HPD 3

Question 1

What is the definition of pain?

Answer 1

an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described of in terms of such damage

Question 2

What is the term for a non-conscious neural traffic originating with trauma or potential trauma tissue?

Answer 2

nociception

Question 3

What’s the difference between acute and chronic pain?

Answer 3

Question 4

What does the Gate Control Theory suggest?

Where is this “gate”?

Answer 4

this theory proposes that pain is not just a direct result of injury but is modulated at the spinal cord level, like a “gate” that can open or close to let pain signals reach the brain

“gate” is in the dorsal horn of the spinal cord

Question 5

1. Why is the Gate Control Theory an Efferent Pathway?
2. What does “opening” the gate refer to?”
3. What does “closing” the gate refer to?

Answer 5

1. not only does the spinal cord modulate pain locally, but the brain can send signals down - EFFERENT PATHWAY - to influence the gate
2. increase pain perception
3. decrease pain perception

Question 6

What factors “open” the gate in the Gate Control theory?

What factors “close” the gate?

Answer 6

Question 7

What is Phantom Pain? What occurs in this phenomenon?

Answer 7

Question 8

What does the Fear-Avoidance Model suggest?

Answer 8

Question 9

Fill in the gaps:

Fear of pain develops as a result of a __1__ interpretation of __2__ as threatening, known as “__3__” and this fear affects __4__ processes, also known as __5__ and leads to __6__ behaviours, followed by disability, disuse, and depression.

Answer 9

1. cognitive
2. fear
3. pain catastrophizing
4. attention
5. hypervigilance
6. avoidance

Question 10

What does Pain Catastophising cause?

Answer 10

Question 11

What does the term Pain and Gain imply?

Answer 11

means that experiencing or expressing pain can sometimes bring benefits—either to the person in pain or to others around them

“Pain” = the unpleasant experience.

“Gain” = the advantage or reward that comes from it

Question 12

How many types of gain are there and what is the behaviour/outcome of each?

Answer 12

Question 13

What is the difference between the Placebo Effect and the Nocebo Effect?

Answer 13

Placebo effect: Positive outcomes from expecting a benefit. Your brain thinks something will help, and it actually reduces symptoms or improves feeling, even if the treatment is inactive (like a sugar pill).

Nocebo effect: Negative outcomes from expecting harm or side effects. Your brain anticipates something bad, and you feel worse or develop symptoms, even if the treatment is harmless.

Question 14

What is the role of antidepressants such as amitriptyline in pain management?

Answer 14

Question 15

What are the main analgesics in clinical use?

Answer 15

Question 16

What are the 3 major classes of opioid receptors?

What is the mechanism of action of exogenous opiates?

Answer 16

mu, delta, kappa

Question 17

What are the signs of potential dependence?

Answer 17

Question 18

What are some non-pharmacological interventions for pain management?

Answer 18

Question 19

What is the most common pain management program and what does it focus on?

Answer 19

Question 20

Define the following:

Answer 20

Question 21

What is CBT? What does it focus on?

Answer 21

Question 22

List 5 facts about CBT.

Answer 22

Question 23

What are the 3 levels of thoughts?

Answer 23

Question 24

List some strengths and weaknesses of CBT.

Answer 24

Question 25

Give an example of another therapy which CBT has been incorporated into.

Answer 25

dialectical behaviour therapy - type of talking therapy (based on CBT but specially adapt for people who feel emotions very intensely)

Question 26

What is CBTi?

Answer 26

Question 27

What are the core features of Person-Centred Therapy?

Answer 27

Question 28

What are some strengths and weakness of PCT?

Answer 28

Question 29

What is the meaning of the terms Transference and Counter Transference?

Answer 29

Question 30

What is Mindfulness-Based Cognitive Therapy and what does it involve?

Answer 30

Question 31

Which disorders can MBCT be used for?

Answer 31

Question 32

What is the first line psychological intervention for a first-episode of depression?

Answer 32

CBT

Question 33

Identify two core features of Cognitive Behavioural Therapy.

Answer 33

Question 34

Answer 34

answer A

Question 35

Identify 2 core features of MBT.

Answer 35

Question 36

Joan is a 45-year-old office worker who re-presents to you with persistent lower back pain. She initially presented 3 weeks ago with acute onset severe pain after lifting a heavy box for which you recommended paracetamol and an NSAID. Her pain has improved but not resolved. Joan’s lower back pain is aching in nature and diffuse, it radiates into her left buttock. Sitting for long periods and housework exacerbate her pain. Joan is worried that her back pain will get worse if she does too much. Explain how worrying may exacerbate Joan’s pain.

Answer 36

Joan’s worry is causing her to engage with maladaptive pain management techniques i.e. not doing too much activity, only relying on medication. However, if this response to pain does not work, pain is likely to continue and worsen until an appropriate solution is found within an appropriate biopsychosocial framework.

Question 37

Mr Clarke calls you on the phone because his chronic neck pain has been worse after he helped his sister move house. He has been on morphine for over a year at the same dose, and repeatedly asks for an increase in the dosage. Use the misdirected problem-solving model to explain Mr Clarke’s persistent pain.

Answer 37

Question 38

Mr Clarke calls you on the phone because his chronic neck pain has been worse after he helped his sister move house. He has been on morphine for over a year at the same dose, and repeatedly asks for an increase in the dosage. Morphine is an opiate drug. How does an opiate drug work?

Answer 38

Question 39

Mr Clarke calls you on the phone because his chronic neck pain has been worse after he helped his sister move house. He has been on morphine for over a year at the same dose, and repeatedly asks for an increase in the dosage. Another doctor suspects that Mr Clarke is abusing his medication. Why might the doctor think this?

Answer 39

because pt is requesting multiple increases in his dosage

Question 40

Mr Clarke calls you on the phone because his chronic neck pain has been worse after he helped his sister move house. He has been on morphine for over a year at the same dose, and repeatedly asks for an increase in the dosage. Mr Clarke is on long-term sick leave, has been diagnosed with depression, and tells you that the pain has taken over his life and he has lost any hope of recovering. What maladaptive thinking strategy is evident in this case?

Answer 40

catastrophic thinking

Question 41

Mr Clarke calls you on the phone because his chronic neck pain has been worse after he helped his sister move house. He has been on morphine for over a year at the same dose, and repeatedly asks for an increase in the dosage. What factors in this case might be hindering Mr Clarke's recovery?

Answer 41

potential dependence, anxiety, depression

Question 42

Mr Clarke calls you on the phone because his chronic neck pain has been worse after he helped his sister move house. He has been on morphine for over a year at the same dose, and repeatedly asks for an increase in the dosage.

Answer 42

answer b

Question 43

Mr Clarke calls you on the phone because his chronic neck pain has been worse after he helped his sister move house. He has been on morphine for over a year at the same dose, and repeatedly asks for an increase in the dosage. You may find it useful to assess Mr Clarke’s pain intensity before and after various interventions to track any changes. What tool might you use to assess pain intensity?

Answer 43

numerical pain rating scale, verbal rating scale or visual analogue scale