Lecture 12 - No Pain, No Gain - What is pain?

Question 1

What is the purpose of pain?

Answer 1

• It is a biological function of stopping and/or reducing further injury (e.g. congenital analgesia)
• Promotes learning to avoid future injury - pain makes you think, remember and prevent
• sets the limits on activity forcing rest and allowing for recuperation and recovery

Question 2

What are the types of pain

Answer 2

TRANSIENT - pain of brief duration having little consequence and rarely producing more than fleeting attention e.g. aches and pains you get during the day go away -> no tissue damage

ACUTE - combination of tissue damage, pain and anxiety which resolves after the damaged tissues have healed (less than 6 months) e.g. tissue damage could be minor [paper cut] or major [fracture]; once the tissue heals, pain goes away

CHRONIC - pain which persists after all possible healing has occurred (more than 6 months). e.g no injury to heal > 6months can impact working life, social life and relationships

Question 3

What is Chronic pain

Answer 3

• persists long after pain can serve any useful function
• no longer a symptom of injury or disease
• becomes a syndrome and a medical problem requiring urgent attention
• the pain becomes an intolerable evil that serves no useful function
• patients feel helpless and hopeless

Question 4

What are the 3 multidimensional experience of pain

Answer 4

SENSORY-DISCRIMINATIVE - intensity, duration, quality and location of a nociceptive (code for intensity) stimulus.

MOTIVATIONAL-AFFECTIVE - aversive, emotional and automatic responses; the drive to reduce pain

COGNITIVE-EVALUATIVE - learning, memory, attention-mechanisms

Question 5

What is multidimensional experience of pain

Answer 5

• pain is a subjective experience affected by more than the extent of injury or organic dysfunction
• many factors are involved in the etiology, severity, exacerbation and maintenance of pain, suffering and disability
• people’s experience of pain and responses to pain are influenced by: life stresses, perception, social support, emotions, expectations, cultural background, financial resources etc

Question 6

What are factors contribute to pain

Answer 6

• Physiological factors - CNS/Neural processing

- Psychological factors - cognitions, expectations, beliefs

Question 7

According to the WHO 1998 how many people reported pain most of the time for 6 months or more during the year

Answer 7

21.5%

Question 8

What are some common pain conditions

Answer 8

LOW BACK PAIN - 65-80% of all people have back pain at some time in their life. Back pain is the most frequent cause of activity limitation in people younger than 45 yrs old

ARTHRITIS PAIN - 2002/03 NZ health survey. 13.9% of men, 17.3% of women reported arthritis

HEADACHE - 45mil Americans have chronic, severe, disabling headaches. More than $4billion spent each yr on over the counter pain medications

OTHER PAIN DISORDERS - such as the neuralgias and neuropathies (Affect nerves throughout the body)

• pain due to damage to the central nervous system (brain and spinal cord)
• pain of unknown origin where no physical cause can be found

Question 9

What are the two pain phenomenons

Answer 9

PHANTOM LIMB PAIN - pain away from part of body you don’t have -> nerve sends signal when it shouldn’t

COMPLEX REGIONAL PAIN SYNDROME - show condition in extremities so limbs show inflammation (fluid) could lead to skin drying and could turn red, so accumulation of chemicals and temperatures difference and fluid in joints.

Question 10

What is the role of the CNS in pain

Answer 10

• the variability of pain experiences is indicative of numerous neural mechanisms that modulate our sensory experiences

Question 11

What is gate control theory

Answer 11

• Describes how a complex arrangement of neurons in the signal cord blocks certain pain signals and allow others to pass through to the brain which lead to the perception of pain
• helps to explain phantom and chronic pain and is widely recognised

Question 12

What is the biopsychological theory of pain

Answer 12

• Physiological and psychological factors contribute to the production, modulation, maintenance and experience of pain.
• a relationship exists between psychological and physical changes and pain:
  > mental events (thoughts, memories, memories) influence physical changes which influence pain
  > psychological states (stress, depression, anxiety) and physical changes (automatic arousal, muscle tension) influence pain