The notes on the lectures of the course Pain, Perception, and Treatment. I only studied these lectures for the exam since they are a good summary of the literature. My grade was a 8.2 for the exam.
Pain Perception and Treatment – Lectures
Lecture
The oral1: Introduction
presentation and what is pain?
A project proposal within the domain of pain research. Based on a theoretical framework / existing
literature – group assignment. One obligatory aspect is that the research topic must include one within
subject dependent variable and one between subjects dependent variable.
Critical question
In addition to presenting your own work, you will also be required to formulate one critical question
for a poster of another group (max 1 page A4). Support your question with existing
literature/knowledge! This question will be graded on the following three levels:
1. Comprehension
2. Critical reflection
3. Integration
It is an individual assignment! Deadline will be announced on Brightspace.
Exam and grading
• 60% Exam (including 30MC questions, mix & match, short open questions)
• 40& Poster and Questions (average grade – equal weighing)
Pain
Acute pain is a warning signal for potential damage. Pain refers more to how you experience and deal
with this. What is your history of pain, how afraid are you of pain, what pain have you experienced?
Pain is not something that is related to bumping your knee or hitting your head.
The definition according to the International Association for the Study of Pain (2020)
An unpleasant sensory and emotional experience associated with, or resembling that associated
work, actual or potential tissue damage
• Pain is always a personal experience that is influenced to varying degrees by biological,
psychological and social factors.
• Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in
sensory neurons.
• Through their life experiences, individuals learn the concept of pain.
• A report of a person of an experience as pain should be respected.
• Although pain usually serves an adaptive role, it may have adverse effects on function and
social and psychological well-being.
• Verbal description is only one of several behaviours to express pain; inability to communicate
does not negate the possibility that human or a nonhuman animal experiences pain.
The biopsychosocial model
1
, What is pain?
Injury without pain Congenital analgesia
= rare condition in which a person cannot feel (and has never felt) physical pain.
- Aangeboren onverschilligheid voor pijn
- No awareness that something is causing damage to their body
- Ratings of verbally presented imaginary painful situations by CIP patients did
not different from controls
- The propensity to infer pain from facial expressions was very similar between
CIP patients and control subjects.
- They can rate normal pain, they do understand that it is pain they are suffering
from, but if they have to imagine themselves in a situation their pain is much
lower. They have empathy for other individuals.
Episodic analgesia
“he was just very easy and not distressed at all”
- These people are not in shock, they are super aware and they do not
experience pain.
- It is thought that it is the release of endorphins that release to suppress the
pain but we do not know why. It is not something that always happens to all of
us. It can happen with very small injuries too. They know what happened and
that there is a lot of damage.
A. No relation severity trauma
B. No simple relationship to circumstances (occurs in battle or at home)
C. Fully aware of injury (but feels no pain)
D. Instantaneous (not initial pain)
E. Limited in time (next day pain is felt)
F. Analgesia localised to injury
Pain without injury Poststroke central pain
Pain following a stroke, often in/surrounding the
thalamus
A. Hyperalgesia
B. Allodynia
- Poor prognosis
- Damage reduces inhibitory power to
suppress pain
- Hyperexcitability result into a lot of pain is a
hypothesis. There cannot be pain without a
logical / physical explanation for it.
- The brain can generate pain.
Low back pain
Pain after the injury healed Phantom pain
= patients reporting serious pain in an amputated limb.
- Mitchell named it phantom limb pain (1871).
- Ramachandran located the phantom in the brain (1998).
- The nerves are damaged and become hyperexcited which induces pain signals
to the brain.
- It could also be at spinal cord level because neurons expand.
- Most found explanation: there might be a reorganisation in the brain in which
the location of the face overlaps with the part that is missing. The neurons in
the hand no longer match with the representation in the brain.
2
,Pain somewhere else than the Referred pain
injury
A delta and C fibres are related to pain.
1. Classification of pain
- First you have the first pain, a sharp
intense pain.
- Second pain is more of a regional kind of
pain, burning, less sharp, slower.
3
, - C is slow
- A delta is fast
Gate control theory (Melack and Wall)
- Stimulating the area it might activate inhibition function again and shut down pain.
the complexity of pain
How we respond to pain differs in situations of mood, expectations, attention, etc
4
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