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Questions and Answers
The historical aim of pain management was to reduce pain perception.
The historical aim of pain management was to reduce pain perception.
False
Psychological intervention forms are a second-level approach in acute pain management.
Psychological intervention forms are a second-level approach in acute pain management.
True
Chronic pain can be influenced by interactions within the social environment.
Chronic pain can be influenced by interactions within the social environment.
True
The five D's of chronic pain management do not include drug misuse.
The five D's of chronic pain management do not include drug misuse.
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Distraction and relaxation are coping skills taught in pain management.
Distraction and relaxation are coping skills taught in pain management.
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Chronic throbbing pain is mediated by A beta fibres.
Chronic throbbing pain is mediated by A beta fibres.
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Gate Control Theory of Pain suggests that psychological influences affect pain perception.
Gate Control Theory of Pain suggests that psychological influences affect pain perception.
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Anxiety and depression can increase pain tolerance.
Anxiety and depression can increase pain tolerance.
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Focusing on pain can reduce the overall pain experience.
Focusing on pain can reduce the overall pain experience.
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Expectations of relief from pain may lead to the placebo effect.
Expectations of relief from pain may lead to the placebo effect.
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A-beta fibres are involved in transmitting information about physical damage.
A-beta fibres are involved in transmitting information about physical damage.
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Cognitions related to pain can influence how pain is experienced.
Cognitions related to pain can influence how pain is experienced.
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The gate control mechanism operates only through physical signals without psychological influence.
The gate control mechanism operates only through physical signals without psychological influence.
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Long-term drug use tends to open the pain gate.
Long-term drug use tends to open the pain gate.
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Massage is a factor that tends to close the pain gate.
Massage is a factor that tends to close the pain gate.
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Engaging in enjoyable activities can open the pain gate.
Engaging in enjoyable activities can open the pain gate.
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Anxiety and depression are factors that can close the pain gate.
Anxiety and depression are factors that can close the pain gate.
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Pain assessment is subjective and relies on patient reporting.
Pain assessment is subjective and relies on patient reporting.
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Distraction techniques can help close the pain gate.
Distraction techniques can help close the pain gate.
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Poor sleep hygiene tends to close the pain gate.
Poor sleep hygiene tends to close the pain gate.
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Optimism can be a factor that helps close the pain gate.
Optimism can be a factor that helps close the pain gate.
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Cognitive strategies are focused on altering beliefs about the unmanageability of pain.
Cognitive strategies are focused on altering beliefs about the unmanageability of pain.
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Withdrawal of attention to pain behaviours is a reinforcement strategy.
Withdrawal of attention to pain behaviours is a reinforcement strategy.
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Providing analgesic medication in response to pain behaviours is a common strategy in pain management programmes.
Providing analgesic medication in response to pain behaviours is a common strategy in pain management programmes.
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Multidisciplinary teams for pain management may include psychologists and counsellors.
Multidisciplinary teams for pain management may include psychologists and counsellors.
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Relaxation techniques are intended to target mental stress rather than physical pain.
Relaxation techniques are intended to target mental stress rather than physical pain.
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The prevalence of chronic pain in Ireland is 35.5%.
The prevalence of chronic pain in Ireland is 35.5%.
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Chronic pain is defined as pain that lasts for at least three months.
Chronic pain is defined as pain that lasts for at least three months.
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The costs of pain in Europe amount to €200 billion annually.
The costs of pain in Europe amount to €200 billion annually.
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Pain is solely a physical sensation and does not involve emotional factors.
Pain is solely a physical sensation and does not involve emotional factors.
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Acute pain is typically a long-lasting response to injury.
Acute pain is typically a long-lasting response to injury.
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A delta fibres transmit information about dull, throbbing pain.
A delta fibres transmit information about dull, throbbing pain.
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The gate-control theory is one approach to understanding pain.
The gate-control theory is one approach to understanding pain.
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The gate control theory of pain was proposed by Ron Melzack and Pat Wall.
The gate control theory of pain was proposed by Ron Melzack and Pat Wall.
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Lisa experienced pain in her left knee after a successful hip surgery.
Lisa experienced pain in her left knee after a successful hip surgery.
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C polymodal fibres are responsible for transmitting sharp pain.
C polymodal fibres are responsible for transmitting sharp pain.
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The majority of doctor consultations in the US are unrelated to pain.
The majority of doctor consultations in the US are unrelated to pain.
