Lewandowski: Pain

Question 1

Health and illness to be viewed as a result of interacting mechanisms at the cellular, tissue, organism, interpersonal, and environmental levels.

Answer 1

biopsychosocial model

Question 2

The biophyschosocial perspective says that pain is influenced by a variety of factors. What are they?

Answer 2

1. biological/physical: ex: tissue damage
2. psychological/emotional: ex: mood
3. social factors

Question 3

Pain is a (blank) experience. No two people will have the same pain experience. Neither somatic or completely psychological models can explain pain/disability by themselves. Chronic pain is a (blank) response in some individuals.

Answer 3

subjective; learned

Question 4

Biological/physiological factors that make chronic pain worse

Answer 4

inappropriate medications
non-restorative sleep
physical deconditioning
dysfunctional activity patterns

Question 5

Psychological/emotional factors that make chronic pain worse

Answer 5

avoidance behaviors
disturbed mood
past learning with pain/injury
cognitions/beliefs about pain

Question 6

Social factors involved in chronic pain

Answer 6

significant other influence
external disincentives
cultural factors
physician influence

Question 7

1 reason people will come see you as a physician?

Answer 7

pain

Question 8

Why is there no respect for pain?

Answer 8

Renee Descarte (mind versus body)
Pain historically seen as an epiphenomenon of disease, or a response of secondary importance. Belief that if you eliminate the physical cause, you "cure" the pain.

Question 9

Serves as a valuable "warning signal"
Spans 0 to 12 weeks
Lasts a short duration then ceases
Symptom of tissue damage
Minimal life disruption

Answer 9

acute pain

Question 10

Treatment of acute pain

Answer 10

correct damage, rest, and take meds

Question 11

Example of acute pain

Answer 11

broken leg, appendicitis

Question 12

Cognitive expectation of acute pain

Answer 12

cured/fixed/relieved/eliminated

Question 13

Pain signal may be the problem and not a sign of tissue damage
Spans 13 weeks to many years
Long duration, many flare-ups
Not a symptom, but IS the problem
Significant life disruption

Answer 13

chronic pain

Question 14

Treatment of chronic pain

Answer 14

movement in a graded fashion

Question 15

Example of chronic pain

Answer 15

back pain accompanied by depression, anxiety, sleep disturbance

Question 16

Cognitive expectation of chronic pain

Answer 16

manage, cope, deal with, accept

Question 17

T/F: It is important to inform your patients of healing times, so that they/you can determine if their pain is chronic or exceeding the normal expectation for healing

Answer 17

true

Question 18

It is important to recognize that your patient has invisible pain that cannot be seen. What are the concepts of social disbelief and credibility?

Answer 18

Patients believe that their doctor doesn’t realize how bad their pain is, and feel the need to convince the doctor that it is bad

Question 19

Who was responsible for realizing that the mind and body interact?

Answer 19

Renee Descarte

Question 20

What are some “Cartesian” ways of thinking today?

Answer 20

If I can't see it on an MRI, it's not real.
Organic vs functional labels.
Tissue damage = pain intensity
Pain ends upon healing
Fix, cure, eliminate mindset
Hurt means harm

Question 21

It’s important to know your patient’s history with pain and trauma. What are some factors involved?

Answer 21

Physical abuse
Sexual abuse
Parental abandonment
Parental drug use

Question 22

It’s important to know your patient’s sleep quality/quantity. Why?

Answer 22

Lack of sleep plays a huge role in chronic pain.

Question 23

Why is it important to know how pain interacts with your patient’s activity levels?

Answer 23

When patients are unable to do the things they love, secondary problems arise. Inactivity plays a pervasive role in our lack of wellness.

Question 24

It’s important to know the “meaning” of your patient’s pain. Why?

Answer 24

Important to know if there’s anyone to blame and if they are worried about getting better – these things can affect their prognosis

Question 25

Which math functions are the most positive predictors for patients?

Answer 25

addition and multiplication

Question 26

Should you use the term opioid or narcotics?

Answer 26

opioid

Question 27

T/F: It's important to know if your patient's pain is acceptable, but not necessarily optimal.

Answer 27

true

Question 28

T/F: ~40% of patients believe that they have not received comprehensive care for their pain.

Answer 28

true

Question 29

Physical therapy aimed at activity increase in a paced manner CBT Biofeedback and relaxation training Medications

Answer 29

Validated treatment approaches for pain

Question 30

T/F: medications can be useful when treating pain IF integrated with other forms of treatment. Medications = only about half of treated patients respond, and their pain reduction averages only about 30 percent

Answer 30

true

Question 31

What are the goals of cognitive-behavioral therapy?

Answer 31

``` problem solving orientation develop a sense of resourcefulness reconceptualize attitudes/beliefs manage rather than cure/fix pacing and modification of activities ```

Question 32

Most pain treatments have (blank) as the primary purpose. CBT is a (blank) model (gaining control over your pain). CBT is about changing the (blank) of the thoughts, like reducing non-productive thinking (catastrophizing)

Answer 32

pain reduction; control based; content

Question 33

How is the third-generation of CBT different?

Answer 33

Places an emphasis on changing awareness of and relationship to thoughts, NOT the content

Question 34

When referring patients to psychologists, what should you refer to them as?

Answer 34

behavioral medicine specialist

Question 35

T/F: It's important to emphasize self-management, not cure.

Answer 35

True

Question 36

Aspects of controlling pain in primary care setting

Answer 36

``` assess pain systemically identify comorbid conditions develop an individual treatment plan treat pain early/diligently consider using multiple modalities measure improvement over time reinforce positive/family involvement ```

Question 37

Describe the intergrated biobehavioral approach

Answer 37

multidimensional versus interdisciplinary | does not have to take place in a specialized pain clinic

Question 38

What does symptom magnification really mean?

Answer 38

a loss of control

Question 39

T/F: Survivors are people who move purposefully towards either resolution or acceptance.

Answer 39

True

Question 40

T/F: Psychological, social and environmental factors are involved in the maintenance of chronic pain

Answer 40

True

Question 41

T/F: Addiction to opioids among patients prescribed opioid analgecis for pain is not common

Answer 41

True