Module Three

Question 1

What is pain

Answer 1

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

Pain is whatever the experiencing person says it is, existing whenever he says it does

Question 2

What is the importance of acute pain

Answer 2

Important protective mechanism and response to nociceptive experience

-Directing attention to a situation and promoting a reflexive withdrawal (gate control theory)

Question 3

What is chronic pain

Answer 3

Persistent, intermittent pain - over months to years

Usually under-recognised and undertreated

Question 4

What is the biomedical component of pain

Answer 4

Nociception: pain arising from actual or threatened damage to non-neural structures due to activation of nociceptors

Neuropathy: pain that is the result of an injury/lesion, or disease in the somatosensory system (peripheral or CNS) — often chronic

Mixed pain may coexist

Question 5

Explain the biopsychosocial model of pain

Answer 5

Biomedical - nociception and neuropathy 
Pain perception 
Attitudes and beliefs
Psychological distress
Pain behaviour 
Environment

Question 6

What is pain perception

Answer 6

Robust psychological predictor of pain related outcomes

Research makes link between catastrophising pain and increase in disability, distress and pain intensity

Question 7

What are pain perception models

Answer 7

Gate control theory

Fear avoidance model

Question 8

Explain gate control theory

Answer 8

Explains pain perception e.g. small fibers and large fibers

Question 9

Explain fear-avoidance model

Answer 9

Explains impact of pain perception on recovery from their experience of pain
e.g. someone scared to exercise because they are worried it will cause too much pain

Includes Pain Catastrophising: tendency to describe a pain experience in more exaggerated terms or thinking of worst-case, irrational outcomes

Look at diagram

Question 10

What is a predisposing factor

Answer 10

factors that put someone at risk of developing a problem e.g. genetics, life events, knowledge

Question 11

What is a precipitating factor

Answer 11

specific event or trigger to the onset of the current problem

Question 12

What is a perpetuating factor

Answer 12

maintain the problem once it has become established

Question 13

What is a protective factor

Answer 13

reduce vulnerability to chronic pain and create more positive outcomes such as exercise, healthy diet, sleep, coping skills, social support

Question 14

What is attitudes and beliefs associated with biopsychosocial model of pain

Answer 14

Stoicism
Self-blame
Self-efficacy
Locus of control

Question 15

What is psychological distress associated with biopsychosocial model of pain

Answer 15

Fear – of increasing pain
Anxiety – relating to impact on life
Stress – physiological response (fatigue)

Question 16

What is pain behaviour associated with biopsychosocial model of pain

Answer 16

Avoidance behaviour – reduced activity/mobility
Reduced social interaction – which could result in depression and reinforcement behaviour
Sick role – how people respond to another persons pain

Question 17

What is environment/external factors associated with biopsychosocial model of pain

Answer 17

Physical barriers – to mobilising
Social influences – pain experience is influenced by others
- Reinforcers
- Detractors e.g. stigma

Gender and social perception
Cultural norms

Question 18

How to assess pain

Answer 18

Scales
History (provoking, quality, region, severity, frequency)
Diary
Pain belief and coping strategies

Question 19

What should goals of care for patients receiving treatment for chronic pain

Answer 19

what does the client/patient want to achieve? Realistic?

Question 20

What is the biomedical approach to treating chronic pain

Answer 20

WHO analgesic ladder

Question 21

What are some psychosocial interventions for treating/managing chronic pain

Answer 21

‘Closing the gate’ (brain perception) - massage, TENS, movement, heat packs

Psychological - depression, anxiety and fear through education & therapy

Social - address social impacts and work issues

Environmental - adaptation to barriers, transport

Question 22

Define the biophysical definition of stress

Answer 22

Stress is the body’s reaction to any change that requires an adjustment or response to return to homeostasis

Question 23

Define the biopsychosocial definition of stress

Answer 23

stress is a physical, cognitive, emotional and behavioural reaction of an individual (or organism) to a stressful event [real or perceived] that threatens, challenges or exceeds the individual’s internal and external coping resources

Question 24

Describe stress as a response

Answer 24

Reaction to a perception of threat

The SNS and endocrine system are aroused, preparing the organism to respond to the anticipated danger by fight or flight

Question 25

Describe stress as a biomedical response

Answer 25

General Adaptation Syndrome (Selye, 1956) Alarm Reaction – person or organism is alerted to a perceived threat Resistance Stage – body attempts equilibrium Exhaustion Stage – when the body’s attempts to resist the stressor are unsuccessful