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Peter Gøtzsche states that prescription drugs are the leading cause of death.
Peter Gøtzsche states that prescription drugs are the leading cause of death.
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A beta fibres inhibit the perception of pain when activated.
A beta fibres inhibit the perception of pain when activated.
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An injury can occur without the experience of pain.
An injury can occur without the experience of pain.
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Approximately 20% of the adult population in Europe is affected by pain.
Approximately 20% of the adult population in Europe is affected by pain.
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Pain is only experienced during the healing process.
Pain is only experienced during the healing process.
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Pain management programmes often rely exclusively on pharmacological interventions.
Pain management programmes often rely exclusively on pharmacological interventions.
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Cognitive strategies in pain management focus on changing unhelpful thought patterns related to pain.
Cognitive strategies in pain management focus on changing unhelpful thought patterns related to pain.
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Reinforcement of adaptive behaviours includes encouraging patients to ignore pain sensations.
Reinforcement of adaptive behaviours includes encouraging patients to ignore pain sensations.
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Multidisciplinary teams in pain management consist solely of medical doctors.
Multidisciplinary teams in pain management consist solely of medical doctors.
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Distraction techniques are not typically used in pain management strategies.
Distraction techniques are not typically used in pain management strategies.
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The modern aim of pain management includes decreasing drug reliance.
The modern aim of pain management includes decreasing drug reliance.
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Teaching coping skills is considered a primary strategy for managing chronic pain.
Teaching coping skills is considered a primary strategy for managing chronic pain.
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In chronic pain management, tertiary gain refers to the expressions of sympathy received from others.
In chronic pain management, tertiary gain refers to the expressions of sympathy received from others.
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Patient controlled analgesia (PCA) is an example of increasing patient control in pain management.
Patient controlled analgesia (PCA) is an example of increasing patient control in pain management.
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The five D's of chronic pain management do not include dependency on others.
The five D's of chronic pain management do not include dependency on others.
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Appropriate medication tends to open the pain gate.
Appropriate medication tends to open the pain gate.
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Inactivity and poor physical fitness can lead to the opening of the pain gate.
Inactivity and poor physical fitness can lead to the opening of the pain gate.
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Engaging in enjoyable activities tends to close the pain gate.
Engaging in enjoyable activities tends to close the pain gate.
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Long-term alcohol use is a factor that tends to close the pain gate.
Long-term alcohol use is a factor that tends to close the pain gate.
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Laughter and humor can help close the pain gate.
Laughter and humor can help close the pain gate.
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Stress and anxiety are considered cognitive factors that open the pain gate.
Stress and anxiety are considered cognitive factors that open the pain gate.
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Cognitive strategies in pain management aim to alter perceptions about pain.
Cognitive strategies in pain management aim to alter perceptions about pain.
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A patient's understanding of pain primarily depends on biological factors alone.
A patient's understanding of pain primarily depends on biological factors alone.
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Cognitive-behavioural principles can be used to provide education on pain self-management.
Cognitive-behavioural principles can be used to provide education on pain self-management.
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Multidisciplinary perspectives are unnecessary for the management of chronic pain.
Multidisciplinary perspectives are unnecessary for the management of chronic pain.
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Pain assessment tools are objective and do not rely on the patient's own perception.
Pain assessment tools are objective and do not rely on the patient's own perception.
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Education and skills training are key components provided to patients in pain management programs.
Education and skills training are key components provided to patients in pain management programs.
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Anti-pain fibres are known as C polymodal fibres.
Anti-pain fibres are known as C polymodal fibres.
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The cost of pain in Europe is estimated to be around €200 billion annually.
The cost of pain in Europe is estimated to be around €200 billion annually.
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Acute pain is a maladaptive response to injury or disease.
Acute pain is a maladaptive response to injury or disease.
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C polymodal fibres conduct information about sharp pain quickly.
C polymodal fibres conduct information about sharp pain quickly.
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Engaging in activities that promote relaxation can help inhibit the experience of pain.
Engaging in activities that promote relaxation can help inhibit the experience of pain.
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The gate control theory suggests that pain perception can be influenced by both physical and psychological factors.
The gate control theory suggests that pain perception can be influenced by both physical and psychological factors.
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Pain is solely a psychological phenomenon and does not involve biological factors.
Pain is solely a psychological phenomenon and does not involve biological factors.
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Phantom limb pain is a type of pain that occurs after healing from an injury.
