Deprescribing Jessica Visco, PharmD, CGP SeniorPharmAssist August 24, 2016 Deprescribing Jessica Visco, PharmD, CGP SeniorPharmAssist Webinar #1 Webinar #20 A Brief Overview of Pain Coping Skills Training Rationale and Strategies Laura Porter, Ph.D. Department of Psychiatry & Behavioral Sciences Duke University School of Medicine
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A Brief Overview of Pain Coping Deprescribing · August 24, 2016 Deprescribing Jessica Visco, PharmD, CGP SeniorPharmAssist Webinar #1 Webinar #20 A Brief Overview of Pain Coping
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DeprescribingJessica Visco, PharmD, CGP
SeniorPharmAssist
August 24, 2016
Deprescribing
Jessica Visco, PharmD,
CGP
SeniorPharmAssist
Webinar #1Webinar #20
A Brief Overview of Pain Coping Skills Training Rationale and Strategies
Laura Porter, Ph.D.
Department of Psychiatry & Behavioral Sciences
Duke University School of Medicine
Disclosures No commercial support has influenced the planning of the
educational objectives and content of the activity. Any
commercial support will be used for events that are not CE
related.
There is no endorsement of any product by DUHS
associated with the session.
No influential financial relationships have been disclosed by
planners or presenters which would influence the planning of
the activity. If any arise, an announcement will be made at
the beginning of the session.
This program is supported by a Geriatric Workforce
Enhancement Program (GWEP) grant (U1QHP28708) from
the U.S. Bureau of Health Professions Health Resources
and Services Administration (HRSA).
Objectives
Describe the evolution in our understanding of pain
Summarize research on psychological processes in pain
Identify common, effective pain coping skills
Identify key components in training patients to use pain
coping skills
Describe the role of family caregivers in pain coping
Identify methods of assessing pain and applying pain
coping skills in patients with dementia
Traditional Model of Pain
• Pain is often viewed
as a sensory event
• Due to tissue
damage
• Treat injury/disease,
pain will be relieved
OUCH!
R. Descartes (17th Century)
Pain
Evolution of Pain Models
• Newer theories and
research about pain
indicate pain is a
multidimensional
experience
Sensory
Affective
Cognitive
Motivational
Brain Imaging
Studies
Evolution of Pain Models
The Pain Neuromatrix
Neuromatrix Theory
Sensory inputs
Visual and other inputs that influence cognitive interpretation
Phasic and tonic cognitive-emotional inputs from brain
Activity of body’s stress regulation systems
• Produce pattern that evokes pain
Key Point: A patient’s thoughts, emotions and behaviors (appraisals and coping efforts) shape and influence the pain experience
Pain as a Stressful Event
Outcome 1
Persistent Outcome 2
Pain
Outcome 3
Stress and Coping Theory (Lazarus and Cohen, 1977)
Persistent
Pain Appraisal Outcome
Conscious judgments:
• Judgment of painful event as
benign/irrelevant vs. threat/harm/loss
• Judgment of what can be done
Threat/Loss Appraisal
A B C
Event Appraisal Feelings/Behavior
“I can’t cope.
Pain flare There is nothing ???
I can do. I will end
up in a wheelchair”
Threat/Loss Appraisal
A B C
Event Appraisal Feelings/Behavior
“I can’t cope. Fear
Pain flare There is nothing Depression
I can do. I will end Avoidance
up in a wheelchair” Irritability
A Different Type of AppraisalA B C
Event Appraisal Feelings/
Behavior
Pain flare “ I know this will ???
be tough but I
know some things
I can do to manage
it.”
Effects of a Challenge
AppraisalA B C
Event Appraisal Feelings/
Behavior
Pain flare “ I know this will Concerned, but
be tough but I confident;
know some things pacing
I can do to manage activites
it.”
Findings from cross-sectional and
longitudinal studies
Pain coping
&
Appraisal
Outcomes
-Reports of pain – intensity, interferene, reports