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Pain is one of the most common complaints made by patients to primary care providers (approximately 50% of patients) prevalence estimates of persistent pain in population samples range between 7% and 64%, depending on survey methodology and population studied. Pain often remains unrecognized, poorly assessed, underestimated, untreated, or inadequately treated.
Pain is one of the most common complaints made by patients to primary care providers (approximately 50% of patients) prevalence estimates of persistent pain in population samples range between 7% and 64%, depending on survey methodology and population studied. Pain often remains unrecognized, poorly assessed, underestimated, untreated, or inadequately treated.
Pain is one of the most common complaints made by patients to primary care providers (approximately 50% of patients) prevalence estimates of persistent pain in population samples range between 7% and 64%, depending on survey methodology and population studied. Pain often remains unrecognized, poorly assessed, underestimated, untreated, or inadequately treated.
The single biggest problem in communication is the illusion that it has taken place. George Bernard Shaw What is chronic pain? Gate control theory The Communication Model of Pain (CMP) Summary Clinical Implications of CMP Pain is one of the most common complaints made by patients to primary care providers (approximately 50% of patients).
prevalence estimates of persistent pain in population samples range between 7% and 64%, depending on survey methodology and population studied .
For some people pain persists and past the point where it is considered adaptive (more than 3 months) and
contributes to negative mood, disability, deteriorating social functioning, and increased use of healthcare system resources.
The high prevalence of unsatisfactory treated pain demonstrates how pain has been to typical clinical care, despite better understanding of the biology of pain
Pain often remains unrecognized, poorly assessed, underestimated, untreated, or inadequately treated.
Therefore, Understanding the biology of pain is vital but inadequate to challenges of pain control.
This has led to the development of biopsychosocial models of pain In 19 th century advances in our understanding of the biology of pain took place
In the mid-20 th century, the Gate Control Theory (GCT, Melzack and Wall, 1965) introduced pain as a complex psychological phenomenon.
Provided a neurophysiological basis for conceptualizing the biological substrates of psychological and environmental determinant of pain .
substantial elaboration of our understanding of the facilitatory and inhibitory mechanisms that modulate nociceptive processes.
The Gate Control Theory
IASP(2005) definition of PAIN: Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Nociception: the neuro-physiological translation of events that stimulate nociceptors and are capable of being experienced as pain
In typical adult humans, pain is associated with meaning, learning, and emotional reactions
This definition Leaves room for multiple causes, mediators, and moderators.
Psychological mechanisms has resulted in novel interventions for both acute and chronic pain
Several multi-aspect perspectives emerged: the operant model, cognitive-oriented models, interpersonal formulations of pain The focus on intrapersonal processes, both biological and psychological, leaving the social dimension underexamined
Pain is also has major social features, occurs rarely in silence, and is important to not only the individual but the social environment.
Pain serves as an archetypical sign of threat and commands the attention and responses of others in the social environment.
Others response in turn have an important impact upon the pain experience and wellbeing of patient (Craig, 2009) Consistent with biopsychosocial conceptualization
The biological mechanisms are fundamental to
Psychological processes engaged during pain experience and expression
Directs attention to social processes as causes and consequences of pain experience
Process of communication is seen as a three step process (A > B > C). Step A (Action): Internal Experience, pain expression, and reaction of receiver
Step B (Interaction): Encoding expressive behavior which is embedded in a broader social context
Step C (Transaction): Decoding and Responding with sensitivity to expressive behavior Where a message is sent or a message is received (e.g., a message left on a telephone or a message is received)
It includes automatic/reflexive reactions of observer (e.g., the gut reaction to another persons horrifying accident)
Self-reports , and nonverbal expression are the manifestation of pain are considered as communication as action
Experience of pain :
consists of affective, behavioral, and motivational components
Is affected by (and interpreted through) the cultural, interpersonal, and situational context
Associated with brain mechanisms where a message (verbal & non verbal) is sent, received, and interpreted, whether as intended or incorrectly
Effectively communicating pain , enables observer understand feelings, thoughts, and expressions of the patient.
