Exam 2 Nature of Pain and Treatment

What is pain?

Pain is the physical sensory and emotional experience of discomfort

typically associated with actual or threatened tissue damage or irritation

Organic pain

Clearly linked to tissue pressure or damage (burns, sprains, cuts)

Psychogenic pain

pain without a clear physical, organic basis (headaches, back pain, stomach aches)

Acute pain 

refers to temporary painful conditions lasting less than three months (toothaches, muscle strains, everyday aches and injuries)

Chronic pain

refers to pain lasting longer than expected or more than 3 months (feelings of hopelessness or helplessness, pain interferes with daily functioning)

types of chronic pain

chronic recurrent pain, chronic intractable benign pain, chronic progressive pain

Chronic recurrent pain

repeated and intense episodes of pain separated by periods without pain, often stems from benign causes (migraine headaches)

Chronic intractable benign pain

Pain that is present all of the time with varying levels of intensity, typically stems from benign causes (harmless) (chronic lower back pain)

Chronic progressive pain

Continuous pain associated with an underlying malignant condition that becomes more intense as underlying condition worsens (cancer, arthritis)

Methods to measure pain

Self-report, behavioral, psychophysiological 

Self report assessments

interview, rating scales, diaries/journals

Interview

description of pain, detailed history, useful in clinical practice to fully understand nature of the condition

Psychophysiology

refers to the study of mental or emotional processes as reflected by changes they produce in physiological activity (Body temperature rising as person gets increasingly angry, Muscle tension in head or neck for headaches, Changes in blood pressure, heart rate, skin conductance, etc.)

Assessment of pain in children

less able to articulate/ describe pain, interviewing requires building rapport, asking right questions, using simplified scales, talk with parent and child about pain behaviors, observations useful

Body senses pain in response to several types of stimuli

Physical pressure, cuts, intense heat or cold

Pain perception

– Sensory neurons for detecting pain are spread throughout our entire body

(except the brain) as part of the peripheral nervous system

– These sensory neurons are called nociceptors

– Nociceptors become activated in response to potential tissue damage around

the injury site and send a signal to the brain indicating potential damage

Pain pathways

Once nociceptors become activated, their information travels along the

peripheral nervous system, up the spine, and to the brain

Pathway for sharp, well-localized, distinct pain

– Travels along a more rapid neural path to the brain

– Once it reaches brain, goes directly to motor and sensory areas

– Allows for rapid response to immediate threats

Pathway for dull or aching pain

– Travels along slower neural path to the brain

– Once reaches brain, goes to brainstem and forebrain

– These types of pain have greater affect on our emotional states

Referred pain

Pain originating from internal organs are often perceived as coming from

other parts of the body

Neuropathic pain 

a type of pain that occurs due to current or past damage to the peripheral nerves (nerve damage)

Phantom limb pain

Many people who have had a limb amputated continue to report sensations of it still being there – such as feeling it “move” or pain

Secondary gain

Benefits person obtains from taking on sick role, E.g., attention, comfort, excused from responsibilities, disability payments

Clinical pain

refers to any pain that receives or requires professional care 

General dimensions of clinical pain

Acute vs chronic, known vs unknown causes, intensity, location

Main treatment modalities for chronic pain

surgical, chemical, psychotherapy, physical therapy

Chemical methods 

– History of relying on chemicals to reduce pain (“medicine” and alcohol)

– Self-medication with drugs / alcohol

– Pursuit of analgesia (“relief from feeling pain”)

Patient controlled analgesia

Patient controls rate of narcotics / painkillers received

– Computerized pump with button used by patient to inject preset

dosages of pain killing chemicals (e.g., morphine)

– Practitioners sets limits on rate and amounts

Goals of psychotherapy

– Helping individual cope with pain

– Reduce frequency and intensity of pain

– Improve emotional adjustment (e.g., symptoms of anxiety / depression,

reduce stress / hopelessness)

– Increase amount of activity (social and physical)

– Reduce dependence on analgesic drugs if possible