Syllabus Review 28/11/15 3:00 PM

PAIN 1. Types and Theories of Pain a. Definitions of pain

i. Acute and Chronic Organic Painii. Psychogenic pain (e.g. phantom limb pain)

b. Theories of pain: i. specificity theoryii. gate control theory (Melzack, 1965).

2. Measuring Pain a. Self report measures (e.g. clinical interview)b. psychometric measures and visual rating scales (e.g. MPQ, visual

analogue scale)c. behavioral/observational (e.g. UAB)d. Pain measures for children (e.g. pediatric pain questionnaire, Varni and

Thompson, 1976).

3. Managing and Controlling Pain a. Medical techniques (e.g. surgical; chemical)b. Psychological Techniques:

i. cognitive strategies (e.g. attention diversion, non-pain imagery and cognitive redefinition)

ii. alternative techniques (e.g. acupuncture, stimulation therapy/TENS).

Types and Theories of Pain 28/11/15 3:00 PM

DEFINITION OF PAINThe most common definition of pain is by The International Association for the Study of Pain (IASP):“An unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage”.

The American Academy of Pain Medicine (AAPM):“An unpleasant sensation and emotional response to that sensation”.

Pain has the dubious distinction of being the most common symptom for which a person approaches medical care.

Acute and Chronic Organic PainAcute Pain:Acute pain is a type of pain that typically lasts less than 3 to 6 months, or pain that is directly related to soft tissue damage such as a sprained ankle or a paper cut. Acute pain is of short duration but it gradually resolves as the injured tissues heal.

Short-term pain (less than 6 months). Arises suddenly in response to a specific injury. Usually treatable. Patients often have higher than normal levels of anxiety while

the pain exists, but their distress subsides as their condition improves and their pain decreases (Fordyce & Steger, 1979).

Chronic Pain: Chronic pain is often defined as any pain lasting more than 12 weeks. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain persists—often for months or even longer.

Persists or progresses over a long period of time. Often resistant to medical treatments. Pain lasts for more than a twelve-week duration. Patients continue to have high levels of anxiety, tend to develop

feelings of hopelessness and helplessness because varied medical treatments have not helped. The pain can dominate their lives.

Turk, Meichenbaum, and Genest (1983) described three types of chronic pain:

Chronic recurrent pain – benign causes. Repeated and intense pain followed by periods of no pain. E.g., migraines, myofascial pain.

Chronic intractable pain – benign causes. Pain is present all the time in varying intensities. E.g., low back pain.

Chronic progressive pain – malignant. Continuous discomfort that gets worse as condition deteriorates. E.g., rheumatoid arthritis and cancer

Psychogenic Pain (e.g. Phantom Limb Pain)Organic Pain: When pain occurs mainly due to tissue damage.

Psychogenic Pain: Pain seems to result from psychological processes and no tissue damage is observed. Also known as somatoform disorders (mental illnesses that cause physical pain and other symptoms without any physical explanation).

Researchers now recognize that virtually all pain experiences involve an interplay of both physiological and psychological factors

Phantom Limb Pain: Carlen, et al. (1978) described the reaction of Israeli soldiers during the Yom Kippur War when they experienced traumatic amputations. Most of them described the initial injury as painless and described the initial sensation as a ‘bang’, ‘thump’, or ‘blow’. They did not seem to be in a state of shock and were fully aware of their injuries. The intriguing aspect about their observation was that depressed mood is usually associated with increased pain rather than reduced pain.

Phantom: something apparently seen, heard, or sensed, but having no physical reality.

Sometimes people who have lost a limb or were born without a limb experience sensations of having that limb.

Melzack (1992) reviewed evidence on phantom limbs and noted the following features:

Phantom limbs have a vivid sensory quality and precise location in space.

In most cases, a phantom arm hangs down when standing but moves in rhythm when the person is walking.

Sometimes the phantom limb gets stuck in a particular position. Wearing an artificial leg or arm enhances the phantom. Phantoms have a wide range of sensations. Patients perceive phantoms to be an integral part of their body. Phantoms are also perceived by some people with spinal injury

Early explanation stated that the cut nerve ends grow into nodules called “neuromas” that continue to produce nerve impulses which the brain interprets as coming from the lost limb. Cutting these nerve ends relieves the pain for a short period of time, but the pain reappears.