Actions of patient: protective or communicative The impact of social context on verbal and nonverbal displays of pain Brain correlates of pain expression where messages are exchanged, but something other than the exchange of messages results (e.g., I do is not just a report of intent but transacts the wedding of one person to another).
When physician and patient communicate interactively and the physician infers pathophysiological process, provides a diagnosis , and commits to treatment Affected by clarity of patients message (verbal is easier than nonverbal)
occurs within the context of contextual, interpersonal, social factors all of which affect interpretation of pain signals
Influenced by observer characteristics (age & gender)
Also sufferer's characteristics influence pain judgments
Patient coping styles
The model serves as a synthesis of preexisting findings and facilitates conceptualization of a vast literature Recognition of social and psychological parameters affecting pain experience and its communication Implications for clinical assessment and treatment
Older adults and seniors with dementia suffering from pain Pain assessment and interventions in different socio-cultural contexts Educational interventions for chronic pain patients caregivers Healthcare providers education in how communicate with chronic pain patients On one hand: Seniors have tendency to underreport pain complaints Dementias interfere with effective pain communication, as cognitive functions decline as a result of dementia. Ability to self-report and describe pain deteriorates, but, nonverbal forms of pain expression is preserved. On the other hand: Effective communication has been shown to be related to pain relief. As a result: Pain assessment in seniors should be different from patients from other ages, and would be better to rely on both verbal (also significant others reports) and nonverbal methods.
Patients from interdependent cultures are tend to underreport their pain in order to keep the harmony of their social group, so they may underreport their pain.
Hidden assumptions and rules Big boys dont cry, take it like a man governs people expressive pain behaviors, which in turn mislead health care providers and caregivers Participants receiving painful stimuli while holding their spouses hand communicated reduced pain unpleasantness (relationship factors were controlled) From fMRI standpoint, the activity of neural system supporting emotional and behavioral threat responses was attenuated. Spouses cognitions and responses to pain behavior (e.g., punishing) contribute to patients pain behavior, intensity, and disability.
Tell others what you can and cannot do Inform them that the severity of your pain varies, even if it is never completely gone Tell them in a friendly way what kind of help you hope to receive and why Tell them when they are helping! Praise wins over blame every time Talk to others regularly, not just when your pain is most intense Frustrations in accurately decoding and interpreting pain messages occur within the context of health care system may lead to patient dissatisfaction and negative mood.
How the practitioner phrases the initial pain question might affect the amount of important information that you respond with (i.e., How are you today?)
Oftentimes, we cannot change the external world So what can we do?
We can help patients to: Take the responsibility for reporting pain and response to the treatment Describe their pain using a pain intensity scale Describe their pain using pain location Describe their pain using pain sensation Evaluate and describe changes Determine if the health provider understand the message
McGill Pain Questionnaire
Reliable in elderly
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Craig, K. D., K. M. Prkachin, et al. (2011). The facial expression of pain. Handbook of Pain Assessment. D. C. Turk and R. Melzack. NewYork, Guilford Press: 117-133.
Craig, K. D., J. Versloot, et al. (2010). "Perceiving pain in others: Automatic and controlled mechanisms." The Journal of Pain 11(2): 101-108.
Hadjistrovropoulos, T. and K. D. Craig (2002). "A theoretical framework for understanding self-report and observational measures of pain: a communications model." Behaviour Research and Therapy 40: 551-570.
Hadjistrovropoulos, T., K. D. Craig, et al. (2011). "A biopsychosocial Formulation of Pain communication." Psychological Bulletin X(X): XXX-XXX.
McDonald, D. D., G. J. Thomas, et al. (2005). "Assisting older adults to communicate their postoperative pain." Clinical Nursing Research 14(2): 109-126.
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Vangronsveld, K. and S. J. Linton (2011). "The effect of validating and invalidating communication on satisfaction, pain and affect in nurses suffering from low back pain during semi-structured interview." European Journal of Pain XXX: XXXX.