chapter 14

Opioid Analgesics

(formerly called narcotics) Agonists (excitatory chemicals) act on receptors in the brain and spinal cord to reduce the intensity of pain messages or the brain's response to pain messages *most powerful and widely used opioid is morphine*

The fast pain system

(involving the A-delta fibers) appears to serve only the skin and mucous membranes

the slow pain system

(involving the C fibers) serves all body tissues except the brain itself, which does not experience pain

Clinical Pain

- Pain that requires some form of medical treatment

Pain Rating Scales; Numeric Rating Scale (NRS)

-has people locate the level of their pain at a point along a horizontal or vertical line that is about 10 centimeters in length and anchored by two extremes: "no pain" and "worst possible pain"

Pain Rating Scales; Visual Analog Scale (VAS)

-has people locate the level of their pain at a point along a horizontal or vertical line that is about 10 centimeters in length and anchored by two extremes: "no pain" and "worst possible pain"

Multidisciplinary pain

-management program that combines cognitive, physical, and emotional interventions; dominant model for treating chronic pain No single pain control technique has proven to be the most effective in relieving chronic pain Many providers use an eclectic approach with pain patients

Hyperalgesia;

A condition in which a chronic pain sufferer becomes more sensitive to pain over time. Opioid-induced Long-term potentiation

Nociceptors

A specialized neuron that responds to painful stimuli. free nerve endings that are activated by noxious (painful) stimuli

Pain process begins when neural signals from free nerve endings are routed to CNS Via three nerve fiber types; A-beta

A-beta; Large, afferent fibers that may inhibit the transmission of pain messages to the brain. myelinated, conduct rapidly and may be involved in inhibiting other pain messages from reaching the brain.

Pain process begins when neural signals from free nerve endings are routed to CNS Via three nerve fiber types; A-delta

A-delta; Small, afferent fibers involved in the experience of acute pain. coated with myelin neural conduction to 15 to 30 meters per second

Which of these is an example of phantom limb pain? A. An amputee reports feeling pain in a missing leg. B. A patient continues to feel a deep, burning sensation in a wound that has healed. C. After an accidental fall, Brad can no longer feel any sensations in his left arm. D. After Sheila bruises her shoulder, her arm goes numb.

A. An amputee reports feeling pain in a missing leg.

Acute, stinging pain is transmitted in which type of nerve fibers? A. fast B. substantia gelatinosa C. periaqueductal D. slow

A. fast

The simplest sensory receptors for pain are called: A. free nerve endings. B. slow nerve fibers. C. fast nerve fibers. D. nocebos.

A. free nerve endings.

One way to assess pain is by recording changes in _____, among other indicators of _____ arousal. A. heart rate; autonomic B. blood pressure; CNS C. skin temperature; endocrine D. skin conductance; cortical

A. heart rate; autonomic

Pain sufferers may experience social reinforcement for _____ from the attention they receive from others. A. pain behaviors B. long-term potentiation C. deferred imitation D. primary gains

A. pain behaviors

There are no specialized receptor cells devoted solely to the sense of: A. pain. B. touch. C. vision. D. hearing.

A. pain.

What are nociceptors? A. sensory receptors in the skin that respond to painful stimuli B. thalamic cells that route pain messages to the appropriate areas of the cortex C. motor nerves in the spinal cord that relay pain signals from the periphery of the body to the central nervous system D. cortical cells that block pain messages from the spinal cord

A. sensory receptors in the skin that respond to painful stimuli

The so-called pain gate is believed to exist in the: A. spinal cord. B. thalamus. C. cerebral cortex. D. brainstem.

A. spinal cord.

To assess a patient's pain experience, nurses and other health care professionals often use: A. the Pain Behavior Scale. B. a pain-rating scale. C. simple measures of autonomic arousal. D. electromyography (EMG).

A. the Pain Behavior Scale.

Which of these is an example of phantom limb pain? A. After an accidental fall, Brad can no longer feel any sensations in his left arm. B. An amputee reports feeling pain in a missing leg. C. After Sheila bruises her shoulder, her arm goes numb. D. A patient continues to feel a deep, burning sensation in a wound that has healed.

