4. Pain Management in Humans

thermode

heated metal box attached to wrist or arm used to measure heat pain threshold and tolerance

cold pressor test

hand or elbow is immersed in cold water usually 4C, causing the limb to become ischemic, causing pain

pressure algometry

researcher presses down on limb, machine tracks amount of force to measure mechanical pain threshold and tolerance

pain threshold

where normal sensation turns into pain

pain tolerance

when person can no longer handle pain, not useful for research on spontaneous pain, measure of willpower in research

verbal rating scale

people get 6 choices of descriptors and tell clinician

numeric rating scale

0-10 11 point pain scale, similar to verbal, but words are replaced with numbers

visual analogue scale

person draws line where on continuum where pain is, left = no pain, right = worst possible pain, patient cannot memorize what they put previously, good for research

FACES scale

pain scale where patient chooses face similar to how they feel, used in peds, 0=smiling, crying=severe

causalgia

rare type of CRPS related to partial peripheral injuries

FLACC pain scale

face, legs, activity, cry, and consolability scale used for clinicians to assess pain in babies

facial action coding system

tool for clinicians to assess pain in patients by Paul Ekman that states that people regardless of culture, move x muscles for certain emotions

McGill Pain Quesitonnaire

pain assessment tool developed by Melzack (gate control theory) that uses 20 qualitative ?’s and a 6 point rating scale, works well to determine cause

Oswestry Disability Index

assessment tool that determines how disabling a condition is and how well pain killers work

DN4 neuropathic pain questionnaire

4 ?, 10pt tool to determine if a patient has neuropathy, including characteristics, symptoms, signs, and if it is provoked by brushing (dynamic pain)

WOMAC questionnaire

pain assessment tool developed specifically for arthritis rating how much pain, stiffness, and degree of difficulty in different tasks and contexts

quantitative sensory testing

induced, measured pain, beside exam looking at allodynia and hyperalgesia

psychophysics

giving a bunch of different intensities of stimulus to indicate where the threshold is, using the staircase method

demand characteristic

research subjects falsifying data to please experimenter

deontological ethics

morality judged based on action's adherence to a rule

consequentialist ethics

morality based on consequences

hot plate test

rodents are placed on hot plate, which warms up until painful, where they lift paw, latency indicates threshold, measures acute heat pain, hard to compare sides

tail flick test

rodent’s tail is put under hot lamp, they flick tail when painful, measuring acute heat pain, will work under anesthesia b/c reflex

Hargreaves’ Test

aims heat lamp at one side of rodent’s paw at time, tests radiant heat

von Frey filaments test

experimental pain test assessing mechanical stimulation in humans, debate on whether painful or annoying

Randall-Selitto Test

experimental method of assessing pain where a rat’s foot is put between 2 pieces of plastic, force is applied and measured until rat withdraws paw

writhing test

acetic acid is injected into belly to cause visceral pain, mice squash belly against ground, inescapable, superthreshold, more like chronic pain

formulin test

formulin is injected into hindpaw causing inflammation, w/ early licking phase, quiescent phase, & late phase w/ more licking

axotomy

surgical procedure, completely severing axon, where all afferent info associated with nerve is completely denerved

autonomy

animals biting off toes after axotomy

vulvodynia

nociplastic disorder with allodynia of the vulva, affecting \~12% of childbearing age women, would be caused by many yeast infections

operant conditioning

method of learning that uses rewards and punishment to modify behaviour

classical conditioning

behaviours are learned by connecting a neutral stimulus with a positive one

biopsychosocial model

pain is a function of biological, sociocultural, and psychological factors

biomedical model

if there is pain in an area, there is a problem in that area

Monogenic pain disorder

disorder of too little or much pain characterized by malfunction of a single gene

somatization

paying close attention to bodily sensations