Chap 10 Management of Pain and Discomfort
Which of the following statements most accurately exemplify the meaning of pain control? (Check all that apply.)
A patient no longer feels anything in an area that once hurt. A patient is still hurting but is now able to tolerate it.
Which of the following is considered an effective pain control technique?
A technique which reduces pain to sensation.
The two major types of peripheral nerve fibers involved in nociception are ____ - ____ fibers and ______-fibers.
A- Detla, C
Match the types of peripheral nerve fibers (in the left column) with their descriptions (in the right column). A-delta fibers- C-fibers-
A-delta fibers-Their activity heavily determines sensory aspects of pain. C-fibers-They influence the motivational and affective elements of pain.
_____ has been used to treat a number of chronic pain syndromes, including headaches and Raynaud's disease.
Biofeedback
Identify the guidelines for intervening with chronic pain patients provided by self-determination theory. (Check all that apply.)
By increasing the experience of support By increasing autonomy By increasing feelings of competence
___ ____ pain typically persists for 6 months or longer and is relatively unresponsive to treatment.
Chronic benign
___ involves inhibiting pain in one part of the body by stimulating or mildly irritating another area.
Counterirritation
Identify the motivational, behavioral, and emotional responses that accompany the experience of pain. (Check all that apply.)
Crying Withdrawal Fear
Identify the typical educational components of pain management programs. (Check all that apply.)
Depression as a consequence of pain Discussions of medications
_____ worsen the experience of pain.
Depression, anxiety, and anger
Match the kinds of pain perception, in the left column, with their descriptions, in the right column. Mechanical nociception- Thermal damage- Polymodal nociception-
Mechanical nociception- Pain experienced due to damage to the body tissues Thermal damage- Pain experienced due to temperature exposure Polymodal nociception- Pain experience that triggers chemical reactions from tissue damage
Identify instances where a chronic pain patient experiences pain strongly. (Check all that apply.)
Overlay of psychological distress High sensitivity to noxious stimulation Impairment in pain regulatory systems
____ ___ ___are a coordinated form of treatment where patients are given extensive information about pain control.
Pain Management Programs
_____ programs aid patients by helping control chronic pain and appear to be successful in doing so.
Pain management
Identify the statements that show the medical significance of pain. (Check all that apply.)
The presence of both pain and mental or physical disorders complicates diagnosis and treatment. Complaints of pain often accompany mental and physical disorders. Pain is a symptom that will lead a person to seek treatment.
Arrange the steps in the biofeedback process in the correct order of occurrence.
The target function to be controlled is identified The target function is tracked by a machine, which gives feedback to the patient The patient learns what behaviors or thoughts will modify the bodily function through trial and error and continuous feedback
Identify the true statements about C-fibers. (Check all that apply.)
They are unmyelinated nerve fibers. They are involved in polymodal pain. They transmit dull, aching pain.
Identify the true statements about A-delta fibers. (Check all that apply.)
They respond especially to mechanical or thermal pain. They are small myelinated fibers. They transmit sharp, brief pains rapidly.
True or false: Chronic patients often withdraw from their families.
True
True or false: Individualized programs of pain management are typically structured and time limited.
True
Identify the maladaptive coping strategies developed by chronic pain patients. (Check all that apply.)
Withdrawing socially Engaging in wishful thinking Catastrophizing their illness
____ (Women/Men) show greater sensitivity to pain.
Women
From a patient's standpoint, pain is a problem, whereas to a medical provider, it is _____.
a by-product of a disorder
Chronic pain leads to a variety of pain-related behavior, and these alterations in a person's life then become _____.
a part of the pain problem and may persist and interfere with successful treatment
In the initial stage of pain management programs, _____.
a qualitative and quantitative assessment of the pain, its duration, and history are checked
While passive coping skills have been tied to poor pain control, _____.
active coping skills can reduce pain in patients with a variety of chronic pains
Unlike the surgical, sensory pain management, and pharmacological techniques, psychological techniques require _____.
active participation and learning on the part of a patient
____ pain typically results from a specific injury that produces tissue damage whereas _____ pain typically begins with an acute episode,
acute, chronic
The C-fibers project onto different thalamic, hypothalamic, and cortical areas of the brain, whereas A-delta fibers project onto _____.
areas in the thalamus and the sensory areas of the cerebral cortex
The fear of not being able to reduce one's suffering _____.
arouses more anxiety than the prospect of losing a limb or even death
The third objective in cognitive-behavioral intervention is that clients are encouraged to reconceptualize their own role in the pain management process from _____.
being passive recipients to competent individuals who can aid in the control of pain
A number of chronic pain syndromes, including temporomandibular joint pain and pelvic pain, have been treated using ____
biofeedback
_____ involves providing biophysiological feedback to a patient about some bodily process of which the patient is usually unaware.
biofeedback
The experience of pain is a protective mechanism to _____.
bring tissue damage into conscious awareness
Relapse prevention techniques that help patients continue their pain management skills _____.
