Practise pain types and gate control, clinical, rating and observational assessment, and biological, psychological or alternative management through evidence.
Explain one strength of the gate control theory of pain, from the nurture side of the debate.
Explain one strength of the gate control theory of pain, from the nurture side of the debate.
Award 2 marks for a detailed explanation of the strength in context.
Award 1 mark for a basic outline/identification of strength.
Strengths might include:
- Application to everyday life: This theory suggests that when someone experiences pain, they have some control over this perception. Techniques such as imagery and attention diversion can be learned and used to help close the gate and reduce pain.
- Free will: Pain is something that people have control over. The perception of pain is not something we are born with but something where we can exert some control through learning (nurture) techniques to reduce this pain (close the gate).
- Holistic: Gate control theory is a more holistic explanation of pain by extending specificity theory to include psychological gates. These psychological gates can be due to learning. For example, a young child will often look to their carer when they hurt themselves. The child often cries more if their carer seems concerned about their injury.
Example:
Gate control theory suggests that pain can be controlled through learning how to close the psychological gates which will reduce the perception of pain. (1) This has good applications to everyday life as patients can be taught techniques such as imagery or attention diversion to reduce their experience of pain. (1)
Other appropriate responses should also be credited.
2
Context = gate control theory of pain
From the key study by Brudvik et al. (2016) on pain assessments by doctors, parents and children:
Outline one rating scale completed by the 3-8-year-old children.
Outline one rating scale completed by the 3-8-year-old children.
Syllabus: 3.3.2 Key Study on comparing pain assessments by doctors, parents and children: Brudvik et al. (2016).
Marks: Award 2 marks for a detailed outline.
Award 1 mark for a partial outline.
Definitive answers:
- the Wong-Baker Faces Pain Rating Scale (1) which has 6 faces showing 0-10 increasing levels of pain (2)
- the Faces Pain Scale (FPS-R) (1) which also has 6 faces with a 0-10 scale (0, 2, 4, 6, 8, 10) (2).
Outline one rating scale completed by the 9-15-year-old children.
Outline one rating scale completed by the 9-15-year-old children.
Award 2 marks for a detailed outline.
Award 1 mark for a partial outline.
Definitive answers:
- the Visual Analogue Scale (VAS) (1) often a line drawn on paper with a severity scale. Like the 'Coloured' below, but without colours (2)
- the Coloured Analogue Scale (CAS) (1) which has a line on a piece of paper with pain severity ranging from 0 (green) to 100 (red) (2)
Suggest one way in which a child's pain can be assessed, other than using a rating scale.
Suggest one way in which a child's pain can be assessed, other than using a rating scale.
Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example.
Award 1 mark for an appropriate suggestion identified but not applied.
Answers may include:
- by using a clinical interview (1) the child can be asked questions (at a young child's level) such as 'point to where it hurts' (2)
- by observing the child's behaviour (1) such as whether they are crying, limping, holding an area (2).
NOTE: 0 marks for MPQ (because it is for adults); 0 marks for PPQ (which is for children but uses a rating scale).
Other appropriate responses to be credited.
Explain two weaknesses with the rating scales used by the 3-8-year-old children.
Explain two weaknesses with the rating scales used by the 3-8-year-old children.
Up to 2 marks for each weakness ×2.
Award 2 marks for an appropriate weakness stated and applied as required by the question with detail / elaboration / example.
Award 1 mark for an appropriate weakness stated but not applied.
Answers may include:
- children might be in too much pain (1) to want to complete a rating scale such as the Wong-Baker faces scale (2)
- children may not understand what they are required to do (1)
- the measure is not valid ( 1 ) the 'smiley face' may not translate into actual pain or the type of pain the child is experiencing (2)
- the smiley face may not be reliable (1), but then again, the level of pain can also change (2).
NOTE: 0 marks for response bias/social desirability (participant bias, not rating scale)
Other appropriate responses to be credited.
Explain what is meant by 'mirror treatment' for phantom limb pain.
Explain what is meant by 'mirror treatment' for phantom limb pain.
Syllabus: 3.3.1 functions of pain; types of pain: acute and chronic pain. Focus on phantom limb pain and mirror treatment to include a case study, e.g. MacLachlan et al. (2004).
Marks: Award 2 marks for a detailed explanation. Award 1 mark for a partial explanation.
Answers may include (other appropriate responses to be credited):
Note: answers may be general, or they may involve a description of the case of Alan (MacLachlan et al.)
- it involves the use of a mirror (mirror box). The patient moves the good limb and observes the reflection. As the patient sees the good hand/leg moving it appears as if the phantom limb is also moving. If there is no pain in the good limb, there is no pain in the phantom limb.
- Alan sits in front of a mirror and performs various exercises, such as bending his legs. The exercises are repeated. Over time the process is repeated without a mirror.
Suggest one biological/biochemical way in which phantom limb pain can be treated.
Suggest one biological/biochemical way in which phantom limb pain can be treated.
Marks: Award 2 marks for an appropriate suggestion stated and applied to study with detail / elaboration / example.
Award 1 mark for an appropriate suggestion identified but not applied.
Answers may include (other appropriate responses to be credited).
- biochemical: the use of biochemical treatments (drugs) to relieve pain (1 mark). Neurontin is a medication used where there is nerve damage (can help manage certain epileptic seizures and relieve pain for some conditions) (2 marks).
- alternative: TENS (transcutaneous electrical nerve stimulation) (1 mark). TENS therapy involves the use of low-voltage electric currents to the skin which release endorphins ('biological') which help to manage pain ( 2 marks).
Note: 0 marks psychological: attention diversion, non-pain imagery or cognitive redefinition.
Explain two strengths of mirror treatment for phantom limb pain.
Explain two strengths of mirror treatment for phantom limb pain.
Marks: Up to 2 marks for each strength ×2
Award 2 marks for an appropriate strength stated and applied as required by the question with detail / elaboration / example.
Award 1 mark for an appropriate strength stated but not applied.
Answers may include (other appropriate responses to be credited): Strengths:
- the treatment does not have side effects / addiction (1 mark) as might occur with biochemical treatments (2 mark)
- the treatment does not involve creating pain (1 mark) as might occur with stimulation therapies such as TENS (2 marks)
- mirror treatment has been shown to be effective (1 mark) e.g. in the study by MacLachlan et al (2004) on Alan; also in the study by Ramachandran (1998) (2 marks)
- the treatment can be applied by the person with phantom limb pain at home (1 mark) and so can be applied actively by the person whenever they with relief from their phantom limb pain (2 marks).