Managing and controlling pain — practice questions

(a) Multimodal plan:

1. Medication review — taper opioids under medical supervision; add NSAIDs or gabapentin (neuropathic component).
2. TENS unit for daily home use.
3. CBT programme — 8 sessions targeting catastrophising.
4. Physiotherapy — graded exercise to rebuild function.
5. Mindfulness/relaxation training.
6. Pain clinic referral for coordinated care.

(b) Theory links:

• TENS: Applies gate control theory — electrical stimulation activates large-diameter A-beta fibres, closing the gate in substantia gelatinosa. Provides competing sensory input Elena can control.
• CBT: Addresses psychological gate-openers — catastrophic thoughts ("I'll never work again") increase anxiety and pain focus, keeping gate open. CBT replaces catastrophising with coping statements, reducing pain-related disability per biopsychosocial model.

(c) Evaluation — psychological vs pharmacological:

Psychological (CBT, distraction):

• Strengths: No side effects or addiction risk; improves function and quality of life even when pain intensity unchanged; addresses chronic pain where drugs fail; long-lasting skills.
• Limitations: Requires motivation and cognitive capacity; slower onset than drugs; access to trained therapists limited on NHS.

Pharmacological (opioids, NSAIDs):

• Strengths: Rapid relief for acute pain; essential post-surgery; NSAIDs reduce inflammation at source.
• Limitations: Opioids — tolerance, dependence, hyperalgesia (ironically increased pain sensitivity with long-term use); do not address psychological maintenance of chronic pain; Milgram parallel — patients may passively comply with prescription without questioning.

Judgement: For Elena's chronic pain, psychological + physical approaches should be primary with pharmacological as adjunct — reversing the typical over-reliance on opioids.

(a) Mean Calculation:

• Pre-Programme Mean:
  • Sum of scores = 8 + 7 + 9 + 6 + 8 = 38
  • Mean = Sum / Number of patients = 38 / 5 = 7.6
• Post-Programme Mean:
  • Sum of scores = 5 + 4 + 6 + 4 + 5 = 24
  • Mean = Sum / Number of patients = 24 / 5 = 4.8

(b) Percentage Reduction Calculation:

• Formula: ((Initial Mean - Final Mean) / Initial Mean) * 100%
• Reduction in mean score = 7.6 - 4.8 = 2.8
• Percentage Reduction = (2.8 / 7.6) * 100%
• Percentage Reduction = 0.3684... * 100% ≈ 36.8%

(c) Strength of Quantitative Data:

• Using quantitative data like VAS scores allows for objective comparison and statistical analysis. It makes it possible to clearly measure the magnitude of change (e.g., a 36.8% reduction), which is more precise than qualitative descriptions like 'feeling a bit better'. This objectivity helps researchers and clinicians determine if an intervention is clinically effective and compare its effectiveness against other treatments.