Week 10: Chronic Pain

What is pain?

Unpleasant sensory and emotional experience associated with, or resembling actual or potential tissue damage.

What is chronic pain?

Pain that lasts beyond normal healing time. Generally 3 to 6 months minimum.

What is the difference between acute and chronic pain?

Acute pain is sudden and usually ends when the cause is treated or healed.

Chronic lasts longer and can continue from acute pain. May be harder to identify.

What is nocicpetive pain?

Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors. (E.g., Burns)

What is neuropathic pain?

Pain that is caused from nerve, spinal cord or brain affects.

(E.g., peripheral neuropathy).

What is musculoskeletal pain?

Muscle, joints, bones, soft tissue pain (E.g., lower back pain)

What is psychogenic pain?

Influenced by psychological, emotional behaviour factors (E.g., tension headache)

What is visceral pain?

Originates from an internal organ (E.g., endometriosis, bladder pain, angina).

What is inflammatory pain?

Activation of immune system (E.g., rhyematoid arthritis, cancer).

What is complex regional pain syndrome?

A chronic condition that usually occurs to a limb after a traumatic injury (including surgery).

Pain is disproportionate to injury.

Usually involves nerve damage

Can present with burning/tearing/hyperalgesia ,allodynia, decreased ROM, skin changes, swelling.

What is the biopsychosocial model?

How does the biopsychosocial model relate to chronic pain?

Biological: Chronic pain in childhood. Family history. Sex

Psychological: Anxiety, depression, stress.

Social: History of abuse. Parent mental health and family functioning.

What are the negative outcomes of chronic pain?

Reduced ability to perform ADLs

Trouble sleeping

Increased falls risk

Decreased independence

Spend more time in hospitals

Suicide is two to three times higher.

Financial difficulty

Medication addiction

What is the 'Gender Pain gap"

The concept that women are less likely to receive pain relief compared to men

More often dismissed, minimised, and attributed to hormonal or psychological factors.

How is pain measured? And why do we measure it?

0-10 scale

However, this scale is used to inform our own clinical approach and record data, whereas it should be used to open a conversation.

Consider age, cognitively impaired, culturally diverse patients.

(Wong baker face scale)

Why do people with chronic pain call 000?

Experiencing pain

Flare up or breakthrough pain

Chronic pain can be heavily influenced by the biopsychosocial model, so often people call because they have worsened pain, stress, worry, depression, anxiety.

What happens in hospital for those with chronic pain?

Chronic patients are unfortunately told that they have to wait.

If new changes or symptoms are present, like new altered sensation, incontinence etc. they will be triaged and reassessed accordingly.

What is the experiences of chronic pain individuals within the healthcare system?

Usually a very negative experience.

Patients describe having to prove themselves to paramedics.

Paramedics are less likely to give adequate analgesia and patients have worse physical and psychological outcomes.

What is the stigma surrounding chronic pain?

Pain is disbelieved by others

Pain is seemed as an excuse for drug seeking

Pain is seen as an excuse for laziness or not working

What is the role of paramedics regarding chronic pain?

be empathetic and compassionate

Recognise the limitations of the prehospital environment.

Identify a chronic pain management plan.

Identify biopsychosocial elements.

How long can it take to be diagnosed with endometriosis? How does this relate to chronic pain and complex callers?

It can take up to 9 years for an endometriosis diagnosis.

You could attend a patient who is just halfway into their journey for diagnosis or on the waiting list for surgery.