Melzack’s (1992) model suggests that the brain contains a neuromatrix – network of neurons. This neuromatrix generates a neurosignature that provides an overall mental picture of the body. Hence, even though a limb is cut off, the neuromatrix still thinks the body is whole.

Melzack (1992) suggests that the neuromatrix is largely prewired (innate) and provides evidence where children can experience phantoms after amputations and people born without limbs experience phantoms.

Evaluation:Nature

There is a strong evidence that this study supports the nature argument of the nature/ nurture debate. This is because people born without limbs also experience the phantom limb syndrome.

THEORIES OF PAINSpecificity Theory (Von Frey, 1895) The body has a separate sensory system for perceiving pain – just as it does for hearing and vision.

There are special receptors for detecting pain stimuli, its own peripheral nerves and pathways to the brain, and its own area of the brain for processing pain signals.

Criticisms: Individual Factors: When we all have the same pain fibers than

why does it hurt a certain individual and not the other one. There is no specialized pain center in the brain according to

biological research. Pain tends to interact with other parts of your body.

Why do our touch receptors get activated and not the pain fibers when we rub are hands against the board. Both of them are in contact with the board. Then why do we only feel touch and not pain.

Melzack and Wall (1988) – specialised receptors respond to certain unpleasant stimuli, but this does not mean that we always feel pain.

Chery, Croze and Duclaux (1980) – found that onset of pain was not connected with the onset of activity in the specialised nerves. Also, different painful stimuli, such as chemicals, pressure, and heat, provoke activity in different group of nerves.

Various clinical observations have proven the specificity theory to be inadequate to explain chronic pain. Dr. Henry Beecher, who worked with severely wounded soldiers during World War II, was one of the first doctors to question the theory. He observed that only one out of five soldiers carried into a combat hospital complained of enough pain to require morphine. These soldiers were not in a state of shock, nor were they unable to feel pain—indeed, they complained when the IV lines were placed. But when Dr. Beecher returned to his practice in the United States after the war, he noticed that trauma patients with wounds similar to those of the soldiers he had treated were much more likely to require morphine to control their pain. In fact, one out of three civilian patients required morphine for pain from these wounds. Dr. Beecher concluded that there was no direct relationship between the severity of the wound and the intensity of pain. He believed the meaning attached to the injuries in the two groups explained the different levels of pain. To the soldier, the wound meant surviving the battlefield and returning home. Alternatively, the injured civilian often faced major surgery and a resulting loss of income, diminishment of activities, and many other negative consequences.

Pattern Theory (Gold Schneider) –NOT CORE STUDY The pattern theory, by contrast, proposed that afferent fibers respond to a host of stimulus modalities, and that the ultimate perception depends on the brain’s deciphering and interpretation of the patterns of activity across the different nerve fibers.

Builds up upon the specificity theory. Instead of pain having its on system (like the blood circulatory system etc.) Pain works with our other sensory system.

Pain fibers are linked to our sensory fibers, so if we feel regular or even high stimulation it is fine. But if any of those senses get over stimulated it converts into pain. E.g.

A pin poking the body

Tasting a very cold drink Standing near the speakers at a concert Looking at the sun directly

Proposed that there is no separate system for perceiving pain and that the receptors for pain are shared with other senses, such as of touch.

People feel pain when certain patterns of neural activity occur, such as when appropriate types of activity reach excessively high levels in the brain.

It takes into account patterns with intense stimulation that eventually produce pain. It does not take into account innocuous stimuli that trigger episodes of causalgia/neuralgia.

According to this view, people feel pain when certain patterns of neural activity occur, such as when appropriate types of activity reach excessively high levels in the brain. These patterns occur only with intense stimulation. Because strong and mild stimuli of the same sense modality produce different patterns of neural activity; being hit hard feels painful, but being caressed does not.

Criticism: Both these earlier theories do not take into account the

psychological factors behind pain.