Phantom limb pain is a type of pain that occurs after healing from an injury.
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The success of multimodal treatments for pain indicates that a singular approach is generally sufficient.
The success of multimodal treatments for pain indicates that a singular approach is generally sufficient.
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Lisa experienced pain in her left knee prior to her hip surgery.
Lisa experienced pain in her left knee prior to her hip surgery.
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Peter Gøtzsche has indicated that prescription drugs are a leading cause of death.
Peter Gøtzsche has indicated that prescription drugs are a leading cause of death.
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The adult population in Europe affected by pain is approximately 50%.
The adult population in Europe affected by pain is approximately 50%.
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Acute pain is a long-lasting response to injury.
Acute pain is a long-lasting response to injury.
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Chronic pain can exist without any current tissue damage.
Chronic pain can exist without any current tissue damage.
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The modern aim of pain management is to eliminate pain completely.
The modern aim of pain management is to eliminate pain completely.
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In pain management, hypnosis is categorized as a primary intervention technique.
In pain management, hypnosis is categorized as a primary intervention technique.
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Secondary gain in chronic pain refers to the cessation of aversive consequences.
Secondary gain in chronic pain refers to the cessation of aversive consequences.
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The term 'five D's' includes dependency on medication as one of its components.
The term 'five D's' includes dependency on medication as one of its components.
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Pain management decisions should respect a patient's attempts at self-management.
Pain management decisions should respect a patient's attempts at self-management.
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A delta fibres are slow conducting and are responsible for transmitting sharp pain.
A delta fibres are slow conducting and are responsible for transmitting sharp pain.
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The gate-control theory suggests that pain perception is regulated solely by physiological mechanisms.
The gate-control theory suggests that pain perception is regulated solely by physiological mechanisms.
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A beta fibres are responsible for transmitting dull, throbbing pain sensations.
A beta fibres are responsible for transmitting dull, throbbing pain sensations.
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The economic cost of chronic pain in Europe is estimated at approximately €200 billion annually.
The economic cost of chronic pain in Europe is estimated at approximately €200 billion annually.
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Pain is only experienced as a direct response to physical injury or disease.
Pain is only experienced as a direct response to physical injury or disease.
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Chronic pain often leads to increased use of social welfare benefits.
Chronic pain often leads to increased use of social welfare benefits.
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Acute pain is usually maladaptive and lasts for extended periods.
Acute pain is usually maladaptive and lasts for extended periods.
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Anxiety and stress can open the pain gate.
Anxiety and stress can open the pain gate.
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Long-term drug use is a factor that tends to close the pain gate.
Long-term drug use is a factor that tends to close the pain gate.
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Relaxation training is considered a physical factor that closes the pain gate.
Relaxation training is considered a physical factor that closes the pain gate.
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Engaging in activities that promote laughter and humor can help close the pain gate.
Engaging in activities that promote laughter and humor can help close the pain gate.
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Poor sleep is a factor that tends to close the pain gate.
Poor sleep is a factor that tends to close the pain gate.
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Distraction is a cognitive strategy that can help close the pain gate.
Distraction is a cognitive strategy that can help close the pain gate.
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Excessive pacing of activities tends to close the pain gate.
Excessive pacing of activities tends to close the pain gate.
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Chronic throbbing pain is mediated by C polymodal fibres.
Chronic throbbing pain is mediated by C polymodal fibres.
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A beta fibres are primarily responsible for transmitting sharp pain sensations.
A beta fibres are primarily responsible for transmitting sharp pain sensations.
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Psychological influences can enhance the experience of pain according to the Gate Control Theory.
Psychological influences can enhance the experience of pain according to the Gate Control Theory.
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Cognitions such as beliefs about pain tolerance can have no effect on pain perception.
Cognitions such as beliefs about pain tolerance can have no effect on pain perception.
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The gate control mechanism involves only physical damage signals without any cognitive or emotional components.
The gate control mechanism involves only physical damage signals without any cognitive or emotional components.
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Expectations of relief from pain can create a self-fulfilling prophecy.
Expectations of relief from pain can create a self-fulfilling prophecy.
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A-beta fibres are always present in pain transmission pathways.
A-beta fibres are always present in pain transmission pathways.
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Anxiety and depression are factors that can enhance pain tolerance.
Anxiety and depression are factors that can enhance pain tolerance.
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Pain management programs only focus on physical aspects and do not consider psychological factors.
