Pain and its management

1
Pain and its management

• Chapter ten

2
Elusive nature of pain

• Chronic back pain
• One of most common causes of disability
• Inability to measure pain

3
Significance of pain

• Critical for survival
• Low-level feedback
• What patients fear most about illness and
  treatment

4
Elusive nature of pain

• Fundamentally psychological experience
• How it is interpreted
• What it means in terms of self and context
• meaning

5
Measuring pain

• Verbal reports
• Throbbing , aching, sharp, dull.
• Psychosocial components
• Fear
• Catastrophic thinking
• Pain behavior
• Ambulation, facial expressions, extent to which
  pain has disrupted life

6
Thus..

• Pain seen as complex event involving
  psychological, behavioral and physiological
  components

7
physiology

• Awareness of tissue damage accompanied by
  emotional, behavioral, motivational responses

8
Pain perception

• thermal
• Mechanical
• Chemical reactions from tissue damage
• A-delta fibers myelinated transmit sharp pain
• C-fibers dull or aching pain unmyelinated

9
Pain perception

• A-delta
• heavily involved in sensory experience
• thalamus and sensory areas of cerebral cortex
• C- fibers
• different thalmic, hypothalmic and cortical
  areas
• cognitive judgments about pain

10
Affective dimension

• Feelings of unpleasantness and negative emotions
  associated with future concerns (secondary affect)

11
Neurochemical considerations

• Messages from brain down spinal cord which
  influence transmission of pain signals
• Endogenous opioid peptides
• Pain regulation system
• Stress induced analgesia

12
Acute and Chronic Pain

• Chronic pain and psychological distress
• Depression
• Anxiety
• Deviant coping styles
• Complex phenomena
• Most common reason for missed work days

13
Pain and Personality

• neurotic triad
• Hypochondriasis, hysteria, depression
• Pain and depression, reduction in
• activity level
• Perception of control
• Feelings of personal mastery

14
Pain Control Techniques

• Pharmacological
• Drugs that influence neural transmission
• Antidepressants
• Addiction
• Sensory
• Surgical
• Biofeedback
• Relaxation

15
Pain Control

• Hypnosis
• Acupuncture
• Distraction
• Coping
• Guided imagery
• Cognitive-behavioral techniques

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Pain management programs

• Managing pain
• Extinguishing pain behavior
• Reestablishing viable lifestyle