Biopsychosocial Model Of Pain Flashcards
Gate Theory
Large/Fast fibers (Abeta) active and close off pain
Small/Slow fibers (Adelta and C) open and allow for pain
Descending modulation occurs
Behavioral science approach
Events outside the person influence pain perception/behavior
Considers influence of social environments
Body-self neuromatrix theory
Network of brain regions
Neural activity signature
Unified experience
Pain exists in brain (solely)
Biopsychosocial Mode
Social environment
Illness behavior
Psychologic distress
Attitudes and beliefs
Pain
What is Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
A multidimensional phenomenon with sensory discriminative, affective-motivational, motor, and autonomic components
Pain Assesssment
“Fifth vital sign”
Uni- and multidimensional assessment methods
Consider:
Intensity
Unpleasantness
Interference with function
Emotions/cognitions
Types of Pain Assessments
Numerical Pain Rating Scale
Visual analog Scale
Global Rating of Change
Defense and Veterans Pain Rating Scale
Multidimensional Scales
McGill Pain Questionnaire - Rates sensory and affective components
Brief Pain Inventory (Short Form) - Rates sensory and degree to which pain interferes with function
West Haven-Yale Multidimensional Pain Inventory - Includes cognitive-behavioral factors; Developed for chronic pain
Treatment Outcomes of Pain Survey - Very long and comprehensive
Fear Questionnaires
Fear-Avoidance Beliefs Questionaire - Correlates with poor outcomes/high disability chronicity
Tampa Scale of Kinesiophobia - Movement-Related Fear
Pain Catastrophizing Scale - Independently predictive of chronicity, poor prognosis, disability
Types of Pain
Nociceptive - Nonneural tissue: activates nociceptors
(Example: sprain/strain)
Neuropathic - Lesion of somatosensory nervous system (Example: lumbar radiculopathy)
Central - Altered/amplified response of CNS (Example: fibromyalgia)
Central sensitization inventory and Clinical prediction rule
Assessment Considerations
Cognitive/communication deficits
Assessment in children
Secondary gain - Monetary, social, etc.
Cultural/gender differences
Chronicity
Mechanism of injury
Sex Differences
Pain consistently higher in women (acute and chronic)
Biological
Testosterone: anti-nociceptive; Estrogen and progesterone: more complex
Oral Contraception = decreased RVM activation (decreased inhibition)
Psychological
Sex differences in coping styles • Catastrophizing vs. self-efficacy
Sociocultural
Willingness to report; Cultural differences; History of abuse
Ethnicity and Race
Non-Hispanic white: 64% of lowest pain sensitivity cluster
Psychological Factors
Attention: Vigilance vs. distraction
Cognitions: Attitudes/beliefs, Expectations, Cognitive sets
Emotions
Behaviors
Cognitive Factors
Perception of condition
Attention<>distraction
Patient coherence
Expectations for treatment
Pain catastrophizing
Fear avoidance
Goals