Gate Control Theory (Melzack, 1965)All gates open and close so does the pain gate. The heart of the gate control theory is a neural gate that can be opened and closed in varying degrees. The gating mechanism is located in the spinal cord. Pain fibers send a signal through the gating mechanism, which activates transmission cells that sends signals to the brain. When the output of signals from the transmission cells reaches a critical level, the person perceives pain. The greater the output beyond this level, the greater the pain intensity.

We have a pain gate, that opens according to three conditions.

Physical condition ( Inappropriate activity level, extent of the injury)

Emotional condition (anxiety worry, tension, depression) Mental conditions (focusing on the pain, boredom)

This pain closes due to three conditions as well: Physical condition (counter stimulation, e.g. massage,

medication, hug) Emotional condition (positive emotions, relaxation, rest) Mental condition (involvement and interest in life activities

intense concentration or distraction)

EvaluationHolistic:

We can say the study is subjective (rich in qualitative data) as it uses the case study method. However, unlike most case studies it is also objective since it utilizes quantifiable means such as heart rates, blood pressure and respiratory rate.

Measuring Pain 28/11/15 3:00 PM

Self Report Measures (e.g. Clinical interview)Ask a patient to describe their discomfort either in their own words or by filling a questionnaire. However people do tend to lie a lot due to demand characteristics etc. One such example would be athletes, they give a much lesser amount of pain because they want to show they are strong and go back in to the game.

Types of Self Report Interviews: usually done in treatment of chronic painInterviews with patients as well as family members/co-workersAccording to Karoly (1985) interviews should examine (to be as holistic as possible) all factors that contribute to pain:

Sensory: intensity, duration, tolerance, threshold Neurophysiological: brain activity, heart rate etc. Emotional and Motivational: anxiety, anger, depression,

resentment Behavioral: avoidance of exercise, pain complaints Impact on Lifestyle: marital distress, changes in family

dynamics/lifestyle Information Processing: problem-solving skills, coping styles,

health belief

Pain Rating Scales: Rate some aspect of their discomfort on a scaleThere are three types of rating scales

Visual Analogs: Graphic represented. Like in the case of Nelson. E.g.: With smiles is very easy to use; can be used by children as young as age 5.

Box Scale: Likert Scale Verbal Rating: Just ask someone how much pain do you feel in

the range of 1-10. Remember Aga Khan post surgery ratings by residentsSlightly reductionist cause the data is only being gathered in numerical form. Primarily quantative data.

Easy and quick to use. Can be used frequently and average ratings taken over a period of time can give a more accurate picture. Repeated ratings can show changes in pain over time. Can also show patterns that may help the patient manage pain better

Pain Diary: A mixed data. Mostly qualitative data. Quantative data only if you

write down today on a scale of 1-10 I feel this. Helps a physician understand. More detailed, in-depth, descriptive. Holistic. You take it home with you, carry it around everywhere (even if you wake up in the middle of the night). You can fill the pain out as you feel it rather than trying to remember it. Longitudinal information. No limitation to what you write in the diary.

Detailed record of the individual’s pain experience Includes timings, information on medication, ratings,

circumstances, etc.

Pain Questionnaire: 1. McGill Pain Questionnaire (Melzack 1975)- MPQ:

Best known and most widely used pain questionnaire By interviewing patients, Melzack realized that pain can be

categorized into three broad dimensionso Affectiveo Sensoryo Evaluative

He conducted a study in which subjects categorized over 100 pain-related words into separate groups

These words were then placed within the above dimensions in an increasing scale

Patients then had to select the ‘best’ word that describes their pain from 20 different categories. The lower the element of pain, the lower the score.

Scores on these 20 categories were added which led to the Pain Rating Index

The MPQ also has Verbal Rating Scales that gives a score called the Present Pain Intensity

Research has shown that pain is multidimensional, and that a person with a toothache will experience pain differently as compared to a person with arthritis

Criticism:Requires a strong vocabulary and cannot be used by individuals with poor English skills and children under 12

Pediatric Pain Questionnaire (Varni and Thompson, 1976) Children don’t have the ability to express their pain. Research conducted by Jeans (1983) found that 5-year olds could

use 5 adjectives to describe pain, while 13-year olds used an average of 26 words

Basis of pain behaviour in children are facial expressions and vocalizations

BABIES FEEL PAIN. THE FACT THAT THEY CRY WHEN HIT ON THEIR BOTTOM IS CLEAR EVIDENCE.

