PAIN

zoe_whitwell
Mind Map by zoe_whitwell, updated more than 1 year ago
zoe_whitwell
Created by zoe_whitwell about 6 years ago
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Description

Pain

Resource summary

PAIN
  1. DEFINITION: an unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such
    1. Acute: normal response to trauma
      1. Recurrent: intense episodes interspersed with no pain (benign)
        1. Chronic (non-cancer): constant daily pain for 3+ months
          1. Chronic pain problems
            1. Chronic Treatment Trap
              1. Chronic Medication Trap
                1. "Take it easy" trap
                  1. Chronic Resentment Trap
                2. Sub-acute: transition from acute to chronic
                  1. Chronic progressive pain: increases in unison with underlying condition
                  2. Pathophysiology
                    1. Categorisation
                      1. Nociception: pain arising from actual or threatened tissue damage
                        1. Neuropathic pain: may be caused by a dysfunction in the CNS or PNS, frequently involves spontaneous pain in the absence of identifiable stimuli
                        2. Neural Mechanisms
                          1. A-delta fibres: small, myelinated; transmit fast sharp pain messages
                            1. Enter spine at dorsal horn; project to thalamus and sensory areas of cortex
                            2. C-fibres: large, unmyelinated; transmit aching, slow pain messages
                              1. Project to thalamus, limbic and cortical areas
                              2. A-beta fibres: everything is ok messages
                              3. Neurochemsitry
                                1. Bradykinin and prostaglandins
                                  1. Released by tissue damage
                                    1. stimulate pain neurons; major producers of pain
                                  2. Glutamate and Substance P
                                    1. Act in spinal cord to increase neural firings
                                      1. Substance P secreted by pain fibres and crosses synapse to T cells; triggers firing
                                        1. Part of the Gate Mechanism
                                  3. Models of Pain
                                    1. BioPsychoSocial
                                      1. Pain comprised of physical, psychological and environmental (social) aspects
                                        1. Fordyce's Aspects of Pain
                                          1. Nociception
                                            1. tissue damage
                                            2. Pain
                                              1. perceived nociceptive input
                                              2. Suffering
                                                1. Affective
                                                2. Pain behaviour
                                                  1. behaviour to nociception
                                                    1. Avoidance learning
                                                      1. Learned pain beahviours
                                              3. Gate Theory (Melzac and Wall)
                                                1. A-beta fibres fire to keep the gate closed, controlling the flow of pain to the brain
                                                  1. A-delta and C-fibres fire above a threshold, opens the gate and pain messages are sent to the brain
                                                    1. messages coming down from the brain can also open and close the gate
                                                      1. central sensitization: increase in excitability of neurons in CNS; pain still experienced after tissue damage heals (chronic pain)
                                                      2. Treatment
                                                        1. Behaviour Therapy
                                                          1. Rewards for well beh's
                                                            1. Decrease rewards for pain beh's
                                                              1. Reduce avoidance beh's
                                                                1. Increase fitness
                                                                2. CBT
                                                                  1. Change cognitions to change beh's, thoughts and emotions
                                                                    1. Insight into self-defeating patterns
                                                                      1. Challenge them
                                                                      2. Increase self-efficacy
                                                                        1. Problem-solving
                                                                          1. Biofeedback and relaxation
                                                                            1. Setting achievable goals
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