmap for getting better.

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What is the GCT?

The Gate-Control Theory proposes that a 'gate' in the spinal cord controls pain signals. This gate can be opened or closed based on both physical and psychological factors.

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What influences pain perception?

Pain perception is influenced by a complex interplay of biological, psychological, social, and cultural factors.

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How is pain assessed?

Assessing pain involves understanding the patient's own perception of their pain and its severity, as pain is a subjective experience.

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Why is a multidisciplinary approach important?

Managing chronic pain effectively requires a multidisciplinary perspective, addressing the interplay between physical, psychological, and socioeconomic factors.

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What are the goals of pain management?

Modern pain management aims to reduce pain perception, improve coping skills, increase functional ability, decrease drug dependence, and distress, while promoting self-management.

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Factors that Open the Pain Gate

Conditions or experiences that increase pain perception, such as injury, inactivity, long-term drug use, and anxiety.

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Factors that Close the Pain Gate

Activities or interventions that decrease pain perception, such as appropriate medication, exercise, relaxation techniques, and distraction.

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Pain Assessment: Subjective Experience

Pain is a subjective experience, meaning it's what the person experiencing it says it is. There's no objective way to measure someone else's pain.

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Patient Reporting and Pain

While patient reports are critical, they shouldn't be the only indicator of pain or injury. Other signs like swelling, redness, or changes in behavior can provide additional information.

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Pain Assessment: What to Consider

Evaluate pain location, intensity, duration, and how it affects daily life. Also, consider factors that might influence pain perception like anxiety, depression, or activities.

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Pain Management: Closing the Gate

Strategies like medication, physical therapy, and behavioral therapy are used to manage pain, often by closing the 'pain gate' and decreasing pain perception.

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Multidisciplinary Approach to Pain Management

Effective pain management often involves a team of health professionals, such as doctors, therapists, and psychologists, working together to address the complex nature of pain.

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Study Notes

Learning Outcomes

  • Define pain as a complex perceptual phenomenon influenced by biological, psychological, and social factors
  • Describe the gate-control theory of pain
  • Outline approaches to pain assessment
  • Identify major psychological approaches to managing pain

BMF Case (HIP FRACTURE)

  • Lisa, an 80-year-old woman, has reasonably good health and lives with her 79-year-old husband, Joe
  • Lisa is due to see her GP (Dr Sam Johnson) soon. She recently had a DEXA scan to assess bone mass.
  • Joe's condition deteriorates, requiring constant supervision and eventually end-of-life care planning. Lisa needs a sustainable health care plan.
  • Lisa falls at home, suffers a lower limb injury, and requires hip surgery, which is uncomplicated and successful.
  • During rehabilitation, Lisa experiences pain in her left knee (opposite the hip injury) and lower back.

What is Pain?

  • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage
  • Subjective
  • Sensation and emotion
  • Pain without injury
  • Injury without pain

The Puzzle of Pain

  • Injury without pain
  • Pain without injury
  • Pain disproportionate to injury
  • Pain after healing (phantom limb pain)
  • Success of multimodal treatments

Definition of Pain

  • An unpleasant sensory and emotional experience associated with actual or potential tissue damage
  • Subjective
  • Sensation and emotion
  • Pain without injury
  • Injury without pain

Pain: An Important Social Issue

  • Prescription drugs are the third leading cause of death (Peter Gøtzsche)

The Cost of Pain

  • Affects approximately 20% of adult European population
  • 80% of all doctor consultations in the US relate to pain
  • Prevalence of chronic pain in Ireland is 35.5% (48% in the UK).
  • Associated with extended hospital stays, lost working days, and increased use of social welfare benefits
  • Cost of pain in Europe is €200 billion annually, and US560−560-560−635 billion
  • Pain statistics underestimate the human cost
  • Pain is often the most debilitating and distressing aspect of chronic disease

Acute vs Chronic Pain

  • Acute pain: A useful biological response provoked by injury or disease, limited duration, and usually adaptive responses
  • Chronic pain: Pain persisting for six months or more, tends not to respond well to pharmacological treatment, and often shows maladaptive responses

Gate Control Theory of Pain

  • Pain sensations are transmitted from the injury site to the spinal gate by nerves called nociceptors.
  • A delta fibres: myelinated pain afferents, very strong noxious stimuli, short duration
  • C polymodal fibres: slow conducting, non-myelinated, dull, throbbing pain, longer duration
  • "Anti-pain" fibres: A beta fibres – myelinated mechanically sensitive afferents, activation inhibits pain perception, e.g., rubbing, massage, heat