WHEN THEY GO THROUGH MEDICAL PROCEDURES AS WHEN THEIR FOOT IS PIERCED WITH A NEEDLE TO DRAW BLOOD.

REACTIONS OF BABIES – CONTORT FACE, SQUEEZE EYES, CONTRACT BROWS, HIGH PITCHED CRY.

Paediatric Pain Questionnaire (Varni & Thompson, 1986) and Children’s Comprehensive Pain Questionnaire (McGrath & Hillier, 1996): Assess the pain and its psychosocial effects (how the child and family reacted to the pain)

Behavioral and Physiological Assessments: Child or parent report the child’s pain behaviour in pain diaries. Structured clinical sessions in which health care workers rate or record the occurrence of pain behaviour.

Psychometric Measures & Visual Rating Scales (e.g. MPQ, visual analogue scale)Find above

Behavioral/ObservationalUniversity of Alabama at Birmingham (UAB) Pain Behaviour Scale (Richards, et al., 1982)Usually used by health care workers (nurses) in structured settings

Health worker asks the patient to perform several activities and rates each of the 10 behaviours on a 3-point scale (none, occasionally, frequently)These ratings are converted into numerical values for a total score (0, 0.5, 1)Easy and reliable measure of pain and correlates with patient’s self-assessmentsThe UAB Pain Behavior Scale can be used to track the severity of chronic pain over time. This can help determine the level of pain control and to identify temporal associations that can influence management.

Pain Measures for Children (e.g. pediatric pain questionnaire, Varni and Thompson, 1976).Find above

Psychophysiological MeasuresElectromyograph (EMG): measures electrical activity in muscles. Muscle tension increases and is higher in pain patients. However, when muscles are inactive, no difference can be seen. The measure reflects pain when taken over an extended period of time

Autonomic Activity: heart rate. Often difficult to interpret as autonomic activity can change due to other factors; e.g. stress, which may not be an indicator of pain

Electroencephalograph (EEG): sensory system detects a stimulus, the signal to the brain produces a change in the EEG voltage. The spikes and peaks in the EEG detect the intensity of pain.

Although the above three methods measure pain, they are not reliable measures on a stand alone basis and should be used with support of self-report measures and behavioural assessments.

Managing & Controlling Pain 28/11/15 3:09 PM

MEDICAL MANAGEMENTChemical: MedicinesPhysicians choose the specific drug and dosage by considering many factors such as:

Intensity Location Cause The patient’s history/age Socio-cultural factors

Many hospital patients in pain are under-medicated, especially children.Pain killing chemicals are either given through injections or pills on a ‘prescribed schedule’ or ‘as needed’ basis.

Types of Medicines Epidural: an injection near the membrane surrounding the spinal cord. (add under anesthesia)

Patient-controlled analgesia: patient pushes a button that releases medication from a pump (add under analgesics)

Indirectly acting drugs: affect non-pain conditions, such as emotionsIncludes sedatives, antidepressants. Reduce anxiety and help patients sleep but do not relieve pain. Can produce psychological and physical dependence

Analgesics

Peripherally Active Analgesics: o reduce pain by their action in the peripheral nervous

systemo Include aspirin, acetaminophen, and ibuprofen. o Aspirin (Hoffman, 1899), best-known and most widely used.o Peripherally acting analgesics provide substantial relief for

many pain conditions, but long-term usage can irritate the stomach lining.

Centrally Acting Analgesicso narcotics (opioids) that bind to opiate receptors in the

central nervous system. These drugs are derived either directly from opium poppy (codeine, morphine) or synthetically (heroin, methadone, demerol).

o Very effective in reducing severe acute pain, but those who use it on a long-term basis report only about one-third reduction in pain (Turk, 2002).

o May have the potential of causing addiction but opioids used for pain relief do not cause addiction as believed.

o Opiate receptors are a type of protein found in the brain, spinal cord and gastrointestinal tract. Opiates activate receptors once they reach the brain. They produce effects that directly correlate with the area of the brain involved. Opiates facilitate pain relief and stimulate the pleasure centers in the brain that signal reward. When a person injects, sniffs or orally ingests heroin or morphine, the drugs travel quickly through the bloodstream to the brain.

