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NEUROSCIENCE OF PAIN > LECTURE 9 > Flashcards

LECTURE 9 Flashcards

1
Q

HYPNOSIS METHODS

A

RELAXED STATE THAT HELPS W/ PAIN MANAGEMENT AND IS RELIANT ON THE FACT THAT IT WILL SHIFT FOCUS FROM A PAIN STATE
VERY INDIVIDUALIZED - NOT ONE TYPE OF PAIN THAT IT WORKS BEST FOR

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2
Q

HYPNOSIS PAIN STATES

A

BETTER FOR STEADY STATE PAIN (NOT CHRONIC PAIN)

ANALGESIA IS INDUCED DURING THE HYPNOTIC SESSION MORE SO THAN AFTER THE HYPNOTIC SESSION

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3
Q

HYPNOSIS ADVANTAGES

A

THALAMUS LIGHTS UP DURING fMRI - RELAY STATION FOR ALL THE SOMATOSENSORY INFORMATION COMING INTO THE BRAIN

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4
Q

HYPNOSIS DISADVANTAGES

A

CLINICAL EFFICACY = RELIANT UPON HYPNOTIC SUSCEPTIBILITY

LASTING ANALGESIA IS NOT PRESENT

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5
Q

PLACEBO ANALGESIA METHODS

A
  • THE COMBINATION OF CONDITIONING AND EXPECTATION ELICITED BY THE TREATMENT CONTEXT AND
  • INTERINDIVIDUAL DIFFERENCES IN OPTIMISM, RECEPTIVITY TO THE PLACEBO, AND BRAIN OPIOID AND DOPAMINE SYSTEMS
  • PLACEBO ANALGESIC RESPONSE - RELIEF IN AN INDIVIDUAL THAT RESULTS FROM THE EXPECTATIONS OF ACTIVENESS OF THE THERAPEUTIC INTERVENTION
  • PLACEBO EFFECTS CAN BE REVERSED BY THE OPIATE ANTAGONIST NALOXONE, THEREBY IMPLICATING THE ENDOGENOUS OPIOID SYSTEM
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6
Q

PLACEBO PAIN STATES

A

IN THE PRESENCE OF SUSTAINED PAIN AND HYPERALGESIA, PLACEBO EFFECTS ARE LARGER (LBS AND IBS)

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7
Q

PLACEBO ADVANTAGES

A
  • THE PROCESS OF LEARNING THAT DRUG CUES SIGNAL PAIN RELIEF AND/OR DRUG-INDUCED CHANGES IN THE BRAIN’S NEUROCHEMISTRY IS KNOWN AS CONDITIONING
  • IT IS POSSIBLE THAT CONDITIONED ANALGESIA IS MEDIATED BY CHANGES IN BRAIN CONNECTIVITY IN NOCICEPTIVE OR AFFECTIVE CIRCUITS THAT REDUCE PAIN IN RELATIVELY UNCONSCIOUS, AUTOMATIC WAY
  • CONSCIOUS EXPECTATIONS OF RELIEF ARE HIGHLY CORRELATED WITH REDUCED ANTICIPATORY RESPONSES IN BRAIN REGIONS LINKED W/ ANTICIPATORY ANXIETY AND REDUCED PLACEBO ANALGESIA, WITH PREFRONTAL ACTIVITY THAT MEDIATES CUE-EVOKED CHANGES IN PAIN, AND WITH PLACEBO-INDUCED OPIOID RELEASE IN THE LIMBIC AND PARALIMBIC REGIONS
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8
Q

PLACEBO DISADVANTAGES

A

RELATIONSHIPS BETWEEN PLACEBO EFFECTS AND PERSONALITY MEASURES HAVE PROVED INCONSISTENT, AND PLACEBO RESPONSES ARE NOT HIGHLY CORRELATED ACROSS TYPES OF PAIN AND VARIATIONS IN SITUATIONAL CONTEXT
* NOCEBO INSTRUCTIONS OFFSET OR REVERSE THE NORMALLY ANALGESIC EFFECTS OF REMIFENTANIL ON PAIN REPORTS AND FMRI RESPONSES ASSOCIATED W/ PAIN. NOCEBOS ALSO APPEAR TO HAVE LARGER AND LONGER-LASTING EFFECTS THAN PLACEBO INSTRUCTIONS DO AND PRODUCE STRONGER PHYSIOLOGICAL RESPONSES, SUCH AS ON CORTISOl

