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Chapter 10

Chapter 10 Chronic Pain Management and Arthritis.docx

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Western University
Psychology 2036A/B
Sarah Khan

Chapter 10 Chronic Pain Management and Arthritis Juvenile rheumatoid arthritis – a form of arthritis that affects children before the age of 16 Section I: Chronic Pain Management - Individuals generally experience pain when an illness or injury causes inflammation or changes to the nervous system – the changes are relayed to the brain, resulting in a physical sensation that a change has occurred - Chronic pain – episodic or continued sensations of pain Measuring Pain - Chronic illnesses – long term (3-6 months or longer) and complex illnesses that can be controlled but not cured - Chronic pain – pain that can be controlled but not cured - Factors that contribute to the general perception of pain: o Pain intensity or duration o Type of pain o Temporal pattern o Treatment effect o Pain quality o Location o Interference o Affect o Pain history o Beliefs about pain (attitude, coping, beliefs about the causes and consequences of pain) - It is not possible to measurable quantify pain – difficult to gauge because it is very subjective Changing Characteristics of Pain - Sensation of pain may differ over time - A person’s pain experiences over weeks or months can appear different each day o The source of pain may be the same but the perception of pain can change based on a person’s subjective assessment of the sensation at the time - Factors that influence perception: o Psychological state o Mood o General affect - Reports of chronic pain lasting over a year is common in older individuals - Pain and disability cause by injuries can last even after the injury has healed o Injury-related pain and disability show rapid improvement for the first 3 months o After that, progress slows o Individuals may never be fully free of pain due to injury or return to full and normal functioning ability - Chronic pain can affect a person’s perceived quality of life and overall well-being o One of the goal of palliative care is pain relief to improve quality of life as best as possible Pain Management vs. Pain Elimination - There is no proven, effective treatment that offers total and complete relief from chronic pain - Research on injury-related pain also focuses on management because often pain due to injury lingers well beyond the pain of treatment o i.e. rotator cuff injuries in athletes – surgery and therapy can only sometimes restore full functioning - Individuals must learn to deal with the decreased functioning or chronic pain as the result of injury - Healing process always requires both physical and psychological adjustments Differences in Pain Perception - Women often report more pain than men - Women are more likely to receive prescriptions for sedatives to suppress the sensation of pain than analgesics to relieve the pain - Perceptions of pain may differ among ethnic groups - There are differences in the epidemiology of pain, access to pain care, and assessment and treatment of pain, as well as pain outcomes - Studies show that African Americans have a lower threshold for heat pain than non- Hispanic whites – results were the same for acute and chronic pain tolerance - Faucet/Gordon/Levine: study on post-operative pain – African Americans and Latinos reported greater pain than Caucasians - Studies examining chronic pain related to chronic health conditions – African Americans were most likely to report persistent pain related to AIDS, arthritis, and severe low back pain - Some studies have reported biological causes that can explain the ethnic differences in perception of pain o Speculation that ethnic factors play a role in triggering activity in the nervous centers of the body that modulate pain - Greater support for causation due to social factors – i.e. limited access to health care due to SES, lack of knowledge, coping styles - Minority patients are more likely to be undertreated for pain and are less likely to receive a comprehensive diagnosis and treatment for their complaints of pain o i.e. Latinos and African American are significantly LESS likely to receive pain medication for a bone fracture - Possible reason for high ratings on pain perception by ethnicities is due to inadequate treatment of pain - Other studies suggest that attitudes or biases that providers hold about their patients may interfere with effective treatment - Ethnicity affects coping strategies for pain management o African Americans are more likely to rely on support systems and religious coping to manage through the pain o Caucasians are more likely to implement techniques such as ignoring the pain or to believe in a greater ability to control the pain themselves o Differences in strategies may be learned within ethnic groups or cultures that such differences may affect an individual’s awareness of and a level of comfort with the pain Caregivers, Pain Management, and Psychological Stress - Chronic pain can have long-term psychological effects on the sufferer o i.e. Arthritis can impair a person’s ability to be self-sufficient and to accomplish basic tasks such as preparing a meal, eating, or getting dressed - A person with chronic pain carried it with the psychological disadvantage of being dependent on others for basic necessities - An increase in functional disability and dependency on others, together with chronic pain, is dispiriting to many individuals - Depression, worry, avoidance behaviour, and a sense of helplessness are common psychological reactions - People who suffer from chronic pain do not suffer alone – affects family and caregivers o Caregiver distress is a common occurrence o Caregivers report more medical visits than non-caregivers - Caregivers are also at a higher risk for anxiety, depression and reported increases in weight loss – females more affected than males - The task of providing ongoing assistance and aid to someone with a chronic illness (incl. chronic pain) can cause emotional, psychological, and physical harm to the caregiver Interventions for Caregivers - Caregivers who are able to set and accomplish small goal-specific tasks each day were more likely to report better overall psychological health in the short term, and in the long term once their responsibilities ended - Caregivers also report less long-term psychological distress when they employ psychotherapy or psychoeducational interventions Section II: Arthritis Defined Arthritis: - 1. A physiological based disease cause either by degeneration (gradual erosion of bones near the joints) or by inflammation (swelling of tissue surrounding the bones and joints) - 2. Arthritis is a progressive disease – degeneration or inflammation worsens over time - 3. Arthritis is a chronic disease - Describe a class of disease that refer to any joint conditions or disease causing inflammation, pain, and stiffness in the join or in connective tissues Rheumatoid Arthritis - Classified as a chronic, inflammatory autoimmune disease for which the exact cause is unknown - Swelling of the joints and of the synovium (thin layer of tissue that covers the joints) - Triggered by the immune system – inflammation is normally the body’s response to injury - In RA, the immune system triggers inflammation in the absence of infection or injury  unnecessary inflammation can damage tissue, blood vessels, and organs, and cause pain, stiffness and swelling of inflamed joints - RA is a progressive disease – inflammation, tissue damage and functional limitations become worse over time - In advanced stages, the joints and surrounding areas may become deformed - RA affects psychological health  b/c of physical disabilities o Limit an individual’s ability to be independent and capable o Depression, excessive worry, avoidance behaviour, and helplessness o Functional limitations affected – ability to perform daily tasks independently - Often affects many joints simultaneously Ankylosing Spondylitis (AS) - Specific type of RA that affects the spinal joints - Ankylos = bent - Spondylitis = inflammation of the spinal column - Diagnosis suggests a rigid or stiff spine - The disease causes the spinal column to fuse - Limits individual’s ability to turn neck or back - May cause a stooped appearance - Largely genetic in origin; AS gene – HLA-B27 - Generally first appears in adolescence and more commonly in men (unlike RA) - Studies mainly focus on men (as with CV studies) - Essentially a genetic version of RA Osteoarthritis - Commonly associated with wear and tear on the body - Cartilage is worn away  new bones may form bone spurs that rub against each other  pain and further deterioration of joints - Erosion process – degenerative joint disease - Unsure of what the cause is - Factors: genetic abnormality, developmental defects, trauma that alters or disrupts the body’s biomechanics, obesity - Most common in hands, knees, hips and feet - Often only affects one or two major joints - Surgery for joint replacements is a quite effective treatment Gout - Cause by crystal deposits in the joints - Commonly associated with the elderly - Other factors: environment, behaviour, genetics, gender o i.e. overeating, excessive consumptions of red meat, excessive alcohol consumption - Main factor: foods consumed o Buildup of uric acid – by product of foods eliminated from our bodies as waste products - Acid becomes lodged in joints and causes inflammation, redness, and soreness
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