HEALTH PSYCHOLOGY- ASSESSING PAIN - ATHIRA

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ASSESSING PAIN

• ATHIRA SREEKUMAR
• I MSc CLINICAL PSYCHOLOGY

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PAIN

• an unpleasant sensory and emotional experience
  associated with actual or potential tissue
  damage, or described in terms of such damage.
• Pain motivates us to withdraw from potentially
  damaging situations, protect a damaged body part
  while it heals, and avoid those situations in the
  future.
• Pain is a major symptom in many medical
  conditions and can significantly interfere with a
  persons quality of life and general functioning.
• Social support, hypnotic suggestion, excitement
  in sports or war, distraction and appraisal can
  modulate pain intensity.

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CLASSIFICATION OF PAIN

• The International Association for the Study of
  Pain (IASP) classifies into 5 categories
• Duration and severity
• Anatomical location
• Body system involved
• Cause
• Temporal characteristics
• This classification was criticized by many
  veterans.

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CLASSIFICATION OF CLINICAL PAIN

• Two kinds of clinical pain Acute Pain
• 
  Chronic Pain
• Acute pain typically results from a specific
  injury that produces tissue damage, such as wound
  or broken limb.
• Acute pain is usually short in duration and is
  defined as pain that goes on for 6 months or
  less.
• Acute pain can produce substantial anxiety and
  prompts its sufferer to engage in an urgent
  search for relief.
  
  
  
  

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• Chronic pain typically begins with an acute
  episode, it does not decrease with treatment and
  passage of time.
• Types of chronic pain
• Chronic benign pain (eg.chronic low back pain)
• Recurrent acute pain (eg.migraine headaches)
• Chronic progressive pain (eg.cancer)

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PAIN CLASSIFICATION BASED ON REGION AND SYSTEM

• According to the location of the body headache,
  low back pain, and pelvic pain.
• According to the body system involved
  myofascial pain, rheumatic pain, neuropathic
  pain, and vascular pain.

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PAIN CLASSIFICATION BASED ON CAUSE

• Somatogenic pain arising from the perturbation
  of body.
• Psychogenic pain the product of psychic
  conflict or psychopathology.
• Somatogenic pain is classified into two as
• Nociceptive pain caused by activation of
  nociceptors.
• Neuropathic pain caused by damage to or
  malfunction of nervous system.

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NOCICEPTIVE PAIN

• Nociceptive pain is initiated by nociceptors.
• Nociceptors are peripheral nerve fibers that
  respond only to stimuli approaching or exceeding
  harmful intensity.
• This pain can be classified into
• 1.Visceral pain(eg.
  referred pain)
• 2.Deep somatic pain(eg.
  sprains)
• 3.Superficial pain(eg.
  minor wounds)

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NEUROPATHIC PAIN

• Caused by damage or malfunction of nervous
  system.
• Divided into Peripheral pain
• Central pain
• Peripheral neuropathic pain is originating in the
  peripheral nervous system.
• It is often described as burning", "electrical
  etc.
• Central neuropathic pain is originating in the
  brain or spinal cord.

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PSYCHOGENIC PAIN

• Caused, increased or prolonged by mental,
  emotional or behavioral factors.
• Also called as psychalgia or somatoform pain.
• Headache, back pain, and stomach pain are
  sometimes diagnosed as psychogenic.
• People with long term pain frequently display
  psychological disturbance, and has elevated
  scores on the Minnesota Multiphasic Personality
  Inventory scales of hysteria, depression and
  hypochondriasis.

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PAIN ASYMBOLIA

• A state described as intense pain devoid of
  unpleasantness in some patients ,with morphine
  injection or psychosurgery.

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INSENSITIVITY TO PAIN

• Howard Beecher,a physician, firstly identified
  the concept of insensitivity in 1959.
  
  
• Episodic analgesia may cause under certain
  circumstances, they includes
• Excitement of sport or war
• Spinal cord injury
• Diabetes mellitus
• Leprosy
• Congenital analgesia

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PAIN THRESHOLDS

• PAIN PERCEPTION THRESHOLD
  It is the point at which the stimulus begins to
  hurt.
• PAIN TOLERANCE THRESHOLD
• It is reached when the subject acts to stop
  the pain.
• Difference in pain perception and pain tolerance
  threshold are associated with ethinicity,genetics
  and gender.

