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Pain Control Techniques (Pain Management programs (Initial Evaluation
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Pain Control Techniques
Pain control can be either
- no longer feel anything in the area that used to hurt
- feels sensation but not pain
- still pain but not concerned anymore
- still pain but can tolerate
Pharmacological Control
-
any drug that influences neural transmission
- affect transmission of pain impulse from peripheral receptors to spinal cord
e.g. spinal blocking agents/ local anaesthetics
some drugs act directly on higher brain regions
e.g. antidepressants = combat pain by reducing anxiety, improving mood and affect the downward pathway from brain that modulate pain
x large quantities of painkillers = only partially effective + side effects
x drug poisoning
x nerve blocking agents can result in limb paralysis and loss of bladder control
x addiction
Surgical Control
-
- works by cutting/ creating lesions in pain fibers so that pain sensations cannot be conducted
- attempt to disrupt transmission of pain from periphery to spinal cord/ interrupt the flow of pain sensations from spinal cord to brain
x very expensive $$$
x high risks, side effects
x damage to nervous system = can worsen problem
x benefits are short-lived
- possible that nervous system has substaintial regenerative powers = the blocked pain impulse will still find their way to brain via different neural pathways
Sensory control
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e.g. spinal cord stimulation
- small electrodes are placed at the point where nerve fibers from the painful area enter the spinal cord
- when pain is experienced > radio signal is activated > delivers a mild electrical stimulus to that area > inhibit pain
x benefits are short-lived = better for acute pain
x require patients' active participation = better for pains that are anticipated and slow-rising
Biofeedback
method of achieving control over a bodily process
- by providing biophysiological feedback to patient about bodily processes that they were unaware about
OPERANT LEARNING PROCESS:
e.g. track HR using a machine > show heart rate info with patients > patients will try to change their HR
- through trial and error and continuous feedback, patient learns what thoughts/ behaviours can modify the bodily function
-
Relaxation
common, either used on its own/ with other techniques
- enable patients to cope more successfully with STRESS and ANXIETY = indirect influence on pain experience
- reduction of muscle tension/ diversion of blood flow = direct influence on pain
shift body into a state of low arousal by progressively relaxing different body parts
- meditation, slow breathing, mindfulness = reduce pain sensitivity, produce analgesic effects through relaxation + self-regulation
moderately successful
- might be due to release of opioids
Distraction
-
2 different mental strategies:
(1) focus on another activity
(2) focus directly on pain but to REINTERPRET the experience
useful for acute pain
x not effective for chronic pain since ppl cannot distract indefinitely
x lacks analgesic properties
Coping Skills training
active coping = generally more effective
passive coping = poor pain control
- recent-onset/ not as severe pain
CBT
- reconceptualise the problem; overwhelming > manageable
- pain must be perceived to be modifiable
- enhance expectations of treatment effectiveness
- promote self-efficacy; passive > active role/ attribute success to own efforts
- monitor thoughts, feelings, behaviours to break up maladaptive behavioural syndromes
- how and when to adopt overt and covert behaviours to respond adaptively
- relapse prevention
- control emotional response
Pain Management programs
Initial Evaluation
- qualitative and quantitative
- functional status
- past coping techniques
- psychological distress, pain behaviours, psychosocial impairments
Individualized treatment
- concrete aims, rules, goals
goals include:
- reduce pain intensity, perception of disability,
use of health care services
- increase physical activity, psychosocial functioning
- decrease reliance on meds
- return to full work status
- patient education
- public commitment to coping
- involvement of family
~ withdrawal/ support may inadvertently reinforce pain behaviours
-
effective for chronic pain, reduce pain, disability, psychological distress + improve social functioning
x $$$
x difficult to coordinate multiple professional services