B. An amputee reports feeling pain in a missing leg.

Before his coronary bypass surgery, Bill used to experience a deep, burning pain in his left shoulder. Bill's pain was an example of _____ pain. A. psychophysiological B. referred C. phantom limb D. dysfunctional

B. referred

Pain process begins when neural signals from free nerve endings are routed to CNS Via three nerve fiber types; C fiber

C-fiber; Small, afferent fibers that are involved in the experience of chronic pain. smaller, unmyelinated fibers that conduct electrical impulses at only 0.5 to 2 meters per second

_____ is an opioid antagonist that binds to opioid receptors in the body and blocks the effects of natural opiates. A. Substance P B. Prostaglandin C. Naloxone D. Enkephalin

C. Naloxone

A key component of cognitive-behavioral therapy is _____, which focuses on helping individuals reinterpret and redistribute pain-related sensations. A. aversive conditioning B. negative reinforcement C. cognitive restructuring D. stimulus control training

C. cognitive restructuring

The most effective pain-management programs: A. are based on classical conditioning. B. are based on operant conditioning. C. combine cognitive-behavior therapy with the judicious use of analgesic drugs. D. focus only on controlling a patient's pain.

C. combine cognitive-behavior therapy with the judicious use of analgesic drugs.

Which personality trait has NOT been linked with patients who have chronic pain? A. hypochondriasis B. depression C. emotional dependence D. hysteria

C. emotional dependence

When Carla had the flu, every part of her body seemed to hurt and she felt compelled to get extra rest. Carla's condition is an example of: A. prechronic pain. B. psychophysiological pain. C. hyperalgesia. D. acute recurrent pain.

C. hyperalgesia.

The area of the brain that, when electrically stimulated, causes an immediate reduction in pain is the: A. pituitary gland. B. substantia gelatinosa. C. periaqueductal gray area. D. hypothalamus.

C. periaqueductal gray area.

On its way to the _____, the fast pain pathway triggers neural activity in the _____, which is the brain's mechanism for arousing the cortex in response to important messages. A. somatosensory cortex; midbrain B. thalamus; medulla C. thalamus; reticular formation D. medulla; thalamus

C. thalamus; reticular formation

The mainstay of the behavioral aspect of cognitive-behavioral therapy related to pain is to modify specific targeted pain behaviors that are associated with continued pain and disability. This targeted approach includes all of these interventions EXCEPT: A. an increase in reinforcing consequences. B. an increase in adaptive coping strategies. C. the maintenance of reinforcing contingencies in response to maladaptive pain behaviors. D. identification of events that act as stimuli, responses, and reinforcers.

C. the maintenance of reinforcing contingencies in response to maladaptive pain behaviors.

The gate control theory attempts to explain how: A. certain nerve cells in the brain respond to specific features of sensory stimuli. B. the perception of pain is mediated solely by emotional cues from the environment. C. the nervous system blocks or allows pain signals to pass to the brain. D. the perception of touch is related to the specific nerve endings that are activated.

C. the nervous system blocks or allows pain signals to pass to the brain.

The fast pain system carries pain that is perceived as: A. stinging and generalized throughout the body. B. coming from the skin. C. dull and localized in one area. D. stinging and localized in one area.

D. stinging and localized in one area.

Which statement regarding pain sensitivity and racial, cultural, and ethnic differences is TRUE? A. Childbirth is construed as equally painful by all cultures of the world. B. Asian individuals are more likely to report greater pain sensitivity than individuals with Middle Eastern roots. C. Differences in pain sensitivity have been found in relation to cultural differences, but not for socioeconomic differences. D. Individuals of Hispanic origin are more likely than individuals with Northern European roots to express pain.

D. Individuals of Hispanic origin are more likely than individuals with Northern European roots to express pain.

Which of these approaches to pain control works BEST? A. Behavioral therapy works best for pain control. B. Biomedical therapy works best for pain control. C. Physical therapy works best for pain control. D. It depends on the patient and the nature of the pain.

D. It depends on the patient and the nature of the pain.

Which of these statements is NOT a stated reason why cross-cultural studies of pain can be difficult to conduct and generalize? A. Cross-cultural studies are typically correlational in nature. B. Pain is a phenomenon that does not have a common universal language. C. Individual personal history, perceptions, and experiences with pain make generalizability difficult. D. There appears to be greater inter-group variation than intra-group variation.

D. There appears to be greater inter-group variation than intra-group variation.

Which of these is NOT true regarding pain measurement? A. Chronic pain is what patients report fearing most about illness. B. Almost all people suffering from headaches tend to choose the same pattern of words to describe their pain. C. The most frequently used measures of pain are based on the patient's verbal or written report. D. There are many objective measures of pain.

D. There are many objective measures of pain.

According to Nestoriuc, Rief, and Martin, (2008), meta-analyses provide evidence for the effectiveness of _____ in relieving the pain of tension headaches. A. surgery B. a placebo C. exercise D. biofeedback

D. biofeedback

The dominant model for treating chronic pain is: A. behavior modification. B. dissociation training. C. rational-emotive therapy. D. cognitive-behavioral therapy.