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9
Q

SCS METHODS

A
  • IN NEUROPATHIC PAIN THE HYPER EXCITABILITY IS RELATED TO INCREASED RELEASE OF GLUTAMATE AND DYSFUNCTION OF THE GABA SYSTEM. EXPERIMENTS ON ANIMAL MODELS SHOWED SCS STIMULATION RESULTED IN INCREASED RELEASE OF GABA AND DECREASED RELEASE OF GLUTAMATE
  • ACTIVATION OF THE DESCENDING INHIBITORY PATHWAY VIA A BRAIN SYSTEM LOOP HAS BEEN PROPOSED AS THE PRINCIPLE MECHANISM OF SCS
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10
Q

SCS PAIN STATES

A
  • SCS IS AN EFFECTIVE TREATMENT FOR NEUROPATHIC PAIN, A CONDITION FOR WHICH THERE ARE FEW ALTERNATIVE THERAPIES
  • RADICULAR AND LUMBAR SPINAL PAIN, CHEST PAIN
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11
Q

SCS ADVANTAGES

A
  • SPECIFIC TREATMENT FOR NEUROPATHIC AND ISCHEMIC SYNDROMES THAT ARE RESISTANT TO OPIATES
  • CAN BE USED FOR LONG TERM PAIN RELIEF
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12
Q

SCS DISADVANTAGES

A
  • SCS DOES NOT EFFECT NOCICEPTIVE PAIN
  • INVASIVE PROCEDURE AND ONLY WORKS ON CERTAIN TYPES OF NEUROPATHIC PAIN AND ISCHEMIC SYNDROMES, TECHNOLOGY CAN FAIL, AND EXPENSIVE
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13
Q

CBT METHODS

A
  • THE MOST POWERFUL MEDS ONLY DECREASE PAIN BY 30-40%. EVEN PEOPLE WHO REPORT SIGNIFICANT REDUCTION IN PAIN OFTEN DO NOT REPORT IMPROVEMENTS IN PHYSICAL/EMOTIONAL FUNCTIONING
  • 6 PHASES OF COGNITIVE BEHAVIORAL APPROACH
  • ASSESSMENT - GET BASELINE MEASUREMENTS TO SEE WHERE THE PATIENT IS IN TERMS OF GOALS BASED HEAVILY ON PATIENT INTERACTION
  • RECONCEPTUALIZATION - THERAPIST ATTEMPTS TO SWITCH MALADAPTIVE BEHAVIORS TO BEHAVIORS THAT ARE CONDUCIVE TO PAIN MANAGEMENT
  • SKILLS ACQUISITION - THERAPIST PROVIDES PATIENT W/ PRACTICE IN DIFFERENT COGNITIVE SKILLS AND COPING STRATEGIES
  • SKILL CONSOLIDATION AND APPLICATION TRAINING - PATIENT HOMEWORK
  • GENERALIZATION AND MAINTENANCE - INTERACTION W/ S.O. AND OTHER FAMILY MEMBERS IN HELPING YOU W/ COPING W/ PAIN MANAGEMENT
  • POST-TREATMENT ASSESSMENT AND FOLLOW-UP W/ THERAPIST
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14
Q

CBT PAIN STATES

A

A WIDE VARIETY OF CHRONIC PAIN SYNDROMES (HEADACHES, TMJ DISORDERS, IBS, ARTHRITIS, BACK PAIN, CHEST PAIN, COMPLEX REGIONAL PAIN SYNDROME)

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15
Q

CBT ADVANTAGES

A
  • OVERRIDING MESSAGE TO THIS APPROACH IS THAT PEOPLE ARE NOT HELPLESS IN DEALING WITH THEIR PAIN, NOR DO THEY NEED TO VIEW PAIN AS AN ALL-ENCOMPASSING DETERMINANT OF THEIR LIVES
  • TEACHES COPING TECHNIQUES THAT CAN BE USED TO RESPOND TO PAIN AND ANY PROBLEMS THAT MAY COME ABOUT BECAUSE OF IT
  • CAN BE USED ON PATIENTS OF ALL AGES, FROM CHILDHOOD TO OLD AGE
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16
Q

CBT DISADVANTAGES

A
  • NOT EXPECTED TO COMPLETELY ELIMINATE PAIN/NOT A REPLACEMENT FOR TRADITIONAL TREATMENTS
  • MOST EFFECTIVE WHEN INTEGRATED WITH OTHER TREATMENTS/REHABILITATION PROGRAMS
17
Q

