HP 252 - Chronic Pain (3)

General Prevalence in chronic pain

• ~30% of people worldwide

• 3 of 10 reasons people seek medical care

Which groups are most affected by chronic pain? (5)

• Women

• Lower SES

• Veterans

• Rural areas

• Racial & ethnic minorities

4 Types of arthritis in prevalence order

1. Osteoarthritis (30.8 million)

2. Metabolic arthritis (9.2 million)

3. Autoimmune arthritis (1.5 million)

4. Infectious arthritis (20,000)

Most common form of autoimmune arthritis?

rheumatoid

What is metabolic arthritis?

Build up of acidic crystal

gout

What is infectious arthritis?

Bacterial, viral, fungal infections that can be treated by antibiotics

What is osteoarthritis?

Damage in tissue of cartilage, bone, muscle 

Acute pain (5)

• Begins suddenly

• Feels sharp, severe, or intense

• Cause by something specific (illness, injury)

• <3 months

• “Adaptive”

How is acute pain adaptive?

pain can alert us that we have tissue damage

Chronic Pain (5)

• May be constant or intermittent

• Varies in intensity

• Independent of specific illness/injury

• >3 months

• “Pathological”

HPA Axis

• hypothalamic-pituitary adrenal axis (stress response system)

• Activated in response to stress & pain sensation

Hormones related to HPA Axis + how its released

CRH - corticotropin-releasing hormone (hypothalamus)

ACTH - adrenocorticotropic hormone (pituitary gland)

Cortisol (adrenal gland)

How does HPA Axis affect chronic pain?

higher levels of cortisol due to overworking the pain reception

How does HPA Axis work? (6)

1. Stress perceived

2. Hypothalamus releases CRH

3. Pituitary gland to release ACTH

4. Adrenal gland releases cortisol into immune system

5. Hypothalamus responds to high levels of cortisol in immune system by shutting down system

Nociceptive pain

damage to tissues

acute and adaptive

Examples of nociceptive pain

cut, burn, muscle tear

Neuroplastic pain

damage to pain system itself (disease/injury affecting NS)

Damage to the nerves rather than the tissues 

Examples of neuroplastic pain

hitting funny bone, sciatica, pain by chemotherapy

Nociplastic pain

maladaptive changes to pain processing without tissue/nerve damage

People sensing pain even if there’s no direct cause of pain 

Examples of nociplastic pain

fibromyalgia, IBS, non-specific back pain

Bio-psycho-social approach to pain (components to all)

Bio - medication, exercise, surgery, sleep

Psycho — cognitions, emotions, behaviors, attention

Social — healthcare, family, work

Treatments for chronic pain (3)

• 1. Medication

• 2. Surgery (not effective for neuroplastic; structural issue)

• 3. Psychotherapy (CBT, ACT, Mindfulness, Pain Reprocessing therapy)

Interdiscriplinary approach to pain (4)

• Multidisciplinary services

• Greater coordination between healthcare professionals from different disciplines 

• Under one roof – services within same facility 

• Multidimensional – more collaboration recognizing biopsychosocial

What does Cohen et al’s article emphasize about pain? (4)

• Chronic pain might be best considered to be a disease with treatment 

• Promoting resilience (i.e. emotional support systems, good health)

• Biomarkers = diagnostic, prognostic, predictive, quantifying susceptibility or risk

• Biopsychosocial framework

What does Gatchell et al.’s article emphasize about pain? (3)

• Introduction of biopsychosocial model of pain stimulated development of more therapeutically effective & cost-effective interdisciplinary chronic pain management programs

• Significant risk for misuse of opioid medication

• Surgical interventions are equally concerning