can maintain posttreatment pain reduction
After the chemical message of injury is passed to the cerebral cortex, those regions of the brain identify the site of the injury and send messages back down the spinal cord, which leads to _____.
changes in other bodily functions, such as breathing
Coping skills training helps ___ pain patients manage pain.
chronic
Continuous low back pain is an example of _____.
chronic benign pain
Pain management programs are a coordinated form of treatment that have taken the place of addictive painkillers like morphine and surgery to deal with __ __ .
chronic pain
____ ____pain persists longer than 6 months and increases in severity with time. It is usually associated with degenerative disorders.
chronic progressive
Rheumatoid arthritis and skin cancer are examples of _____.
chronic progressive pain
The pain problem must be perceived to be modifiable for ____ and ____ methods to have any impact.
cognitive and behavioral
Unlike acute pain, chronic pain involves a great amount of _____.
complex interaction of physiological, psychological, social, and behavioral components
In relaxation, ___ ___ is added, in which breathing shifts from relatively short, shallow breaths to deeper, longer breaths.
controlled breathing
Spinal cord stimulation is an example of _____.
counterirritation
Surgical treatment to control pain involves _____.
creating lesions or cutting so-called pain fibers at various points in the body so that pain sensations cannot be conducted
_____ reflects the feelings of despair or hopelessness that can accompany long-term experience with unsuccessfully treated pain.
depression
Patients may be taught to identify situations likely to give rise to their pain and to _____.
develop alternative ways of coping with the pain
One barrier to the treatment of pain is the _____.
difficulty people have in describing it objectively
One mental strategy for controlling discomfort is to _____.
distract oneself by focusing on another activity
Playing video games or watching an exciting movie can drive attention away from a painful injury. This is an example of ____ .
distraction
Acute pain is defined as a pain that goes on for 6 months or less, whereas chronic pain _____.
does not decrease with treatment and the passage of time
Clients are encouraged to attribute their success to their own efforts, making them see themselves as _____.
efficacious agents of change and pain modification
Clients must be convinced that the skills necessary to control the pain can and will be taught to them, thereby _____.
enhancing their expectations that the outcome of the training will be successful
A mental strategy that enables an individual to control his or her mental discomfort is by _____.
focusing directly on the events but to reinterpret the experience
Pain questionnaires help a practitioner _____.
get a full picture and address the psychosocial components of a patient's pain
Most patients are trained in a variety of measures to reduce pain and because many pain patients are emotionally distressed, _____.
group therapy is conducted to help them control their emotional responses
Families may get frustrated and annoyed by a patient's pain complaints and inactivity. Thus, a goal of family therapy is to _____.
help family members develop more positive perceptions of each other
The degree to which pain is felt and how incapacitating it is depends in a large part on _____.
how it is interpreted
In the initial stage of pain management programs, after an evaluation with respect to patients' pain and pain behavior, an assessment is made of the functional status that explores _____.
how patients have coped with the pain in the past as it helps establish treatment goals
Chronic pain patients typically show elevated scores on three subscales of the Minnesota Multiphasic Personality Inventory (MMPI). These subscales are _____.
hypochondriasis, hysteria, and depression
Understanding what pain behaviors a patient engages in and knowing whether they persist after the treatment of the pain are _____.
important factors in treating the total pain experience
By making patients responsible for success, they see themselves as agents of change and are _____.
in a better position to monitor changes in the pain and bring about successful pain modification
Social support for pain can _____.
inadvertently act as a reinforcement of pain behaviors, which then become part of the pain problem
Depression increases perceptions of pain, and so it can feed back into the total pain experience, _____.
increasing the likelihood of pain behaviors
While distraction is effective, its practical significance for chronic pain management _____.
is limited because patients cannot distract themselves indefinitely
Crossing and uncrossing our legs, shifting our posture, or rolling over while asleep are all examples of _____.
low-level feedback for pain
Among chronic pain patients whose spouses remain supportive, such positive attention may inadvertently _____.
maintain the pain and disability
Patients are taught how and when to employ overt and covert behaviors in order to _____.
make adaptive responses to pain problems
Clients learn how to monitor their thoughts, feelings, and behaviors to break ___ ___ ___ up that accompany chronic pain.
maladaptive behavioral syndromes
Relaxation is modestly successful for controlling some acute pains and _____.
may be useful in treating chronic pain when used with other methods of pain control
Patients with chronic pain may suffer a deterioration in relationships as they _____.
may not communicate well with their families
Social pain, which is the feeling of social rejection or loss, relies on the same pain-related neurocircuitry that physical pain relies on. This suggests there are _____.
meaningful similarities in the way that social and physical pain are experienced
The three kinds of pain perception are _____.
mechanical nociception, thermal damage, polymodal nociception
The most common method of controlling pain is through the administration of drugs. The most popular drugs are _____.
morphine and local anesthetics
Any drug that influences ___ ___ is a candidate for pain relief.
