CAS PS 332 Lecture Notes - Lecture 17: Paracetamol, Rheumatology, Wisdom Tooth
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22 May 2019
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Lecture 17: 4/23/19
• Review of chronic pain
o Chronic pain is prevalent and costly: Number one problem why people
seek help in the US and it is not easy to treat
o Definition of pain: more comprehensive than just tissue damage: actual
and potential tissue damage and psychological aspects of that
o Four stages (acute, pre-chronic (transition stages), chronic, & chronic
recurrent)
o Measuring pain
o Physiological pain pathways
▪ Transduction, transmission, perception, modulation
o Substance P & enkaphalins
o Descending modulatory pain pathways increase or decrease pain
signals
o Specificity vs. gate control theories of pain
o Psychosocial influences in pain perception
o (Health disparities article)
▪ Ran out of time to discuss it in class, but look @ it on BB
• Describe multidisciplinary pain management programs
o Treatment vs management: treatment heals, management helps you
learn how to deal with it
o Medications for Pain (works for acute)
▪ Mild pain (e.g., sore back)
• Take an Aspirin
▪ Moderate (e.g., wisdom teeth removed) to Severe (e.g., post
surgery): helpful in the short-term, and better treatment of short-
term pain helps prevent chronic pain
• Vicodin, Hydrocodone - Morphine, Oxycodone
▪ Chronic Pain
• Antidepressants, Marijuana?
▪ NOT EFFECTIVE to take pain pills (e.g., vicodin) for chronic pain
AND strong abuse potential
o Physical Treatments
▪ Acupuncture: endorphin release, restore energetic balance
▪ Massage
▪ Electronic stimulation (e.g., TENS)
o Psychological Treatments
▪ Cognitive-behavioral therapy
▪ Meditation
▪ Relaxation
▪ Biofeedback
▪ Hypnosis
o Multidisciplinary Pain Management
▪ Integration and collaboration of multiple healthcare
disciplines with specialized training in the assessment and
treatment of pain, with the goals of addressing the physical,
social and psychological components of pain and creating an
individualized treatment plan for each patient
• Anesthesiology / Neurology / Rheumatology
• Psychology
• Physical Therapy/Occupational Therapy
• FAMILIES & SCHOOLS!
▪ Biopsychosocial model
• Explain the main psychological approaches to pain management:
o Pain cycle: physical changes, functional changes, emotional changes ->
bidirectional relationships that make pain worse without reinjury
o Over time, negative thoughts or beliefs about pain and behaviors related
to pain can become very resistant to change.
▪ Thoughts: My body has failed me, This is never going to end, I'm
worthless
▪ Behaviors: Staying in bed all day, Sleeping all day, Staying away
from friends
o CBT & ACT
▪ CBT is effective for chronic pain conditions
• Headache, rheumatic diseases, chronic pain syndrome,
chronic low-back pain, irritable bowl syndrome, etc.
• Why is this surprising to many people? People don’t really
know this, they don’t understand the mechanisms of pain
and don’t know that this type of treatment is where we
should be putting our efforts.
▪ Components of CBT for pain include:
• Encourage increasing activity by setting goals (frame pain
treatment as getting back to normal activities / living life
that they value)
• Identify and challenge inaccurate beliefs about pain
(cognitive)
• Teach cognitive and behavioral coping skills (e.g.,
restructuring negative thoughts, activity pacing, relaxation
training)
• Practice and consolidation of coping skills
• Reinforcement of adaptive coping & “approach” behaviors
▪ Present a Convincing Treatment Rationale!
• Treatment only works if patients are engaged
• Patients will drop out of treatment if they don’t think you
have something to offer them
• Help the patient arrive at the decision to try psychological
approaches
• Set realistic treatment goals (make sure that clients
understand that treatment needs to be realistic)
▪ Time-Based Activity Pacing
• Activity breaks are based on time intervals, not on how
much of the job is completed
• Ideal for the patient who tends to over-do it (“I’ll take a
break as soon as I…”)
o The weekend warrior
o “This is the way I was trained”
• The Professional Athlete example
o How do they perform at their best?
▪ Cognitive Restructuring
• Cognitive Restructuring teaches patients to recognize
cognitive errors and maladaptive thoughts, challenge those
thoughts, and substitute more adaptive/accurate