PAIN FINAL - Lecture 1/10

while pain is a strong motivator of behaviour, Prof Mogil argues that…

it depends on how much pain you’re in

T/F: pain is a perception

T

pain is more ______ than other sensations of disease states bc…

psychological, the correlation b/n intensity of stimulus vs perception is weak

the “Nail in boot” incident is an example of …

pain w/o injury

the “Nail in skull” incident is an example of…

injury w/o pain

what is an inguinal hernia?

intestine pops out through a hole in the muscle wall

in Prof Mogil’s inguinal hernia story, what was intensifying the pain?

the thought of him being out of work for 3 weeks in recovery … pure psychology

Henry Beecher is the father of the…

placebo effect

who created the “narcotics, yes or no? war wounds vs post op patients” study?

Henry Beecher

In Henry Beecher’s narcotics study, by narcotics he means…

opioids

In the Henry Beecher narcotic study, what were the 2 questions he asked the patients?

1) how much pain are you in? (none, slight, moderate, severe)

2) do you want narcotics? Yes or no?

In the Henry Beecher narcotics study, how many of the war wound patients wanted the opioids?

32%

In the Henry Beecher narcotics study, how many of the post op patients wanted the opioids?

83%

In the Henry Beecher narcotics study, what were some confounding variables?

Age (soldiers were younger), Time treated (post op was sooner), soldiers trying to be “macho”

what is osteoarthritis?

disease of the joints narrowing, bones grinding against each other

what did we learn from the osteoarthritis study?

Just because you have knee pain doesn’t mean you have OA, and just because you have OA doesn’t mean you have knee pain, they’re independent

T/F: The findings from the osteoarthritis study doesn’t apply to back pain

F, it does

pain is the #1 reason…

to seek health care

T/F: When someone has a chronic disease, they’re primary concern is dying

F, it’s being in pain

T/F: Pain can kill

T, but indirectly

Who said it “Pain is a more terrible lord of mankind than even death itself”?

Albert Schweitzer

At the University of Florida, headaches is one of the most common pain event, what percentage of undergrads have had headaches?

94.1%

At the University of Florida, more students have been _____ than given birth

shot

we want pain, we need pain; but not…

chronic pain

¼ of the population have…

point prevalence

what is point prevalence?

chronic pain right now

½ of the population has had…

lifetime prevalence

what is lifetime prevalence?

has had chronic pain before

the epidemiologist’s bathtub: incidence (stagnant or changes?)

new cases, changes over time

the epidemiologist’s bathtub: prevalence refers to…

point prevalence

epidemiology

looking at how and why diseases affect groups of people

the epidemiologist’s bathtub, what should we note about recovery?

things get better by themselves a lot

Back pain and the NHS in one year: Population prevalence

16,500,000

Back pain and the NHS in one year: Consulting GP

3,000,000-7,000,000

Back pain and the NHS in one year: Out-patients

1,600,000

Back pain and the NHS in one year: In-patients

100,000

Back pain and the NHS in one year: Surgery

24,000

Prevalence of back pain in women vs men…

W(22.2%), M(19.8%)

Prevalence of arthritis in women vs men…

W(19.2%), M(12.6%)

Prevalence of migraines in women vs men…

W(14.9%), M(6.6%)

Prevalence of Bowel disorder/Chohn’s disease of colitis in women vs men…

W(6.1%), M(2.9%)

T/F: Chronic pain can change one’s personality

T

Back pain, Oth MSK, Neck pain, Osteoarthritis, and Headaches are…

the biggest burden of pain

what is comorbitidy?

having 2+ health condition at the same time

T/F: In comorbidity, pain has one health concern that causes the other

F, the direction is unclear.

Ex. You can’t go to sleep bc you’re in pain OR bc you’re not sleeping, it makes the pain worse

How many chronic pain patients have attempted suicide?

5.2%

what is this graph called?

A Kaplan-Meyer plot

Prof Mogil said “People really only die of 3 things:… ~95% of deaths if you put there 3 things together in rich countries” What are the 3 things?