CAM ACUPUNCTURE

A

*INVOLVES INSERTION OF NEEDLES INTO THE SKIN FOR THERAPEUTIC PURPOSES BUT THE ACUPUNCTURE POINTS CAN ALSO BE STIMULATED BY PRESSURE, HEAT, ELECTRIC CURRENT AND LASER LIGHT
* IT IS MOST EFFECTIVE FOR ALLEVIATING TENSION-TYPE HEADACHE, OSTEOARTHRITIS, NECK, MUSCLE AND POST-SURGICAL PAINS
*ADVANTAGES - IT’S CONSIDERED TO BE A SAFE TREATMENT
DISADVANTAGES - BIAS IS LIKELY TO DISTORT THE CLINICAL EVIDENCE AND IT IS HARD TO EXCLUDE BIAS IN ACUPUNCTURE TRIALS
ACUPUNCTURE INVOLVES REPETITIVE/REGULAR TREATMENTS, SO THE COSTS INVOLVED MAY BE CONSIDERABLE

18
Q

CAM MASSAGE THERAPY

A

*INVOLVES DIFFERENT TECHNIQUES OF MANIPULATING SOFT TISSUES THROUGH USE OF MANUAL PRESSURE, TRACTION AND VIBRATION
* IT IS FREQUENTLY RECOMMENDED AND USED FOR A RANGE OF SKELETAL MUSCLE PROBLEMS, SUCH AS BACK PAIN OR FIBROMYALGIA. IT ALSO HELPS WITH CANCER PAIN, NOT PROVEN TO BE EFFECTIVE FOR NECK PAIN
ADVANTAGES - IT HAS A RANGE OF PHYSIOLOGICAL EFFECTS INCLUDING A REDUCTION IN MUSCLE TONE AND AN INCREASE IN LOCAL BLOOD FLOW, WHICH MIGHT BE A PLAUSIBLE MECHANISM FOR EXPLAINING EFFECTIVENESS AND ADVERSE EFFECTS ARE RARE
DISADVANTAGES - IT IS NOT VERY COST-EFFECTIVE BECAUSE LONG TERM TREATMENTS ARE USUALLY RECOMMENDED BY THERAPISTS

19
Q

CAM HERBAL MEDICINE

A
  • USES DIFFERENT PLANT EXTRACTS THAT TYPICALLY CONTAINS A MIXTURE OF SEVERAL PHARMACOLOGICALLY ACTIVE INGREDIENTS AND PROVIDES SMALL TO MODERATE PAIN RELIEF IN NECK, SKELETAL MUSCLES, BACK AND THE BONES BUT THE EFFECTS ARE STILL LESS THAN SYNTHETIC DRUGS
  • ADVANTAGES - MEDICATIONS ARE MORE NATURAL (PLANT EXTRACTS), AND THUS NOT CHEMICALLY SYNTHESIZED
  • DISADVANTAGES - TOXICITY TO ONE OF THE USED PLANT EXTRACT INGREDIENTS, ADVERSE INTERACTIONS WITH OTHER PRESCRIBED DRUGS, AND, CONTAMINATION WITH TOXIC SUBSTANCES SUCH AS HEAVY METALS
20
Q

CAM CHIROPRACTIC TREATMENT

A

*INVOLVES SPINAL MANIPULATION IN ORDER TO ADJUST “SUBLUXATIONS” (PARTIAL DISLOCATIONS)
*ADVANTAGES - SOME EVIDENCE EXISTS ON CHIROPRACTIC EFFECT ON TREATING BACK PAIN BUT EVEN THE DATA FROM THAT STUDY IS FULL OF CONTRADICTIONS.
*DISADVANTAGES - THERE IS NO POSITIVE EVIDENCE SUGGESTS THAT CHIROPRACTIC TREATMENTS ARE EFFECTIVE. IN FACT, SPINAL MANIPULATION LEADS TO MILD OR MODERATE TRANSIENT ADVERSE EFFECTS IN ABOUT 50% OF PATIENTS.
THERE ARE RISKS ASSOCIATED WITH CHIROPRACTIC SPINAL MANIPULATION AND NUMEROUS SERIOUS COMPLICATIONS, EVEN DEATHS HAVE BEEN REPORTED FOLLOWING TREATMENTS

NEUROSCIENCE OF PAIN (8 decks)

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