L4.10 Communications: Patient in Pain

Question 1

Does pain occur in isolation? (Is pain the same for all individuals?)

Answer 1

1. No.
2. psychosocial, economic, and cultural contexts cause individual definitions of pain
3. Also, each person expresses pain differently

Question 2

7 steps of the chronic pain spiral

Answer 2

1. sleep disturbance 2. declining physical capacities and functioning 3. inability to work 4. financial distress 5. feelings of stress and depression 6. insidious breaking down of coping mechanisms 7. worsening of pain

Question 3

name 2 psychiatric disorders associated with chronic pain

Answer 3

depression and anxiety (test Q!)

Question 4

5 components of successful pain management

Answer 4

1. giving an acceptable explanation of the symptoms to the patient
2. Avoiding unwarranted interventions
3. antidepressants, if warranted
4. Alternative therapies, if warranted
5. Regularly scheduled, brief office visits

Question 5

2 goals of therapy

Answer 5

1. Reduce pain and suffering

2. progressively diminish and then stop emergency visits and telephone calls

Question 6

6 components of patient education

Answer 6

1. Discuss diagnosis (whether it’s somataform or pain) - acknowledge pt’s symptoms and suffering
2. physician should assume role of evaluating and monitoring symptoms
3. pt should attempt to maintain interpersonal function
4. Pt try to identify anxiety and stress sources because stress reduction may improve physical symptoms
5. aggressive surgical approaches should be used cautiously
6. expect pt to improve and return to normal function

Question 7

List some alternative pain therapies

Answer 7

PT, OMM, relaxation, imagery, acupuncture, cognitive behavioral therapy, music therapy, hypnosis

Question 8

When should the patient reach out to family for medical assistance?

Answer 8

Patients should not seek assistance from family in assessing the seriousness of their symptoms or the diagnosis. The primary care provider should direct any need for subspecialty evaluation

Question 9

2 roles for family members

Answer 9

1. Family should pay attention to the patient when symptoms are absent. For the patient, this reinforces the idea that their symptoms do not bring special attention (testable)
2. Family may help by providing healthy distraction activities if somatic symptoms are present

Question 10

How do you approach collecting patient history?

Answer 10

1. Ask open-ended questions 2. Probe into ways patient’s pain is affecting their life. They want to talk about it! (Testable)