Gate Control Theory of Pain: Psychological Influences

  • Mood: Anxiety and depression can affect pain tolerance and reporting
  • Cognitions: Focusing on pain increases pain experience, expectations of pain increase or decrease it
  • Types of influence include attributions of pain cause, beliefs about tolerating pain, beliefs about pain control, expectations of pain relief

Combined Gate Control Theory Inputs

  • Peripheral pain receptors transmit information about physical damage, linking to other nerves in the spinal column, transmitting impulses to pain centres in the brain
  • Experience of physical damage also includes cognitions and emotions, activating CNS nerve fibres and taking information down the spinal column to the pain gate

Factors that Open or Close the Pain Gate

  • (Tend to open the gate)*
  • Physical: Injury, inactivity, poor physical fitness, long-term drug/alcohol use
  • Behavioural: Poor or too little pacing of activity, poor sleep
  • Emotional: Anxiety, depression, stress, helplessness/hopelessness, focus on pain
  • Cognitive: Worrying about pain
  • (Tend to close the gate)*
  • Physical: Appropriate medication, heat/cold, massage, exercise
  • Behavioural: Relaxation training, sleep hygiene
  • Emotional: Laughter/humor, optimism, engagement in enjoyable activities
  • Cognitive: Distraction

Pain Assessment

  • Unidimensional scales: Verbal rating scales (words ranked in severity), Visual analogue scales (continuous or intermittent pain measurement scales)
  • Multidimensional scales: McGill pain questionnaires (consist of 20 descriptors, each with variable words and intensities, divided into four dimensions. Sensory, affective, evaluative, miscellaneous categories)

Think, Pair, Share

  • Is pain objectively measurable? How might you clinically know if someone is in pain?
  • Is patient reporting of pain a good indicator of injury? Give examples
  • Can you find useful mnemonics for pain assessment?

Pain Management: Acute

  • First line is generally pharmacological
  • Second-level interventions include increasing patient control (e.g., PCA), and teaching coping skills (e.g., distraction, relaxation, hypnosis)

Pain Management: Acute (VR Pain Management)

  • Using virtual reality (VR) as a distraction.

Pain Management: Chronic

  • Causes of chronic pain: Complex and multifactorial (influenced by social interactions). Primary gain (avoidance of unpleasant tasks), Secondary gain (gaining extra attention or sympathy), Tertiary gain (satisfaction from helping others)
  • Results ("Five D's"): Dramatisation, Disuse (inactivity), Drug misuse (overmedicating), Dependency on others, Disability

Pain Management (Chronic): Behavioral and Cognitive Strategies

  • Behavioral strategies: Based on operant learning, contingent management, reinforcement of adaptive behaviours (appropriate exercise), withdrawal of attention or rewards for pain behaviours, analgesic medication at set times
  • Cognitive strategies: Focus on altering beliefs about pain, addressing catastrophizing, challenging distorted thoughts about pain, information provision to reduce anxiety, distraction, relaxation

Pain Management Programmes (PMPs)

  • Multidisciplinary teams (doctors, nurses, physiotherapists, psychologists, occupational therapists, counsellors)
  • Underpinned by cognitive-behavioral principles (CBT)
  • Provide education on pain physiology, psychology, healthy function/self-management
  • Group format to normalize pain experiences
  • Patient receives full assessment, education, skills/exercise training, relapse prevention planning, family work

Pain Assessment Tools

  • Different pain assessment tools are used to assess the subjective qualities of pain, which often have multiple dimensions
  • Pain intensity can be assessed using 10-cm unmarked lines, facial anchors, coloured analogue scales, and verbal rating scales

Summary

  • Pain perception is influenced by biological, psychological, social, and cultural factors
  • The gate control theory provides a good basis for understanding the complexities of pain.
  • Pain is a subjective symptom; pain assessment tools should be based on the patient's perception.
  • Appropriate management of chronic pain requires a multidisciplinary perspective by addressing factors (physical, psychological and socio-economic)

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P HHD - Describing, Assessing, Managing Pain (PDF)

Description

This quiz focuses on the complex nature of pain, especially in elderly patients like Lisa. It covers definitions, the gate-control theory, pain assessment techniques, and psychological strategies for pain management. Understand the multifaceted factors that influence pain and learn how to apply this knowledge in clinical settings.

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