neural transmission
Chronic pain patients typically show elevated scores on three subscales of the Minnesota Multiphasic Personality Inventory (MMPI).This group of traits is commonly referred to as the ___ ____
neurotic triad
Sometimes pharmacological treatments may not help a patient feel better. Patients may consume large quantities of painkillers that are _____.
only partially effective and have side effects, including inability to concentrate and addiction
Some of the beneficial physiological effects of relaxation training may be due to the release of _____.
opioids
The basis for assessing how pain has disrupted the life of a patient or a group of patients is provided by ___ _____.
pain behaviors
A constellation of personality traits that predispose a person to experience chronic pain is known as a ____-____ ____
pain-prone personality
Because psychological factors are clearly implicated in the experience of pain, and because pain serves functions for some chronic pain sufferers, researchers have examined the presence of a ___-___ ___.
pain-prone personality
Due to its temporary nature, counterirritation is used appropriately as _____.
part of a general regimen for chronic pain
A common feature of pain management programs is _____, which includes teaching nonpharmacological measures for pain control, such as relaxation skills and distraction.
patient education
Chronic pain may result from a(n) _____.
predisposition to react to a bodily insult with a specific bodily response
While nerve-blocking agents may be administered to reduce pain, these can also _____.
produce side effects including anesthesia, limb paralysis, loss of bladder control, and a quick return of the pain
Pain is critical for survival because it _____.
provides low-level feedback about the functioning of bodily systems
Unlike acute pain, chronic pain often carries an overlay of ___ ____, which complicates diagnosis and treatment.
psychological distress
The first objective in cognitive-behavioral interventions is that patients are encouraged to _____.
reconceptualize the problem from overwhelming to manageable
____ _____ pain involves intermittent episodes of pain that are acute in character but chronic as the conditions recur for more than 6 months.
recurrent acute
Migraine headaches and trigeminal neuralgia are examples of _____.
recurrent acute pain
Meditation, slow breathing, and mindfulness _____.
reduce pain sensitivity and can produce analgesic effects
Just as ___ ___ is an important part of health habit change, it is important in pain control as well.
relapse prevention
Once a patient is discharged from a pain management program, to prevent patients from reverting back to their previous condition, ___ ___ techniques are taught.
relapse prevention
According to Hernandez and Sachs-Ericsson, people from some cultures _____.
report pain sooner and react more intensely to it than those from other cultures
Nociceptors in the peripheral nerves first sense injury and, in response, release chemical messengers, which are conducted to the spinal cord, where they are passed directly to the ____ ____ and thalamus and into the cerebral cortex.
reticular formation
The third objective in cognitive-behavioral intervention promotes feelings of ___-__ in patients.
self-efficacy
While counterirritation has some success in reducing pain, its effects are often _____.
short-lived and thus more appropriate for temporary relief from acute pain
Psychological techniques are more effective for managing _____.
slow-rising pains, which can be anticipated and prepared for than for sudden, intense, or unexpected pains
____ is a pain technique whereby focusing attention on an irrelevant and attention-getting stimulus or by diverting oneself with a high level of activity, one can turn attention away from pain.
Distraction
_____ is most effective for coping with low-level pain.
Distraction
_____ are the natural pain suppression system of the body where opiate-like substances, produced within the body, constitute a neurochemically based, internal pain regulation system.
Endogenous opioid peptide
Identify the pain behaviors that arise from chronic pain. (Check all that apply.)
Facial and audible expressions of distress Avoidance of activities Distortions in posture or gait
True or false: Catastrophic thinking reduces the pain experience.
False
True or false: Chronic pain patients never require special guidance to get benefits from slow breathing.
False
True or false: In the context of pain management programs, studies that have evaluated behavioral interventions in comparison with nontreatment have found an increase in pain, disability, and psychological distress.
False
True or false: Pain has objective referents.
False
The endogenous opioid peptides, which are the natural pain suppression system of the body, were uncovered by _____.
H. Akil, D. J. Mayer, and J. C. Liebeskin
Identify the goals a patient needs to achieve in individualized programs of pain management. (Check all that apply.)
Increasing physical activity and improving psychosocial functioning Reducing the intensity of pain Reducing dependence on medication and perception of disability
Pain is heavily influenced by _____.
the context in which it is experienced
Acceptance and commitment therapy, mindfulness interventions, and self-determination theory are techniques which train patients in pain _____.
to help them control their emotional responses to pain
Some surgical techniques attempt to disrupt the conduct of pain from the periphery to the spinal cord while others are designed _____.
to interrupt the flow of pain sensations from the spinal cord upward to the brain
True or false: Practitioners helping pain patients to develop more positive monologues increases the likelihood that cognitive-behavioral techniques will be successful.
true
Drawing on the large and informal vocabulary a person uses to describe pain helps medical practitioners _____.
understand a patient's complaints and the implications of pain
Unlike chronic pain, most pain control techniques _____.
work well to control acute pain
