PAIN

Understanding and Managing Pain

 DEFINING PAIN
Pain is due to two factors:
 The sensation
 The person’s reaction to that sensation
 DEFINING PAIN
Pain can be viewed in terms of three stages:
 Acute pain - normally brief from a cut, burn, injury; adaptive in that
it signals the person to avoid further injury
 Chronic pain - endures over months; no adaptive reason or
biological benefit
 Pre-chronic pain - occurs between acute and chronic pain
 EXPERIENCING PAIN
 The experience of pain is individualized, subjective, situational, and cultural
 Individualized differences in pain
 Cultural differences in pain
 African Americans and Hispanic Americans show higher sensitivity to pain than European
Americans
 EXPERIENCING PAIN
Gender Differences in Pain Perception
 Women report pain more readily than men
 May be due to gender roles and socialization
 THEORIES OF PAIN
 The first theory of pain was the specificity theory; however, this theory is too simplistic
 Currently, the gate control theory of pain is used to understand pain
 SPECIFICITY THEORY
Specificity Theory of Pain-pain perception is subjected to the specific pain fibers and pain
pathways that make the experience of pain virtually equal to the amount of tissue damage or
injury
 GATE CONTROL THEORY OF
PAIN
Gate Control Theory of Pain - pain perception is subjected to a number of modulations
that influence the experience of pain
 Structures in the spinal cord as a gate for the sensory input that the
brain interprets as pain
GATE CONTROL THEORY OF
PAIN
 GATE CONTROL THEORY OF
PAIN
Gate Control Theory also suggests that pain has motivational and emotional components
 Gate control trigger - nerve impulses that descend from the brain
and influence the gate mechanism
• For example, distraction or relaxation could cause the gate to
close, causing a decrease in pain
 PAIN SYNDROMES
 More than 30% of people in the US experience chronic or intermittent persistent pain
 Chronic pain is categorized as a syndrome - symptoms that occur together
 HEADACHE PAIN
Headache pain
 Most common of all types of pain; 90% of people will experience
headaches
 Three primary types of headaches:
• Migraine headaches
• Tension headaches
• Cluster headaches
 LOW BACK PAIN
Low back pain
 Approximately 80% of people will experience low back pain
 Injuries, pregnancy, infections, degenerative diseases, and
malignancies all can cause lower back pain
 ARTHRITIS PAIN
Arthritis Pain
 Rheumatoid arthritis - an autoimmune disorder characterized by
swelling and inflammation of the joints
 Osteoarthritis - progressive inflammation of the joints; affects
mainly older adults
 Fibromyalgia - characterized by tender points throughout the body;
not considered arthritis
ARTHRITIS PAIN
 CANCER PAIN
Pain is present in 44% of all cancer cases
 Almost half of all cancer patients’ pain is left untreated
 PHANTOM LIMB PAIN
Phantom Limb Pain - the experience of chronic pain in a part of the body that is missing
 Reports vary but it may be that 90% of amputees experience phantom
limb pain
 Pain is more likely to occur when a person experienced much pain
before the amputation
 There may be an emotional basis to this pain but also the CNS and
PNS may make maladaptive adaptations after the amputation
PHANTOM LIMB PAIN
 THE MEASUREMENT OF PAIN
Pain can be measured in a number of ways:
 Self-report ratings
 Behavioral assessments
 Physiological measures
 SELF-REPORTS
Self-reports ask people to evaluate and make ratings of their pain using:
 Rating scales, such as the Visual Analog Scale, where people rate
their pain
 Pain questionnaires, where people are asked to make certain
distinctions about their pain
 Standardized psychological tests, where dishonesty about pain can
be assessed
 BEHAVIORAL ASSESSMENTS
 Behavioral assessments of pain use observation of the patient to assess pain
 Record body movements and facial expressions looking for signs of pain
 This method may be especially useful for children and elderly who may not be able to
accurately self-report on pain
 PHYSIOLOGICAL MEASURES
 Electromyography (EMG) - measures level of muscle tension, as pain may increase
tension
 Heart rate - predicts perception of pain, but only for men
 Overall, physiological assessments may not be as valid as self-report or observational
methods