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Title: HEALTH PSYCHOLOGY- ASSESSING PAIN - ATHIRA


1
ASSESSING PAIN
  • ATHIRA SREEKUMAR
  • I MSc CLINICAL PSYCHOLOGY

2
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.

3
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.

4
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.




5
  • 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)

6
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.

7
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.

8
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)

9
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.

10
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.

11
PAIN ASYMBOLIA
  • A state described as intense pain devoid of
    unpleasantness in some patients ,with morphine
    injection or psychosurgery.

12
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

13
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.

14
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.

15
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.

16
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.

17
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

18
ASSESSMENT IN INFANTS
  • Crying
  • Infants are more sensitive to painful stimuli.

19
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

20
AIDS TO DIAGNOSIS
  • Time of onset
  • Location
  • Intensity
  • Pattern of occurrence
  • Exacerbating and relieving factors
  • Quality of pain

21
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

22
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

23
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.

24
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
25
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

26
THANK YOU
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