o Once heroin gets to the brain, it converts rapidly to morphine, which activates the receptors. In the reward system, the drugs activate these areas of the brain: ventral tegmental area (VTA), cerebral cortex and nucleus accumbens. Research shows that stimulation of the opiate receptors by heroin, morphine and other opiates results in feelings of reward. It also activates pleasure circuits by causing a larger amount of dopamine to be released in the nucleus accumbens. This causes a rush, or intense feelings of euphoria, which subside quickly and are followed by relaxation and contentment. The calm typically lasts a few hours. Excessive release of dopamine and activation of the reward system can lead to addiction.

Anesthesia/ Local anesthetics: can be applied topically or through injection. These chemicals block nerve cells in the region from generating impulses, and they relieve pain for hours or days. Examples include novocaine, lidocaine, epidural. Long-term use is not recommended, as they have serious side effects.

Surgery: A radical approach and is usually the last option Disconnects portions of the peripheral nervous system or the

spinal cord, thereby preventing pain signals from reaching the brain

Produces numbness and sometimes paralysis in the region of the body served by the affected nerves

Procedures seldom provide long-term relief

BEHAVIORAL Operant Approach: usually applied with patients whose chronic pain has already produced serious difficulties in their lives.

Goals are to:

Reduce patients reliance on medication. This is done through ‘pain cocktail’ (with the patient’s approval mixing painkiller with a cocktail mix and giving it at prescribed times). Dosage is slowly decreased in the cocktail.

Reduce disability that accompanies chronic pain conditionso Encourage and reward good behaviouro Ignore pain behaviourso Therapist trains people in the patient’s social environment

to monitor and record pain behaviour and systematically reward physical activity

Criticisms: Some patients revert to their old pattern of inactivity and pain

behaviour Not all chronic pain patients are likely to benefit from it. Usually

more effective for those with chronic-recurrent and chronic-intractable (benign) type

Success depends on willingness of people around the patient to participate and enforce

COGNITIVECognitive strategies effectively reduce pain. The following are different cognitive methods to control pain:

Distraction: focusing on a non-painful stimulus in the immediate environment

to divert one’s attention from discomforto More effective when pain is mild or moderate than if it is

strong (McCaul & Malott, 1984)o The greater the attention the task requires, the lower the

pain ratingso The more interesting and engrossing the tasko Credibility of the persono Distraction is particularly useful with mild or moderate pain

Active Coping:

try to keep functioning by ignoring their pain or keeping busy with an interesting activity.

Passive Coping: taking to one’s bed and curtailing social activities. Vicious cycle

develops; passive coping leads to feelings of helpless and depression which lead to more passive coping.

Imagery: Also called guided imagery. Person tries to alleviate discomfort by conjuring up a mental

scene that is unrelated to or incompatible with pain (Fernandez, 1986).

Therapists guide the person to include aspects of different senses.

Like distraction but based on the person’s imagination rather than on real objects or events in the environment.

Works best when person is attentive and involved and like distraction works for mild to moderate pain levels (McCaul & Malott, 1984).

Depends on the person’s imagination and creativity. Some individuals are not so adept in imagining scenes.

Imagery is also particularly useful with mild or moderate pain

Pain Redefinition: Cognitive therapists say that for everything that happens in our life we tend to perceive it in an ABC model. Antecedents (A): The stuff that happens in one’s life. Beliefs (B). Consequences (C).

Antecedents (A) Beliefs (B) Consequences (C)BBQ, no one came Negative: No one

likes me or my cooking

How will it make you feel: Miserable.

The job of a therapist is to change the believe. They usually give a thought diary to be used for a week, and say that one record at least one row worth details each a day.

The therapist then creates a fourth column Dispute (D). A positive outlook to put in the Dispute column for the above example would be; it was raining the other day.

The idea is that this will not just work for just one day. You have to carry it on for a few month a couple of sessions. The therapist would do the same on a regular basis until eventually they learn to have such constructive beliefs on their on.

