HealthPsychNotesApril29th - Pain Measurement • Ask...

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Unformatted text preview: Pain Measurement • Ask providers? – Very poor accuracy • Ask patients? – How create a reliable measure that How can be used clinically? can – Single item or scale? – Standardized tests that are hard to Standardized fake? fake? – Language and cultural equivalency? Lecture 24 1 Pain Measurement • Assess behavior? – e.g., limp, grimace, use of medication – Who does it? Takes a lot of training – Good for people who cannot provide selfreport • Measure physiology? – EMG to detect tension, spasms – Autonomic indicators (e.g., finger pulse) – Not well related to self-reported pain Lecture 24 2 Pain Scale Variations Visual Analog Scale No Pain Worst Pain Possible Worst Pain Possible Box Scale No Pain 0 1 2 3 4 5 6 7 8 9 10 Verbal Rating Scale No pain Some Pain Considerable Pain Worst Pain possible Wong-Baker Faces Pain Rating Scale Lecture 24 3 Multidimensional Assessment • McGill Pain Questionnaire – Assesses multiple dimensions of pain • • • • • • • Lecture 24 Sensory Affective Evaluative Indicate pain locale on drawings of body Circle descriptors that best describe pain Assesses temporal course of pain Intensity of present pain on 5-point scale 4 – Four sections West Haven-Yale Multidimensional West Pain Inventory Pain • Three sections – Pain experience • Characteristics of pain • Interference with life • Mood – Social effects • Ratings of others’ responses to patient’s pain – Daily activities • How often engage in common activities Lecture 24 5 Recap • Pain is pervasive and can have a major Pain effect on people’s lives effect • Pain is not simply sensation of tissue Pain damage damage • Actively regulated by brain • Influenced by experience • Expression subject to cultural influence • Difficult to assess Lecture 24 6 Managing Stress Managing and Pain and Readings: Chapter 8 Lecture 24 7 Plan Prevention Coping Medical CAM Recap Lecture 24 8 treatment Pain Prevention • • • • • • Prevent acute injury Prevent progress to chronic pain Workplace interventions Adding exercise helps Tailored programs improve impact Continuing activity may be best of Continuing all interventions all 9 Lecture 24 Stress Prevention • Modify environment • Change appraisal • Increase coping resources • Bolster social support Lecture 24 10 Managing Pain & Its Effects Medical Treatments • For stress-related anxiety, anxiolytic or For antidepressant medication antidepressant • For pain, analgesic medication – Opiates • • • Morphine Oxycodone, hydrocodone Problems: underuse, tolerance, Problems: abuse/dependence (low risk) abuse/dependence • Improved by self-paced administration – Anticonvulsants – Antidepressants Lecture 24 12 • Non-narcotic analgesics – NSAIDs – Acetaminophen Medical Treatments • Medication no better than being active for back Medication pain, less satisfying pain, • Surgery – – – To correct problem (early is better than delayed) Ablate nerves Stimulate spinal cord and brain to block pain Stimulate messages via implant messages – Surgery not very effective, highly invasive Lecture 24 13 CAM: Manipulation Tx • Massage (manipulation of soft tissue) – Biggest effect on mood – Pain relief while treatment ongoing – May improve immune functioning, bp • Chiropractic (manipulation of the spine) – Better than no treatment, not other treatment • Acupuncture and acupressure – Design to unblock flow of energy, qi, through body – Effective for nausea, post-op and back pain Lecture 24 14 CAM: Movement-Based Tx • Tai chi chuan, qi gong – Series of slow, rhythmic exercises – Diaphrammatic breathing – Demonstrated efficacy Demonstrated for improving balance – Reduced anxiety/depression – Promotes relaxation – May boost immune functioning Lecture 24 15 • Most (55%) use it as complement, rather than alternative Most (28%) (28%) • Integrative medicine on the rise – HMOs incorporating and insurance covering chiropractics, massage… CAM Use • Pain clinics models of integrative care – Multiple disciplines, specialties represented – Medication – Transcutaneous electrical Transcutaneous nerve stimulation nerve – Physical therapy Physical – Biofeedback – Deep muscle relaxation – Cognitive