Pain and it's management ( for hospitalized patient)

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1. Psychosoci a l aspects of pain Presented by: Maryam jalal Aroosa Arooj

2. Psychosocial aspects of pain Pain is a “complex perceptual and affective(emotional) experience determined by the unique past history of the individual, by the meaning to him of the injurious agent or situation, by his ‘state of mind’ at the moment and by the sensory nerve pattern that evoked physical stimulation”

3. TWO ASPECT OF PAIN Cognitive Motivational Sensory Affective (emotional)

4. THE FACTORS WHICH INFLUENCE THE CONTENT

5. Types Acute pain: Signal of discomfort in the body CHRONIC PAIN: Pain that lasts for a long time

6. Acute Pain Acute pain is a type of pain that typically has a sudden onset and lasts for a relatively short duration. It is often caused by an injury, surgery, or illness, and serves as a warning signal for the body to protect and heal itself. Acute pain is usually sharp and intense, and it gradually subsides as the underlying cause of the pain is treated or healed.

7. Acute Pain Emotional content: Description like “excruciating, boaring . Sickening, dull, disgusting, terrifying. Throbbing., killing” etc.

8. Acute pain Pre morbid Personality Anxiety prone, sensitive, LFT (Low Frustration Tolerance), Always preoccupied about health.

9. Chronic pain Chronic pain refers to persistent or long-lasting pain that lasts for an extended period of time, typically more than three months. Unlike acute pain, which serves as a warning signal for the body, chronic pain persists even after the initial injury or condition has healed. It can be caused by various factors, such as underlying medical conditions, nerve damage, or inflammation. Chronic pain can have a significant impact on a person’s daily life and may require ongoing management and treatment.

10. Psychogenic pain disorder. In some patients pain and associated symptoms don’t fit any of the known psychiatric morbidities.

11. Cont … Psychogenic pain disorders, also known as psychogenic pain syndromes, are conditions where a person experiences chronic pain that is primarily caused or influenced by psychological factors, rather than a physical injury or illness. In these cases, the pain is real and can be severe, but its origin is related to psychological or emotional factors, such as stress, trauma, anxiety, or depression. Treatment for psychogenic pain disorders often involves a multidisciplinary approach, including therapy, medication, and lifestyle changes to address both the physical and psychological aspects of the condition.

12. Pain Behavior (Sick Role): Functional disabilities. Over use of medicines. Sleep disturbances. Decreased social activities Avoidance learning. Reinforcement of passive learning of taking on a new unhealthy life style.

13. Psychological management of pain Presented by: Aroosa

14. Management of pain: A treatment strategy tailored towards the specific needs of patient can be developed by: Allowing patient to express feelings of distress. Providing an opportunity to describe the experience and Taking patient’s view about the cause. Discussing the perpetuating and precipitating factors. All this has long term positive effects on treatment of pain and its outcome. Steps of management: Psychological assessment Psychotropic drug treatment Psychological interventions

15. Psychological assessment: Establishes the primary cause of pain i.e. is the pain organic, a symptom of a psychiatric morbidity or primarily psychogenic in origin. Define the exact role of psychological factors in clinical scenario: are they etiological, precipitating or perpetuating in their influence? Make an assessment of various environmental factors i.e. interpersonal, social, occupational, economic and cultural as determinants of pain somatization.

16. Psychotropic drug treatment: Other than the long list of narcotic/non-narcotic and non steroidal anti inflammatory analgesics, certain psychotropic drugs have also been found useful in treatment of pain. This includes some anti depressants, e.g tricyclic antidepressant ( Impiramine ) relives pain by blocking biogenic amine uptake, thus enhancing the inhibitory action of serotonin and nor-adrenaline on the spinal pain transmission pathways. The following psychological interventions can be employed to deal with chronic pain: Relaxation methods Operant techniques Cognitive strategies Social skill training Assertiveness training Coping strategies approach

17. Cont ... Relaxation methods: Using muscular biofeedback (EMG biofeedback ), progressive relaxation, cognitive relaxation and cue controlled relaxation the muscular tension is brought under control thereby breaking the pain cycle. Operant techniques: These are based on learning theory and aim to identify the problems and modify an individual’s responses to the problem. Techniques include activities training, meditation reduction and activities focused on functional disability. The techniques result in decreased disability levels and fear, and improved physical fitness and body image.

18. Cont … The steps include: Measuring the baseline level. Selecting target activities. Starting with simple activities and moving on to complex one. Gradually increasing the activity level. Reinforcing the activities by providing feedback and verbal praise. Checking progress and modifying the target as necessary. Selecting a new activity once the first activity has been accomplished. Operant techniques are also used in medication-reduction training in chronic opioid use. The drugs are dispensed using a “time contingent ” rather than a “pain contingent” treatment technique. This improves pain relief, decreases pain behaviour and has a decreased addictive potential. In this technique, the medication is provided at regular time intervals rather than pain intensity. The dose is then systematically reduced.

19. Cont … Cognitive strategies: Cognitive strategies aimed at pain management focus on: Dealing with stress. Modifying pain related cognitions. This involves the stress oriented techniques like relaxation therapies and cognitive techniques such as: a) Imaginative inattention: Thinking about something incompatible with the pain experience e.g relaxing in a beautiful quiet place alongside transformation of context, that is, imagining that pain is actually occurring but under more appropriate circumstances. b) Attention diversion methods: Attention is diverted towards another engaging task e.g counting or reading.

20. Cont….. Social skills and assertiveness training: Social skill training focuses on increasing social activities at work and at home. Assertiveness training is similar but focuses more on communication skills. It enhances quality of life and reduces pain related stress. Coping strategies approach: This focuses on patient’s interpretation of pain problems and various coping methods. Patients with chronic pain syndrome usually use passive methods of dealing with pain such as hoping pain will go away. Coping skill training identify methods of dealing with pain, belief about pain and resulting disability. Relaxation and activity programs can later be added to plan.

21. Cont….. Active coping: Engaging in physical exercise and physical therapy. Cleaning your mind of bothersome thoughts or worries. Passive coping: Restricting or cancelling your social activities. Taking medication for the purposes of immediate pain relief.