Now how this works in relation to pain. This works best with chronic pain patients because they have to live with it forever, also their pain is usually not their severe. E.g. 15 years ago this person was in an accident, they have had lower back chronic pain since then. Their negative belief is that they are fixative on the past. “The accident was my fault now I have to live with it for the rest of my life. I deserve this. When I wakeup in the morning with a twinge in my back I knew the whole day would go like this- a bad day. I could do so much more when I didn’t have it.” The therapist has to challenge each idea at a time. “The fact that this is a bad day means there are some good ones. You cant do that but there is so much that you can do.” The idea is to not minimize the pain but minimize the pain gate.

person substitutes constructive or realistic thoughts about the pain experience.

Internal dialogue using positive statements Coping statements; emphasize the person’s ability to tolerate the

discomfort. Reinterpretative statements; negate the unpleasant aspects of

the discomfort. Therapists can provide information about the sensations to

expect in medical procedures.

o Therapists can help individuals see that some of their beliefs are illogical

Redefinition appears to be more effective with strong pain

ALTERNATIVES:Hypnosis:

Hypnosis can reduce the intensity of acute pain but it is not highly effective for all individuals.

The argument that hypnotists say if it doesn’t work is that you didn’t believe in it enough. It will not work on people who are not susceptible to the idea of hypnosis. The idea is that you are in a limbo of a conscious and unconscious self.

People vary in their ability to be hypnotized Those who can be very easily and deeply hypnotized seem to

gain more pain relief from hypnosis How hypnosis works is not clear. It may be due to: Physiological changes that occur in brain and spinal cord Deep relaxation people experience when hypnotized Cognitive-behavioural methods produce similar pain relief.

Combining these methods does not enhance their effects. Related Phenomena: Hypnosis, Lucid dreaming, Out of Body

experience. Like a pain killer works for a while but not permanent.

Reiki (Not part of syllabus): It is convenient to the person giving it because the patients

comes again and again meaning multiple pay checks

Hajama (Not part of syllabus): You pierce a part of the skin through a small. They then draw the

blood out through a suction device until all the impure blood out. Another way might be to do through slugs or leeches sucking blood out.

Acupuncture:

Poke certain muscles (that do not feel pain) and then pass a certain level of electric charge through your body.

Fine metal needles are inserted under the skin at special locations and then twirled or electrically charged to create stimulation.

Does not provide long-term relief for most chronic pain patients Useful in treating headache and low back pain

TENS: Transcutaneous Electrical Nerve Stimulation Placing electrodes on the skin near where the patient feels pain

and stimulating that area with a mild electric current, supplied by a small portable device.

Research shows that TENS is not effective in reducing acute pain (Johnson, 2001)

Its success in treating chronic pain is unclear They attach wire through your body then pass current to balance

out the charge through out the body.

Acupressure There is a part of your foot that reliefs pain of some other part

through pressure. The left hand thumb bone in the palm being relieved through the right hand thumb until throat feels relieved in case of cough.

Description Answer 28/11/15 3:09 PM

Description Answer (to go with this Evaluation Answer)Definition of Pain 1st Bullet Point- Types and Theories of Pain Theories of pain: gate control theory (Melzack, 1965).

2nd Bullet point (two from these) Measuring Pain Self report measures (e.g. clinical interview)Behavioral/observational (e.g. UAB)

3rd Bullet Point- Managing and Controlling Pain Psychological Techniques: cognitive strategies (e.g. attention diversion, non-pain imagery and cognitive redefinition)connects with the gate control theory list all cognitive techniques but talk about imagery in depth

Evaluation Question 28/11/15 3:09 PM

SECTION BMAY 2012/32(b) “How can I get the doctor to understand how much pain I’m in?” Evaluate what psychologists have discovered about pain and include a discussion of the usefulness of self reports. [12]

OCTOBER 2014/33(b) Evaluate what psychologists have learned about pain, discussing the usefulness of quantitative data. [12]

MAY 2015/31(b) Evaluate what psychologists have found out about pain and include a discussion about the interaction of physiological and psychological factors. [12]

Evaluate what psychologists have learned about pain including a comparison of measurement techniques.