therapy – Acupuncture Lecture 24 – Injection therapy (local Injection anesthetic) anesthetic) – Steroid therapy – Diet counseling 16 Hypnosis • Induction into hypnotic state that allows control physiology through suggestion (supported by brain imaging) • Alternatively, hypnosis may reflect stable suggestibility (not altered state) • Suggestion predicts acute pain reduction, even burns • Helps reduce anxiety • Not widely used Lecture 24 17 Behavioral Strategies • Body Awareness – Awareness of effects of stress on the body – Western culture ignores mind-body link • Progressive Relaxation – Reduces muscle tension caused by stress – Increases perceived control over stress – More natural, healthier than drugs, alcohol Lecture 24 18 Behavioral Strategies • Meditative relaxation – – – – Muscle relaxation + Focus on breathing Passive attitude Repetition of a phrase or syllable • Mindfulness meditation – Focus on cultivating awareness – Helps reduce suffering – Promotes left frontal brain activity associated with positive emotion Lecture 24 19 Relaxation Strategy Efficacy • Relaxation appears to help reduce stress Relaxation and pain and – In children and adults – For headache, low back pain, cancer pain – Helps reduce hypertension, depression, Helps anxiety, insomnia anxiety, • Guided imagery appears to reduce stress Guided and pain and Lecture 24 20 Guided Imagery • Develop complex images of peaceful, calming place • Occupy mind, focus less on stress or pain • Build self-efficacy • Thoughts re. action/feeling affect the body • Used to treat emotional problems • Can involve memories for traumatic events • Positive images enhance mood Lecture 24 21 Cognitive Behavioral Therapies • Behavior modification helpful in reducing Behavior disability in chronic pain (reducing secondary gain) secondary • Cognitive therapy based on Cognitive understanding that thoughts influence affect and behavior affect – Changing interpretation of pain changes Changing experience of pain, associated behavior experience – Reduce catastrophizing Lecture 24 22 CBT Efficacy • Stress inoculation improves functioning Stress and reduces anxiety, even after trauma and • Pain inoculation reduces experimental and Pain clinical pain clinical • CBT may improve immune system • Help people cope with chronic pain • Works for a variety of stressors, pain Lecture 24 23 Emotional Disclosure • Pennebaker et al. have shown that writing about Pennebaker emotions for as little as 15 minutes per day 3-4 times / week reduces doctor visits, improves immune function, improves overall functioning, and lowers disease rates and • Self-reflection and disclosure through language Self-reflection thought to be key ingredients thought • Particularly effective for physical problems • Helps to focus on a positive aspect of problem Lecture 24 24 Petrie et al., 2004 • Double-blinded RCT • 37 HIV+ adults • 2 groups: – Write about deepest thoughts about an event not discussed with others (experimental) – Write about how spent time, in descriptive manner only (control) – Write for 30-minutes per day for 4 days in office Petrie et al., 2004 • Assessed – Viral load – CD4+ counts – 3 weeks, 3 months, 6 months post-writing – Controlled for baseline levels • 2 groups equivalent to start (demographics, perceived stress, viral load, CD4+) Petrie et al., 2004 • How does writing for 30-minutes per day for 4 days affect immune system functioning 6 months later? – May share mechanism with CBT stressmanagement, which seems to reduce catecholamine and cortisol levels in HIV+ men – Improvement linked to increase in use of positive emotion words, increase in causal/insight language Recap • Variety of strategies for dealing with Variety stress and pain stress • Multimodal strategies often better • Psychosocial treatments can do as well or Psychosocial better as medical treatments for stress and pain and • Important to demonstrate efficacy relative Important to other, cheaper efficacious treatments, not just placebo not Lecture 24 30 ...
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This note was uploaded on 03/22/2009 for the course PSYCHOLOGY 830 taught by Professor 346 during the Spring '09 term at Rutgers.

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