pain

• Pain


  Subjective experience with sensory and affective components
• Pain


  • Those believing pain is a threat to health will rate the affective level as higher than someone who believes the same pain is just because they over-exercised
  • Individual response to pain is affected by social, genetic and cognitive factors
• Function of pain


  • To prevent us from further injuring ourselves
  • Doctors use pain as a clue when diagnosing
• Acute pain


  Sudden, sharp pain lasting less than six months (ICD-11)
• Chronic pain


  • Usually lasts longer than six months
  • Causes high levels of anxiety and exhaustion
  • Can affect sleep and impact the ability to lead a normal life
• Phantom limb pain


  • Experienced by 80 per cent of people after limb loss
  • More common in women than men
  • May be explained by mixed signals, brain adjustment or damaged nerve endings
  • A chronic condition, either recurrent or intractable, described as 'shooting', "burning' or 'cramping' pain (Sarafino, 2006)
• Mirror treatment


  1. Uses a mirror to create the illusion of the amputated limb being there, by placing the opposing limb in front of the mirror, with the amputated limb behind it

  2. The patient massages and moves the opposing limb and feels the benefit in the phantom limb

  3. Breaks the negative feedback loop telling the brain the limb is not moving and establishes new connections to 'feel' it again, easing the pain
• Specificity theory


  • Suggests we have a sensory system specifically dedicated to pain
  • The more the specific pain pathway (pain nerve fibres and specific pain centre) is used, the more intense the pain is
• Gate control theory


  • Small, slow fibres carry pain stimulation to the spinal cord
  • They pass through a 'gating mechanism', activating T-cells to transmit the pain signal to the brain
  • The extent to which the gate is open depends on activity level in slow pain fibres, activity level in other peripheral fibres, and messages from the brain to the spinal cord
• Anxiety and boredom open the gate, happiness and distraction close it
• The gate control theory of pain focuses on the nature side of the nature versus nurture debate, ignoring environmental (nurture) factors affecting pain perception
• Gate control theory and MacLachlan et al.'s research take a holistic approach to pain, accounting for both physical and psychological factors, but neither accounts for individual differences in pain experience
• Subjective measures


  Self-report measures are important to understand the severity/ daily impact of patients' pain
• Clinical interview


  Used to assess patients with chronic pain, allowing observation and assessment of a patient's emotional state and beliefs about pain causes, and using psychometric tests to help understand the type and intensity of the patient's pain, everyday functioning, emotional distress, beliefs and expectations
• Clinical interviews may not be effective for all as they rely on good communication and trust between patient and physician
• McGill pain questionnaire


  Constructed by Melzack and Torgerson (1971), it has 4 categories (sensory, affective, evaluative, miscellaneous) with 20 questions to measure pain rating index, number of words chosen, and present pain intensity

  
• The McGill pain questionnaire is reliable and valid, but quantitative pain measures may limit the patient's ability to communicate their real experience of pain
• Visual analogue scales


  Measure subjective pain along a continuum, with the patient identifying their current intensity of pain
• Visual analogue scales are quick and easy to use, but patients are unable to elaborate on pain experience and its impact
• UAB pain behaviour scale

  Measures observable pain behaviour and verbal/ non-verbal signs of pain, with an observer judging how frequently each behaviour occurs across a three-week period
• The UAB pain behaviour scale is dependent on the observer's ability to accurately record pain behaviour, and has a low correlation between observer scores and self-reports

  
• Brudvik et al. (2016) study

  • Explored the relationship between children's self-reported pain and parents' and doctors' pain ratings, how age, medical condition and severity of pain affect pain estimates, and whether pain assessment affects administration of pain relief
  • Found doctors significantly underestimate pain in 3-15-year-olds, and only 14.3% of children self-rating pain as severe were given pain relief medication
• Brudvik et al.'s (2016) research illustrates the nomothetic approach, measuring pain numerically and using statistical analysis, rather than a more idiographic approach to learn more about how/why some children experience greater pain than others
• The Brudvik et al. (2016) study can be used to support changes in Norwegian paediatric care, including training on listening to children/parents regarding pain levels and remembering individuals with the same condition may experience pain differently
• Biological treatments for pain, such as paracetamol, take a nomothetic approach despite individual differences in effectiveness and side effects, so an idiographic approach is more appropriate
• Acupuncture demonstrates alternative pain relief techniques to traditional Western drug therapy, supported by research evidence showing greater reduction in pain for cancer patients receiving acupuncture alongside conventional drug therapy
• The gate control theory of pain proposes that pain is detected and picked up by sensory signals, but the spinal cord plays a key role in whether the pain is experienced, with a mechanism acting like a gate that can open or close to reduce the experience of pain
• Weaknesses of pain measures for children include limited vocabulary to describe pain and parts of the body, communication problems with a distressed child, and lack of understanding of the need to be truthful
• Stimulation therapy/TENS involves the use of electrical stimulation to the skin to help manage and treat pain
• Understanding of the need to be truthful
• Level 3 (5–6 marks)


  • Candidates will show a clear understanding of the question and will discuss at least two appropriate weaknesses
  • Candidates will provide a good explanation with clear detail
• Level 2 (3–4 marks)


  • Candidates will show an understanding of the question and will discuss one appropriate weakness in detail or two or more in less detail
  • Candidates will provide a good explanation
• Level 1 (1–2 marks)


  • Candidates will show a basic understanding of the question and will attempt a discussion of weaknesses
  • Candidates will provide a limited explanation
• Level 0 (0 marks)

  No response worthy of credit
• Other appropriate responses should also be credited
• 'stimulation therapy/TENS'


  • Provides pain relief through the use of a mild electrical current
  • Electrodes are placed around the source of the pain
  • The sensation of pain is reduced through the electrical current either through releasing the body's natural pain killers (opioids) or blocks pain-gate that sends pain messages to spine and brain or acts as a distraction to pain
• self-report measures


  clinical interview
• psychometric measures and visual rating scales

  McGill pain questionnaire, visual analogue scale
• behavioural/observational measures


  UAB pain behaviour scale
• pain measures for children

  paediatric pain questionnaire, Varni and Thompson, 1976; Wong-Baker scale, 1987