Question 26

Describe stress as a stimulus

Answer 26

Yerke’s-Dodson Law 1908 Performance is affected by stress Stress necessary to complete activities (source of motivation) However, too much stress will mean the person cannot perform any type of activity (impaired)

Question 27

What is the social readjustment rating scale

Answer 27

Statistical Prediction Model | Stressful events can cause the development of a disease (score over 300 indicates stress can impact health)

Question 28

Describe stress as a process

Answer 28

Lazarus Two Factor Model of Stress Appraisal Primary Appraisal – is the stressor harmful? Secondary Appraisal – are my internal and external coping resources adequate for this stressor? These then determine whether stress is initiated Focused on nature of stressors and own of coping abilities

Question 29

What are the symptoms of psychological distress

Answer 29

Altered sleep, appetite, headache, memory and sensory perception

Question 30

What are negative coping styles

Answer 30

Denial, escape/avoidance and repression associated with: - Increased in alcohol intake and self-medication (prescribed and illicit) - Mood changes – unpredictable anger, depression - Social isolation

Question 31

How does prolonged stress effect the body

Answer 31

High levels of cortisol contribute to health problems such as: gastric ulcers, delayed wound healing (immune systems), and osteoporosis (through decreased calcium absorption), also effects autoimmune diseases (AIDS, diabetes, cancer)

Question 32

What is burnout

Answer 32

Occurs in situations of prolonged chronic stress Characterised by: - Emotional exhaustion which manifests as depersonalisation and cynicism - Diminished sense of self-efficacy and personal accomplishment - Negative coping practices – excessive alcohol use or medication use

Question 33

What are psychological impacts of burnout

Answer 33

depression, anxiety

Question 34

What are psychosomatic impacts of burnout

Answer 34

headaches, increased vulnerability to infection

Question 35

What are physical health problems of burnout

Answer 35

CVD

Question 36

Describe burnout amongst nurses

Answer 36

Social context of work more than content of work - context issues included: - Lack of professional recognition - Professional uncertainty - Interpersonal and family conflicts - Tensions in work relations

Question 37

Describe post-traumatic stress disorder

Answer 37

Debilitating mental illness affecting some people who have experienced or witnessed an extremely stressful event – involving threat of death or serious injury to self or others

Question 38

What are symptoms of PTSD

Answer 38

insomnia, intrusive dreams and thoughts, irritability and outbursts of anger, poor concentration May also include survivor guilt, detachment from loved ones and relationship difficulties Could cause immunosuppression

Question 39

Examples of intermediate social determinants that affect stress

Answer 39

``` Inadequate housing Poverty Low levels of education Overcrowding High levels perceived stress Social dysfunction ```

Question 40

Define coping

Answer 40

Process by which people try to manage the perceived discrepancy between demands and resources they appraise in a stressful situation

Question 41

What are internal resources of coping

Answer 41

Personality factors, perceptions and beliefs Internal locus of control and health LOC -- belief that one has ability to change the situation Self-efficacy – positive self-talk Optimism Resilience (protective factor) – self-belief, good communication

Question 42

What are external resources of coping

Answer 42

Social support – family, friends, work or student colleagues Resources: - Finances - Time - SES (higher --> greater access to resources) - Access to and utilisation of health and social support services

Question 43

What are methods of coping

Answer 43

Problem-focused | Emotion- focused

Question 44

Explain problem-focused coping

Answer 44

aimed at resolving stressful situations or altering the source of stress e.g. problem-solving, time-management, social support

Question 45

Explain emotion-focused coping

Answer 45

Trying to reduce the negative emotions associated with the situation, rather than changing the situation itself e.g. drug therapy, distraction, meditating, eating more, drinking alcohol, journaling

Question 46

Example coping styles: Diagnosed with diabetes

Answer 46

Emotion - join support group | Problem - enrol in education class

Question 47

Example coping styles: Made redundant at work

Answer 47

Emotion - take holiday | Problem - register employment agency

Question 48

Example coping styles: Recurrent arguments with partner

Answer 48

Emotion - go out with friends | Problem - seek relationship counseling

Question 49

Example coping styles: Wake up feeling ill on day of exam

Answer 49

Emotion - roll over and go back to sleep | Problem - make GP appointment to obtain medical certificate

Question 50

Describe carer stress assessment tool

Answer 50

The Carer Strain Index is used to assess the level of stress/strain experienced by a family carer looking after a person with dementia Gender and relationship to the person with dementia can affect the level of stress experienced. Daughters, daughters-in-law and wives also score higher than husbands