Pain management programs only focus on physical aspects and do not consider psychological factors.
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Education on pain physiology is an essential component of cognitive-behavioral therapy for managing pain.
Education on pain physiology is an essential component of cognitive-behavioral therapy for managing pain.
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Cognitive strategies in pain management exclusively focus on physical rehabilitation techniques.
Cognitive strategies in pain management exclusively focus on physical rehabilitation techniques.
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Chronic pain is universally defined as pain persisting for at least six months.
Chronic pain is universally defined as pain persisting for at least six months.
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Analgesic medication is typically administered at unscheduled times in pain management programmes.
Analgesic medication is typically administered at unscheduled times in pain management programmes.
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Pain perception is solely a biological response without influence from social or cultural factors.
Pain perception is solely a biological response without influence from social or cultural factors.
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The Gate Control Theory of Pain suggests that emotional states can modulate pain perception.
The Gate Control Theory of Pain suggests that emotional states can modulate pain perception.
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Withdrawal of attention from pain behaviors can lead to an increase in maladaptive coping strategies.
Withdrawal of attention from pain behaviors can lead to an increase in maladaptive coping strategies.
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Multidisciplinary teams in pain management can include various professionals such as doctors, psychologists, and occupational therapists.
Multidisciplinary teams in pain management can include various professionals such as doctors, psychologists, and occupational therapists.
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Distraction techniques are primarily utilized to enhance emotional coping rather than reducing the perception of pain.
Distraction techniques are primarily utilized to enhance emotional coping rather than reducing the perception of pain.
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Study Notes
Learning Outcomes
- Pain is defined as a complex perceptual phenomenon, influenced by biological, psychological, and social factors.
- The gate-control theory of pain is described.
- Approaches to pain assessment are outlined.
- Major psychological approaches to pain management are identified.
BMF Case (Hip Fracture)
- Lisa, an 80-year-old woman, has hip surgery for a lower limb injury.
- Post-surgery, Lisa experiences pain in her left knee and lower back.
- Joe, Lisa's husband requires end-of-life care and planning.
- Lisa needs a more sustainable management plan for her health care.
Learning Outcome 1: Defining Pain
- Pain is a complex sensory and emotional experience associated with actual or potential tissue damage.
What is Pain?
- Pain is a subjective experience.
- Images depicting pain and an image of a person using/experiencing fire are included.
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
- Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
- Pain is subjective.
- Pain involves sensation and emotion.
- Pain can occur without injury.
- Injury does not always cause pain.
Pain: An Important Social Issue
- Prescription drugs are a major cause of death.
- The coming epidemic of arthritis.
- The Cost of Pain, the third leading cause of death is due to prescription drugs.
The Cost of Pain
- Approximately 20% of adult Europeans are affected by pain.
- 80% of all doctor consultations in the U.S. relate to pain.
- Chronic pain prevalence in Ireland is 35.5%.
- Chronic pain prevalence in the UK is 48%.
- The cost of pain in Europe is €200 billion annually.
- The cost of pain in the U.S is 560−560 - 560−635 billion annually.
Acute vs Chronic Pain
- Acute pain: A useful biological response to injury or illness, of limited duration.
- Chronic pain: Pain lasting six months or more, often unresponsive to pharmacological treatment; reactions are often maladaptive.
Learning Outcome 2: Gate Control Theory of Pain
- Pain sensations are transmitted from the injury site to the spinal gate by nerves known as nociceptors.
- A delta fibers: Myelinated pain afferents; transmit signals related to potential or actual damage. Experience lasts a short time.
- C polymodal fibers: Slow-conducting, non-myelinated; transmit information about dull, throbbing pain; experience typically occurs for a longer time.
- Anti-pain fibers: A beta fibers- Myelinated, mechanically (touch) sensitive afferents. Activate to inhibit pain perception.
- These fibres transmit information at varying speeds, resulting in varied pain experiences
- Pain involves the experience of sharp pain at first, then a more chronic throbbing pain later.
- A beta fiber activation counteracts pain at least partially.
Gate Control Theory of Pain: Periphery
- There is a transmission of pain from injury to the spinal gate by nerves known as nociceptors, which contain A delta fibers (myelinated and quick acting) and C polymodal fibers (non myelinated and prolonged acting).
- Anti-pain fibers (A beta fibers) activate to inhibit pain perception.
