CAS PS 332 Lecture Notes - Lecture 16: Primary Care Physician, Chronic Pain, Fluid Ounce

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Published on 22 May 2019
Professor
Lecture 16: 4/18/19
Chronic Pain
Summarize historical approaches to pain management
o Early humans related pain to evil, magic, and demons. Relief of pain was
the responsibility of sorcerers, shamans, priests, and priestesses, who
used herbs, rites, and ceremonies as their treatments. Some may have
had placebo effect, but some may have had psychological impact on
perception of pain.
o Early 19th Century Pain Relief
Most pain relievers made from plants (not always the safest things
to ingest in large qualities)
Overdoses deadly!
Opium derived from the poppy flower
Other substances used included alcohol like wine,
mandrake, belladonna, and marijuana
WIZARD OIL
Touted as a cure for Rheumatism, Sprains, Bruises, Lame
Back, Frost Bites, Diarrhea, Burns & Scalds. Contents =
50%-70% alcohol, camphor, ammonia, chloroform,
sassafras, cloves, & turpentine. Wizard Oil could also be
used on horses and cattle
Mrs. Winslow's Soothing Syrup
Indispensable aid to mothers and childcare workers.
Containing one grain (65 mg) of morphine per fluid ounce,
it effectively quieted restless infants and small children.
Headache treatment
“Pain annihilator;” ethyl alcohol and opium
Cocaine toothache drops
Discuss the prevalence, cost, definition, and purpose of pain
o Chronic Pain is PREVALENT
Chronic Pain = major public health problem
Most common reason people seek treatment
Affects 1.5 billion people worldwide
10% of the world’s population (11.2% of US pop.)
More than cancer, heart disease, & diabetes combined
Higher prevalence in women (Johannes et al., 2010)
34.3% women; 26.7% men
Associated with low income & unemployment
o Chronic Pain is COSTLY!
NIH- chronic pain is the costliest medical problem in the US,
affecting >100 million people
Americans spend $600 billion annually on treatment for chronic
pain (~$2,000 for every person living in the US)
Pain is cause of 80% of all visits to physicians
Most common reason to see primary care physician
o Been dubbed the “fifth vital sign” >>> blood pressure, pulse, temperature,
respiration, pain scale
o What is Pain?
Traditional Conceptualization
A direct consequence of physical injury
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Degree of tissue damage >>> degree of pain (1:1
correlation)
Strong’s theory (1895) >> more to pain then just tissue damage
Part physical sensation
Part psychic reaction
o Psychological causes given equal importance
o Current definition:
“An unpleasant sensory and emotional experience associated with
actual or potential tissue damage, or described in terms of such
damage”
International Association for the Study of Pain, 1979
What is important / surprising about this definition? Physical and
emotional, potential tissue damage = vague, unpleasant may be
downplaying but use valence here, tissue damage may not be
there but its still felt like there’s damage there
What is the purpose of pain?
Acute pain vs. chronic pain
Body’s way of telling you to take care of yourself, signal to
heal
Evolved to be safe, maintain bodily integrity (response to
placing hand on hot stove)
Distinguish the four stages of pain
o 1) Acute
Generally result of injury
Cuts, burns, childbirth, surgery, etc.
Brief duration
Adaptive >> signal to avoid further injury
o 2) Pre-chronic
Between acute and chronic stages
Transition point: person either overcomes acute pain, or develops
feelings of hopelessness >> chronic pain
o 3) Chronic
Lasts 6+ months (often many years)
Variability: Continuous or intermittent; moderate or severe; felt in
any part of the body’s tissues
May be due to chronic illness (e.g. rheumatoid arthritis) or
an injury that does not heal promptly
Can exist in the absence of tissue damage
NO BIOLOGICAL BENEFITS!
Not adaptive - Result of physiology designed to be
protective
Worsened by psychological factors
Depression, hopelessness, helplessness, stress, anxiety,
etc
Cyclical, pain and psych problems
o 4) Chronic recurrent
Alternating episodes of intense pain and no pain
E.g., migraine headaches
3+ months
Explain the primary approaches to measuring pain
o No direct way to measure physiological sensation
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