Week 7

Question 1

Pain

Answer 1

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

Question 2

Classification of pain according to the cause

Answer 2

• Nociceptive pain: due to tissue damage.
• Neuropathic pain: due to damage to the nervous system.
• Mixed pain: nociceptive and neuropathic pain combined.
• Idiopathic pain: pain without a clear organic cause.

Question 3

Classification of pain according to duration

Answer 3

• Acute pain: pain that lasts for less than 3 to 6 months. Can stop when it’s healed, but can also be recurrent.
• Chronic pain: continues for more than 3 to 6 months.

Question 4

Allodynia

Answer 4

Experiencing pain because of a stimuli that normally doesn’t cause pain (like a feather)

Question 5

Hyperalgesia

Answer 5

Experiencing very severe pain due to a very small pain stimulus.

Question 6

Consequences of chronic pain

Answer 6

• Economical: costs, sickness absence, disability etc.
• Psychological: depression, anxiety, sleep etc.
• Social: social network, partner, children etc.

Question 7

The biological model of pain

Answer 7

The injury causes the pain receptor to send a signal to the brain. The amount of pain is related to the amount of injury.

Question 8

Gate control theory (psychobiological model)

Answer 8

There is a ‘gate’ at the spinal cord and an interaction between the gate. This process goes in 2 steps:
1. Biological processes: pain stimulus –> pain receptor–> brain.
2. Interaction between the pain signal and cognitions / emotions: causes a release of chemicals at the gate that open or close the gate, which cause more or less pain.

Question 9

Importance of the Gate Control Theory

Answer 9

It explains why psychological variables (past experiences, mood) can influence the pain experience (inhibition / facilitation). The also made the influence of psychology upon pain credible.

Question 10

Learning theory (psychological theory)

Answer 10

Is based on operant conditioning, which is based on the law of effect: when a specific response is followed by regards, the chance of reoccurrence of the response increases. Pain responses are learned and maintained by reinforcement.

Question 11

Cognitive Behavioural Theory

Answer 11

Includes all different kinds of factors. Pain can be a viscous cycle of cognitions, emotions and behaviour. this is influences by:

• Attention: paying attention to the pain increases the pain.
• Attributions concerning the cause of pain: to what do you ascribe the pain.
• Expectations: about the ability to tolerate or control the pain and engage in other activities.
• Coping.

Question 12

Differences between Learning Theory and Cognitive Behavioural Theory

Answer 12

Learning theory does not consider the cognitive and emotional aspects of pain and is restricted to behaviour.

Question 13

Important dimensions of pain to asses

Answer 13

• Pain perception itself: consists of pain intensity, frequency, type of pain, pattern etc.
• Psychological dimension: consists of the emotional dimension (anxiety, depression) and the cognitive dimension (cognitions, coping strategies).
• Behavioural dimension: consists of pain behaviour and functional limitations / quality of life.

Question 14

Pain assessment focused on pain perception

Answer 14

• Unidimensional assessment of pain: indicating how bad the pain is on a scale or in a daily log. (Ex: 0-10 scale, diary,)
• Multidimensional assessment of pain: where is your pain, what does it feel like, how does it change, how strong is it? (Ex: Mc Gill Pain Questionnaire)

Question 15

Pain assessment focused the psychological dimension

Answer 15

• Focussed on emotions: anxiety, sleep, depression.
  (Ex: symptoms checklist-90, brief symptom inventory, depression scale)
• Focused on cognitions: rumination, helplessness, coping, catasrophising.
  (Ex: pain catastrophising scale, pain coping strategies questionnaire).

Question 16

Pain assessment focused on the behavioural dimension

Answer 16

Pain observation scales that look into pain behaviours and functional limitations / quality of life.
(Ex: SF-12, SF-36)

Question 17

Virtual reality

Answer 17

Entering an immersive virtual environment can serve as a powerful pain control technique (like snow-world and spider-world). Can cause less pain-experience, alsof during painful procedures and wound care. The effectiveness can be explained by the gate-control theory: in order to experience pain, conscious attention to the pain is important.

Question 18

Medical treatments of pain

Answer 18

• Surgical intervention: severing the nerves that transfer the pain signal. The effects were short-term and nerve pathways rewired themselves. Caused damage to the nervous system and neuropathic pain.
• TENS: transcutaneous electrical nerve stimulation. Electrical signals block other electrical signals in the brain. Effectiveness is not proven and only has short-term effects.
• Pain medication: painkiller, narcotics, anti-inflammatory drugs, anxiolytics, antidepressants.

Question 19

Psychological treatment of pain

Answer 19

Necessitates an active participation of the patient, because it influences the effectiveness. There often is a lot of reluctance because people think that you undermine their problems. You need to make a clear distinction between factors that caused the pain initially and the factors that maintain or aggravate the pain.
(Ex: relaxation, biofeedback, meditation, hypnosis, behavioural interventions, CBT)

Question 20

Direct and indirect influences of relaxation on pain

Answer 20

• Direct: muscle tension causes a lack of oxygen in the blood, which causes pain.
• Indirect: feeling more relaxed causes stress to have less impact on the body, better stress coping mechanisms and less pain experience.

Question 21

Biofeedback

Answer 21

The patient receives information their own biological processes. The combination of relaxation and biofeedback is NOT more effective than just relaxation, and it’s also very expensive.

Question 22

Mindfulness meditation

Answer 22

Includes focused attention and whole field awareness in the present moment. Observing, without judging, thoughts, emotions, sensations and perceptions as they arise moment by moment. Is effective in chronic pain patients. Positive effects were found on functional limitation, medication intake, anxiety and depression. Doesn’t have an impact on pain itself, but on pain management and pain coping.

Question 23

Hypnosis

Answer 23

The basis of hypnosis is deep relaxation and suggestion. During hypnosis the patient is instructed to think differently about the pain and makes a reinterpretation of the pain and distraction from the pain.

Question 24

Behavioural interventions

Answer 24

Increase healthy behaviour and decrease pain behaviour by rewarding the positive health behaviour an ignoring the unhealthy pain behaviour. It’s quite effective for pain itself, limitations and mobility, but the family has to know about it.

Question 25

Cognitive Behaviour Therapy (CBT)

Answer 25

There is an interaction between cognitions, emotions and behaviour:
- Cognitions: irrational dysfunctional, catastrophic beliefs.
- Emotions: pain related fear and fear of movement.
- Behaviour: avoidance behaviour.
CBT is very effective for treatment of chronic pain.

Question 26

Rational Emotive Therapy (RET)

Answer 26

Is a form of CBT where you challenge irrational automatic thoughts by means of the ABC scheme:
- A: actual situation
- B: more rational, alternative beliefs
- C: consequences

Question 27

Group CBT therapy

Answer 27

Proven to be just as effective as individual therapy and is more cost-effective. You can also use the group dynamics for:
- Treatment effects: modelling of adequate pain management.
- Patient satisfaction: social support

But: it’s not a good choice for patients with a history of interpersonal problems or cognitive impairment and the ideal group-size is 5-7.

Question 28

Self-help CBT programs

Answer 28

Use the same techniques as normal CBT and involves:
- Improvement of problem-solving skills.
- Self- and pain-management
- Perceived control and self-efficacy.

Effects: effective in decreasing pain intensity, functional limitations, anxiety and depression.

Advantages: you can reach a large group of patients and it’s cost effects, but it’s less effective without a physician/ therapist.

Question 29

Multidisciplinary Pain Rehabilitation Centers / Pain Management Clinics

Answer 29

Different medical / psychological / social disciplines work together to develop and individualised treatment for chronic pain patients. The psychologists also train the other disciplines about CBT.