Gate Control Theory of Pain
- Information transmission along A and C fibers to the substantia gelatinosa in the spinal cord to the brain.
Gate Control Theory of Pain: Psychological Influences on Pain Perception: Cognition & Mood
- Mood: Anxiety and depression can influence pain tolerance and reporting.
- Cognition: Attention on pain increases pain experience. Expectations on pain increase or decrease pain experience.
- Thought types: Cause of pain, Ability to tolerate pain, Ability to control pain, Expectations of pain relief (placebo effect).
Combined Gate Control Theory inputs
- Peripheral pain receptors send information to spinal column 'gates.'
- At the same time, cognitions and emotions activate CNS fibers, sending info down the spinal column influencing the 'pain gate'.
Gate-control theory
- The gate-control theory describes how pain signals are transmitted.
- The brain sending pain signals to the spinal cord, through differing signals (+9, -3, +6, -2) influence the opening and/or closing of the gate.
Factors that Open or Close the Pain Gate
-
Tend to open the gate: Injury, inactivity, poor physical fitness, long-term drug or alcohol use, poor sleep, anxiety, depression, stress, helplessness, focussing on pain, worrying about the pain (cognitive), poor or insufficient pacing of daily activity (behavioral).
-
Tend to close the gate: Appropriate medication use, heat/cold, massage, exercise, relaxation training, sleep hygiene, laughter, humor, optimism, engagement in positive activities (behavioral and emotional).
Learning Outcome 3: Pain Assessment
- Unidimensional Scales: Verbal rating scales use words ranked in order of severity. Visual analogue scale is an 10cm unmarked line or is coloured for visual aid. Facial expressions act as anchors.
- Multidimensional Scales: McGill Pain Questionnaire assesses 20 descriptor scales, each with a variable number of words, helping diagnose and identify various pain dimensions such as sensory, affective, and evaluative.
- Pain is defined as what the patient says it is.
Think, Pair, Share
- Is it true that pain cannot be objectively measured?
- Is patient reporting of pain a good indicator of pathological processes?
- Useful mnemonics for pain assessment?
Learning Outcome 4: Managing Pain
- Historical aim: Eliminate pain.
- Modern aim: Reduce pain perception, improve coping ability, increase functional ability, decrease drug reliance, respect attempts at self-management.
Pain management: Acute
- First line: Pharmacological interventions.
- Second-level: Psychological interventions, including increasing patient control (e.g., PCA), teaching coping skills, including distraction, relaxation, and hypnosis.
- This often includes using VR pain management for distraction.
Pain management - Chronic
- Causes: Complex and multifactorial, including interactions within social environments (gain). This includes primary (intrapersonal) gain, secondary (interpersonal) gain, and tertiary gain.
- Results: So-called "five D's": Dramatisation, Disuse, Drug misuse, Dependency, Disability.
Pain Management (Chronic)
- Behavioral Strategies: Based on operant learning (contingency management), reinforcement of adaptive behaviors (e.g., appropriate exercise levels), withdrawal of attention/rewards for pain behaviors, and providing analgesic medication at set times rather than based on pain.
- Cognitive Strategies: Altering beliefs about pain unmanageability, addressing catastrophising or negatively biased thinking, identifying and challenging distorted thinking, providing information, distraction, anxiety reduction, relaxation, and targeting pain area muscles.
Pain management programmes (PMPs)
- Multidisciplinary Teams (MDTs): Include doctors, nurses, physiotherapists, psychologists, occupational therapists, and counselors.
- Principles: CBT (cognitive behavioral therapy) underpinnings, education on pain physiology, psychology, healthy function, and self-management.
- Delivery: Group format to normalize pain experiences and maximize learning, complete assessment, education, skills training, exercise schedules, relapse prevention, and family involvement.
Summary
- Pain perception is influenced by biological, psychological, social, and cultural features.
- The gate-control theory offers a framework for understanding the complexity of pain.
- Pain is a subjective symptom, and pain assessment relies on patient perception.
- Effective chronic pain management requires a multifaceted approach addressing physical, psychological, and socioeconomic factors.
Reading
- Relevant reading materials are listed, including book chapters and YouTube videos on pain and pain management from various authors.
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Description
This quiz explores the complex nature of pain, including its definition and the factors that influence its perception. It delves into pain assessment methods, psychological approaches to pain management, and case studies illustrating the implications of pain in patients like Lisa. Equip yourself with essential knowledge to better understand and manage pain effectively.
