Medwiki

1 - Psychology of pain

This touches on persistent pain and its effects, as well as pain in general

Patient understanding of pain

People often have no understanding of pain at 68%, People also often doubt the reality and impact of pain at 65%. The total costs of pain management in NZ are 15 billion in 2016 which is a lot of money, and 20% of the the NZ population experiences persistent pain.

Persistant pain

The effects of ongoing pain (important for exams)

Ongoing pain can being about

  • Distrust in the medical system
  • Feelings of invalidation
  • Feelings of making it up

Persistent pain can influence how you act and how you feel about yourself

It can change how you are in society:

  • Loss of employment
  • Changes in role
  • Limited social interactions
  • Leading sense of burden

Pain terminology

What is Pain?

It is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or describes in terms of equivalent damage

It is more than just physical experience as we see later (Panicaption is not pain)

Acute vs chronic pain (important for exams)

Acute pain is less than 6 months It usually has/is:

  • recent onset and limited duration
  • A waring sign of damger
  • Facilitating healing through immobilistion (try not to move)
  • Less complex psychological processing and social acceptance

Persistant pain (Persistent Somatic Symptoms is now the preferred umbrella term)

Persista\ent pain defined as pan longer then 6 months (kinda arbitrary timeframe)

  • Pain persisting beyond expected helaing of injury
  • Often no identifiable cause
  • Complicated psychological processing and social acceptance

Acute pain to persistent pain

To understand a theory of how persistent pain develops it is helpful to understand the mechanisms of pain:

Pain mechanisms

Nociception

Nociception is the nervous response to sensory neurons sensing noxious stimuli. This is sent to the brain and eventually a experience results: pain.

Nociplastic

Nociplastic response is altered nociception. There is no clear damage of ongoing injury (eg hidden infection).

Persistant pain

Persistent pain is the result of repeated and ongoing noxious stimulation. It can enhance the sensitivity of pain as well as lead to neuroplastic changes.

Its like the nociceptive signals happen so often that it strengthens the pathway and makes baseline pulses register as nociception

Subjectivity of pain

As pain is an emotional and mental experience many factors affect the experience of pain. for example

  • The source of injury

If it is an accident or self inflicted, abuse or treatment, this can affect the feelings of pain.

  • Beliefs/concerns

No pain, no gain, if you go to the gym and feel your muscles are sore afterward you don’t have such a negative mindset about it (less applicable example of persistent pain)

  • Cultural issues

Language, expectations, expressions health inequity

  • Other illnesses and body sensitivity
  • Coping strategies
  • Social factors

Family, work etc

  • Psychological factors

Anxiety and anger, etc

Biopsychosocial perspective of pain (important)

This is a framework to understand attitudes to pain and resulting effects

There are 2 cycles:

Pain control focus

This is where you have a negative mindset about the pain (I’m going to hurt, I’m not going to get better, I cannot manage). This leads to high threat and you focus on the pain, your worry and your body. This leads to fear, and you are always thinking about the pain. You avoid activities that may help you or make you feel better, or push through and injure yourself more. It interferes with your life and as it does it negatively affects you, leading to further high threat thoughts

Focus on life

Optimistic focus leads to more pain reduction.

Clinical approach to pain

Pain management

These people are involved with helping

  • Physician
  • Occupational therapist
  • Nurse
  • Physical therapist
  • Psychologist

Working with patients with pain

  1. Build support, use active listening, validate and normalise
  2. Find out more about the pain (clinical skills connect)
    1. frequency, intesity, duration of pain
    2. Area of pain or injury
    3. Description of pain
    4. What makes it better and worse
    5. Impact of pain
    6. as well as assessing the other factors of the subjectivity of pain

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Relevant lectures: L2 Psych med Other links in medwiki: Comments:

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