D. cognitive-behavioral therapy.

Analgesia created by triggering another, mildly painful stimulus is called: A. phantom pain. B. referred pain. C. stress-induced analgesia. D. counterirritation.

D. counterirritation.

One study of patients suffering from _____ found that those with one variation of the COMT gene displayed the most severe psychological and functional impact pain scores. A. chronic fatigue syndrome B. referred pain C. restless leg syndrome D. fibromyalgia

D. fibromyalgia

One research study of catastrophizing among rheumatoid arthritis patients found that _____ was associated with elevated levels of _____. A. rumination; prostaglandin B. cognitive distraction; inflammation C. poor emotional regulation; substance P D. helplessness; C-reactive protein

D. helplessness; C-reactive protein

Chronic Pain:

Dull, burning pain that is long-lasting. pain that lasts six months or longer lowers overall quality of life and increases vulnerability to infection

Cognitive Reappraisal

Key component of CBT that focuses on helping individuals reinterpret pain-related sensations, restructure maladaptive thought patterns, and make positive self-statements

Recurrent Pain:

Pain that involves episodes of discomfort that recur for more than three months interspersed with periods in which the individual is relatively pain-free. ex. Periodic migraines and noncardiac chest pain

Free Nerve Endings

Sensory receptors found throughout the body that respond to temperature, pressure, and painful stimuli. which are found throughout the body: in the skin, muscles (cramps) (stomachaches) membranes that surround joints and bones (arthritic pain) even the pulp of teeth (toothaches)

Acute Pain:

Sharp, stinging pain that is short-lived and usually related to tissue damage. ex. burns & fractures

Substantia Gelatinosa

The dorsal region of the spinal cord where both fast and slow pain fibers synapse with sensory nerves on their way to the brain

Pain Pathways

Unlike other senses, pain is not triggered by only one type of stimulus, nor does it have a single type of receptor

Pharmacological Treatments Analgesic (pain-relieving) drugs

are the mainstay of pain control include "central acting" opioid drugs and "peripherally acting" non-opioid drugs

Non-opioid Analgesics; Non-steroidal Anti-Inflammatory Drugs (NSAIDs)

aspirin, ibuprofen acetaminophen, and other drugs that relieve pains and reduce inflammation at the site of injured tissue

overgeneralizing

believe that their pain will never end; this one thing is going to dictate the rest of what happens

dwelling on the pain

can't stop thinking about pain; rumination

Cognitive errors in the thinking of pain patients;

catastrophizing overgeneralizing victimization self-blame dwelling on the pain

catastrophizing

caused by unfortunate experience; having to be in a wheelchair for a month due to injury and you thinking youll be spending the rest of ur life in one etc

Long-term potentiation

ex. the flu makes you weak and achy and drives you back to bed, which is exactly where you need to be to recover.

dysfunctional patients

extremely inactive, high levels on pain, no control to fix it

victimization

feel that they have experience injustice and it consumes them; why me?

self-blame;

feeling worthless, its their fault they are feeling this pain

adaptive copers

indiv who report low levels of pain, and low levels of distress, function at relatively high level

Opioid-induced;

long-term use of opioids leads to an increasing sensitivity to noxious stimuli, even to the point at which common sensory stimuli become painful

interpersonally distressed patients

patients who precede little social support, and feel other people in their lives dont take their pain seriously

mediation Appears to affect four areas of the brain:

primary somatosensory cortex anterior insula anterior cingulate cortex prefrontal cortex

Standardized Pain Inventories McGill Pain Questionnaire (MPQ):

sensory quality, affective quality, evaluative quality of pain

Non-opioid Analgesics; Prostaglandin

the chemical responsible for localized pain and inflammation; also causes free nerve endings to becoming more and more sensitized

Acceptance and Commitment Therapy (ACT)

— emphasizes observing thoughts and feelings as they are, w/out trying to change them, and behaving in ways consistent w/ valued life goals

Electromyography (EMG)

—assesses the amount of muscle tension experienced by patients suffering from headaches or lower back pain.

Sensory Focus

—attending directly to the sensations of painful stimulus w/out necessarily trying to change those reactions - Seems to be more effective for people who score high on measures of health anxiety - has also proven effective in helping patients manage the pain associated w/burns, dental procedures, labor and childbirth

(MMPI) scales: Hypochondriasis

—tendency to be overly concerned about health and to overreport more pain

(MMPI) scales: Hysteria

—tendency to exaggerate symptoms and ise emotional behavior to solve problems