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Lecture 7

Lecture 7.docx

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Nevena Simic

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Lecture 7 Pain and Its ManagementPainan unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such danger definition by International Association for the Study of Pain IASPCase Study Miss CNormally developing women of average intelligenceNever felt any pain as a child o bit off the tip of her tongue while chewing food didnt know rdo have 3 degree burns from a radiatoro cant remember ever sneezing or coughing no gag reflex or corneal reflexPhysicians studied her electrical shocks immerse hands in hotcold water pinched o no changes in heart rate blood pressure or breathingSevere medical problems knees hips spine remain in one position too longinflammation of jointso She never readjusted her positions o neglect injuriesinfectionno treatmentDied at age 29 from massive infectionsSignificance of PainPainsymptom of chief concern to patients o Leads them to seek medical attentionPain often considered of secondary importance to MD o Physicians see pain to a consequences to another illnessPatients fear ain in illness and treatment most o Fearing that they cannot relieve sufferingincrease anxiety o Most common reason for euthanasia 4 billion is spent annually in Canada on overthecounter pain medications Why do we feel painPain is adaptive o Tells is to avoid behaviours that may hurt us o Forces us to rest and recover after an injuryCan be reflexive and unconscious o Hot stove burner pull away hand before you think about the painCan be used as a learning mechanism o Electric shock for rats o Spanking for childrenPain as an Inhibitory MechanismLearning is conditioningClassical conditioning o Ivan Pavlovs dog o Got his dog and put out juicy meat and everytime he saw the meet he would salivate o Salivatingunconditioned response o Meatunconditioned stimulus o Take the meat and pair it with a neutral stimulus that would not elicit salivation o Eventually pairing the sound with the food the dog came to associate the sound with the presentation of foodWould eventually salivate to the sound without the foodSalivating to tuning responseconditioned responseSound conditioned stimulusOperant Conditioning o Learning based on consequences o Positiveadd negativetake away o Reinforcement consequences increases likelihood of behaviour in the futurePositive reinforcement application of desirable stimulus reward candyNegative Reinforcement removal of a negative stimulus dont have to do a chore if good o Punishment consequence decrease likelihood of behaviour occurring in the futurePositive Punishment application of an aversive stimulus spankingNegative Punishment take away something good TV timeUsing pain to learn o Therefore positive punishment and negative reinforcement as a learning mechanism o These involve aversive potentially painful stimulus eg Electric shock spanking and soothing burnsHow do we know when someone is in painPain Behaviours are behaviours that occur in responses to pain such as 1 Facial and audible expressions of distress 2 Distortions in posture of gait 3 Negative affect 4 Avoidance of activity Verbal Reports o Use of informal vocabulary to describe painie a throbbing pain has different implications then does a shooting pain o Pain questionnaires McGill Pain Questionnaire provides indications of the nature of pain as well as the intensityo Can also measure psychosocial measures of painie fear it causesWhat is painElusive NaturePain is a subjective experience o Degree to which pain is felt and how incapacitating it is depend on how it is interpreted Heavily influenced by context in which it is experienced o Beechers example of soldiers versus civilians25 wounded soldiers ask for morphine versus 80 of civilians after surgeryWhat is pain for the soldier For the patientSoldier pain indicated that they were alive and survived an injuryCivilian meant that they were being taken away from their regular routines o Sports injury continue to play
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