Cancer, cardiovascular disease, and pulmonary disease

The estimated total cost of headache in the US…

$14 billion

The estimated total cost of back pain in the US…

$200 billion

The estimated total cost of arthritis in the US…

$189 billion

What is the more expensive economic burden of back pain in the UK?

the loss of productivity

Who said it “No fatigue, not disease, nor anxiety, nor sadness, nor pain, nor distress befalls a Muslim even if it were the prick he receives from a thorn, but that Allah expiates some of his sins for that.”?

Prophet Mohammed

Poine/Poena:…

The Greek Spirit of Punishment

Who said it “Pain is an emotion in the heart”?

Aristotle

Who said it “Pain is a sensation in the brain”?

Galen

Who said it “Pain is an independent sensation from touch/temperature”?

Avicenna

Who said it “There exists a ‘pain pathway’ from the body to the brain”?

Descartes

what is theodicy?

trying to explain the question “if God is good, why does pain happen to those who don’t deserve it?”

the Mind-Body problem

how is it possible that the body produces the mind? and are they the same/different?

the Mind-Body problem: Monist

The mind is what the brain does

What is phantom limb pain?

If you loose a limb, you’ll still feel that you have a limb in space & it will hurt often. “Where does it hurt?” You point to the empty space of where that limb would’ve been

What is the Problem of Other minds?

I’m pretty convinced that I exist and I have a mind, but I don’t know about you guys. There’s no way to prove to s1 else that you exist, and they can’t prove to us that they do.

Prof Mogil talks about meeting Peter Singer, on what did they agree on?

The use of animals is ethically permissible as long as the benefits outweigh the cost

Who said it “The fundamental interest that entitles a being to equal consideration is the capacity for suffering and/or enjoyment or happiness”?

Peter Singer

Why is Frida Kahlo important to this class?

After a bus accident, she suffered from chronic pain, she made paintings to express what she felt

What is the OLD definition of pain?

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

What is masochism?

Finding pain as pleasant

Examples of non-unpleasant pain

Delayed Onset Muscle Soreness (DOMS) being sore the next day after working out, Spicy food

What does it mean to say “Pain is a drive state”?

something that demands an action to restore homeostasis, that cannot be ignored

Why does surgery hurt after the patient wakes up?

Cells ruptured

OR

A wound causes inflammation

What is the NEW definition of pain?

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

somatosensation

touch

T/F: Pain is not touch

T

Anesthesia

inability to feel any somatic sensation at all

Analgesia

inability to feel pain

T/F: Social rejection causes inflammation

T

T/F: Benadryl reduces social pain

F, acetaminophen does

T/F: Up until the 1950’s, ppl didn’t think babies felt pain

F, 1980’s

Nociception

the body’s detection of harmful signals before pain is felt

Explain the Thermal Grill Illusion

Alternating warm and cool bars, nociception gets confused so you get a burning sensation

what are the 3 time-frame’s of pain? (names and times)

Acute (seconds-to-minutes)

Tonic (hours-to-weeks)

Chronic (weeks-to-years)

Evolutionarily speaking, why do we have acute pain?

learn our physical limitations (lesson learned)

Evolutionarily speaking, why do we have tonic pain?

as a punishment

Evolutionarily speaking, why do we have chronic pain?

no evolutionary advantage, it’s a pathology

Ppl w/ Congenital Insensitivity to Pain (CIP) rarely live past their…

50s

what’s the difference between CIP and CIPA?

CIPA is CIP w/ anhydrosis

Anhydrosis

inability to sweat

superficial pain

skin or right under it (cuts, burns, insect bites, blisters)

visceral pain

internal organs (stomach, heart, kidneys, intestines)

nociceptive pain

tissue damage causing pain

neuropathic pain

nerves misfiring causing pain

phantom limb pain is an example of…

neuropathic pain

spontaneous pain

pain that occurs w/o any external trigger, often due to underlying nerve or tissue damage

what are the 2 types of spontaneous pain?

continuous or paroxysmal (comes in episodes)

evoked pain

pain caused by a stimulus (aka pain hypersensitivity)

pain hypersensitivity

pain caused by a stimulus (aka evoked pain)

Allodynia

pain from a normally non-painful stimulus

Hyperalgesia

exaggerated pain from a normally painful stimulus

Static vs Dynamic

static = poke, dynamic = brush