PharmD Program / Fourth Year

PAIN AND ITS

MANAGEMENT
Dr. Souada Elhdere

PharmD Faculty of Pharmacy/ Libyan International Medical University

 Intended learning outcomes
2

By the end of this session you will be able to:

1- Describe psychological pain;
2- Explain the gate control theory;
3- Describe the psychological factors in pain
perceptions;
4- Define the psychological factors in pain
treatment.

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 Introduction
3

Pain is often a warning sign that something is

wrong and results in protective behavior such as
avoiding moving in a particular way or lifting
heavy objects.
Pain also triggers help seeking behavior and is a
common reason for patients visiting their
doctor.
Pain also has psychological consequences and
can generate fear and anxiety.

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 The significance of pain
4

 Obvious significance
 Pain hurts and so it disrupts our lives

 Pain is critical for survival

 Minor pains provide low-level feedback

 Medical consequences

 Pain is the symptom most likely to lead an

individual to seek treatment

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 continuing
5

 Psychological significance
 Depression and anxiety worsen the
experience of pain
 Patients fear pain when undergoing treatment
 Inadequate relief from pain is the most
common reason for euthanasia requests

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 The Experience & Perception
6
of Pain
Pain serves three functions:
1) Warns of potential serious injury
survival value; produces withdrawal reflex to
prevent further injury
2) Pain that prevents further injury promotes
learning to avoid same situations later
3) Certain pains limit physical activity and
promote rest facilitates healing processes
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 Types of pain
7

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 The Gate Control Theory of Pain
8

The GCT integrated psychology into the

traditional biomedical model of pain and
described not only a role for physiological
causes and interventions, but also allowed for
psychological causes and interventions.
The way in which we experience pain is very
complex. All sorts of factors influence our
experience, including our thoughts and feelings.

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For example, you will probably be aware that

there are times when, even though you have
pain, you are only dimly aware of it. This can
happen, for example, when you are really
engrossed in doing something interesting or
having to face a situation which demands all
your attention.

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A very good example of this are the stories you

might have heard about wounded soldiers, who
despite being seriously injured will continue in
battle and not really be aware of much pain until
after the danger has passed.
On the other hand, you will probably be aware of
how in some circumstances your pain can feel
much worse. Indeed, you may find that the more
you think about your pain, the worse it can feel.
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In the Gate Control Theory, pain messages

travel from the periphery of the body through
nerve “gates” in the spinal cord and up to the
brain. The theory uses the concept of “gates” in
the central nervous system to describe how
some pain messages are allowed get through
and reach the brain, while others are blocked

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 Experience of pain in GCT
12

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Nerves from all over the body run to the spinal

cord, which is the first main meeting point for
the nervous system. In the spinal cord, you
might imagine a series of gates into which
messages about pain arrive from all over the
body.

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These gates can sometimes be much more open

than at other times. This is important because it
is through these gates that messages from your
body pass towards your brain. If the gates are
more open, then a lot of pain messages pass
through to the brain and you are likely to
experience a high level of pain. If the gates are
more closed, then fewer messages get through
and you are likely to experience less pain.
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So, what are the factors that make a

difference to how open or closed the
gates are?

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 Factors that open the gate
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There are three main ways in which the gates to pain

can be made more open, so that the pain feels
worse. These are to do with how we feel about
things, how we think about things, and what we are
doing.
1- Physical factors such as injury
2- Emotional factors, such as anxiety and depression
3- Behavioral factors, such as focusing on the pain

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 Factors that closes the gates
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In the same way as above, the way we feel, the

way we think and what we do can all have a
part to play in helping to close the gates to pain.
1- Physical factors such as medication
2- Emotional factors, such as optimism or
relaxation
3- Behavioral factors, such as concentration,
distraction or involvement in other activities.
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 The role of psychosocial factors
in pain perception
19

Psychological factors, such as the situational and

emotional factors that exist when we experience
pain, can profoundly alter the strength of these
perceptions.
Attention, understanding, control, expectations,
and the aversive significance can affect pain
perceptions.

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 The role of psychology
21
in pain treatment
Psychological treatments are also an important
part of pain management. Understanding and
managing the thoughts, emotions and behaviors
that accompany the discomfort can help you
cope more effectively with your pain — and can
actually reduce the intensity of your pain.

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Acute pain is mostly treated with pharmacological

interventions. However, chronic pain has proved to be
more resistant to such approaches . The goals of the
treatment is to
1- Improving physical and lifestyle functioning: this
involves improving muscle tone, improving self-esteem
and decrease pain behavior and secondary gains.

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 continuing
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2- Decreasing reliance on drugs and medical

services: this involves personal control,
decreasing the sick role and increase self-
efficacy.
3- Increasing social support and family life: this
aims to increase optimism and distraction and
decrease anxiety

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 Summary
25

1- We defined psychological pain;

2- Explained the gate control theory;
3- Also we describe the psychological factors in
pain perceptions and in pain treatment.

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