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PAIN AND PERSONALITY

• PAIN PRONE PERSONALITY
  A constellation of personality traits that
  predispose a person to experience chronic pain.
• Research suggests that pain itself can produce
  alterations in personality and feeling of pain is
  different for different types of personality.

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MEASUREMENT OF PAIN

• In measuring pain, medical practitioners uses
• 1. Verbal reports
• 2. Pain behavior
• According to Margo McCaffery in 1968Pain is
  whatever the experiencing person says it is,
  existing whenever he says it does.
• McGill Pain Questionnaire is used in order to
  identify the quality of pain indicating which
  words best describe their pain.
• To assess pain, the patient is asked to locate
  their pain on a scale of 0 to 10,with 0 being no
  pain at all, and 10 the worst pain they have ever
  felt.

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MULTIDIMENSIONAL PAIN INVENTORY(MPI)

• It is a questionnaire designed to assess the
  psychosocial state of a person with chronic pain.
• Analysis of MPI results by Turk and Rudy
  (1988)found 3 classes of chronic pain patient
• 1.Dysfunctional
• 2.Interpersonally
  distressed
• 3.Adaptive copers
• Combination of MPI characterization of the person
  with their IASP five category pain profiles
  recommended for deriving the most useful case
  description.

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ASSESSMENT IN NON VERBAL PATIENTS

• Facial grimacing
• Increase or decrease in vocalizations
• Change in routine behavior patterns
• Mental status changes
• Withdrawn social behavior
• Decreased appetite and nutritional intake
• Limited range of motion

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ASSESSMENT IN INFANTS

• Crying
• Infants are more sensitive to painful stimuli.

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BARRIERS IN REPORTING PAIN

• Age adults ability in recognizing pain may be
  blunted by illness or the use of multiple
  prescription drugs.
• Depression
• Decline in self care activities
• Fear towards treatment and hospitalization
• Shameful in reporting pain
• Feel pain as a deserved punishment for past
  transgressions.
• Cultural barriers
• Religious beliefs
• Stigma of addiction.
• Gender differences

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AIDS TO DIAGNOSIS

• Time of onset
• Location
• Intensity
• Pattern of occurrence
• Exacerbating and relieving factors
• Quality of pain

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PAIN CONTROL TECHNIQUES

• Pharmacological control of pain
• Surgical control of pain
• Sensory control of pain
• Biofeedback
• Relaxation techniques
• Hypnosis
• Acupuncture
• Distraction
• Coping techniques
• Guided imagery
• Cognitive-Behavioral interventions

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ASSESSING PAIN USING ACRONYMS

• The acronym is used to gain an insight into the
  patients condition, and to allow the Health Care
  Provider to develop a plan for dealing with it.
• SOCRATES is a mnemonic acronym used by emergency
  medical services,doctors,nurses and other health
  professionals to evaluate the nature of pain that
  a patient is experiencing.
• S site
• O-onset
• C-character
• R-radiation
• A-associations
• T-time course
• E-exacerbating\relieving factors
• S-severity

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ASSESSING USING PAIN SCALES

• A pain scale measures a patients pain intensity
  or other features.
• Pain scales are based on self-report,behavioral
  or psychological data.
• Self-report is considered as primary.
• Pain scales are available for neonates,infants,chi
  ldren,adolscents,adults,seniors and persons whose
  communication is impaired.
• Pain scores are sometimes regarded as the Fifth
  Vital Sign.

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Example of pain scale
SELF REPORT OBSERVATIONAL PHYSIOLOGICAL
INFANT ----- PREMATURE INFANT PROFILE NEONATAL\INFANT PAIN SCALE -----
CHILD FACES PAIN SCALE REVISEDWONG BAKER FACES PAIN RATING SCALECOLOURED ANALOGUE SCALE FLACC(FACE ARMS CRY CONSOLOBILITY SCALE)CHEOPS(CHILDRENS HOSPITAL OF EASTERN ONATARIO PAIN SCALE) COMFORT
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PAIN MEASUREMENT SCALES

• Brief Pain Inventory (BPI)
• Dolorimeter Pain Index (DPI)
• Faces Pain Scale Revised (FPS-R)
• Face Legs Activity Cry Consolability Scale
• McGill Pain Questionnaire (MPQ)
• Neck Pain and Disability Scale NPAD
• Wong-Baker FACES Pain Rating Scale

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THANK YOU