Evaluationa. Comparison of measurement techniques- 2 similarities, 2 differences Similarities: Both yield quantative data

MPQ Physiological Measures (Heart Rate )

Advantage + Disadvantage of quantative data No experimenter/ observer bias

Differences Holistic Vs. Reductionist

Physiological Measures- Reductionist: Only collecting pain in terms of physiological means

MPQ + PPQ holistic Self reports are more prone to social desirability/ demand characteristics. But physiological can’t be taken so more accurate

b. Usefulness: o Gate Control Theory

It not only explains pain but also links it to emotions hence comes up with other ways to manage pain. Explains why the intensity of pain differs. Also led to the development of MPQ.

o ImageryOnce you learn it you can do it yourself, train your mind. Limited in usefulness as it does not deal with severe acute short-term pain. It does not work effectively in terms of all type of pain. It is so time consuming and long term that it cant be done with a medical doctor but a therapist. Imagery also doesn’t give any quick relives from pain, only over time it leads to healing.

c. Cultural Relativism: o The McGill Pain Questionnaire (MPQ)- low in cultural relativism as it has

been translated into 50 different languages. However high in cultural relativism because it can not be applied to places where literacy rates are low, as it is reading question.

o Physiological Measures- low- everyone will give you a blood pressure, heart rate and other ratings. High- 3rd World Countries do not have advanced medical equipment and insurances. Not accessible so all cultures do not have equal access.

Section C Answers 28/11/15 3:09 PM

June 2015 Variant 32- Patient controlled analgesia, is when an acute pain patient can control their own degree of pain by controlling their dosage. What are the medical ways of managing an controlling pain? (6 marks)

Anasthesia Surgeries Medicines

Suggest how you would conduct an experiment to investigate the effectiveness of patient controlled analgesia. (8 marks)

Baseline measure of pain: The only way to know if the treatment is working is to know the amount of pain they were in to compare it to that later.

If you have an adult you can do this through the MPQ. You might want to do multiple test incase you want a higher concurrent validity.

Give analgesia Attach them to the heart rate measure and redo the baseline

measure (no more as baseline) and do it every few hours for test retest reliability.

NOTE: Every time you have an 8 mark question put in a few evaluation point here and there.

OR

Matched Pair Design Use any baseline to determine that both have the same pain

level Must have roughly same results- Must have roughly same injury

(pain cause) 2 patients- 1 with other method

- 1 given PCA Measure their level of pain every 6 hours

Compare results between both patients

SECTION CMAY 2012/31Jamal is a nurse who works in a hospital looking after long-stay patients who have pain following a major accident.(a) Describe how Jamal could use a behavioural/observational technique, such as UAB, to record whether the pain of the long-stay patients is reducing. [6](b) Suggest how Jamal’s observations of pain could be checked to see if they are correct. [8]

OCTOBER 2012/33If I’m in pain, such as when I trap my finger in a door, all I have to do is to think of my favourite food, pizza, and the pain goes away!(a) Devise a cognitive strategy for reducing acute pain that could be used by anyone. [8](b) Explain the theory that would enable your strategy to work. [6]

MAY 2013/31There is theory and there is the real world.(a) Describe the specificity theory of pain. [6](b) Suggest how you could gather ecologically valid evidence to test this theory. [8]

OCTOBER 2014/31Visual rating scales of pain often use a scale of numbers or words from low to high. This is not very helpful for children who may not understand the words or numbers.(a) Design a visual rating scale that would be appropriate for a 5-year-old child and suggest how it would work. [8]

(b) Describe two visual rating scales that are designed for adults. [6]

MAY 2015/32Patient controlled analgesia is where people can control the amount and frequency of a pain-controlling drug they give to themselves to manage acute pain. This is instead of being given a fixed amount of the drug at a fixed time by a medical practitioner.(a) Suggest how you would conduct an experiment to investigate the effectiveness of patient controlled analgesia. [8](b) Describe medical techniques for managing or controlling pain. [6]

OCTOBER 2015/31A person has had a limb amputated and is suffering from phantom limb pain.(a) Suggest how you would measure phantom limb pain. [8](b) Describe psychogenic pain using an example. [6]

Summary 28/11/15 3:09 PM