Define Quality of Life and Explain How It Is Evaluated

Objective 1: Define quality of life and explain how it is evaluated.

Scope of issue
-At any given time, 58% of the population has a chronic condition.

-More than 1/3 of adults aged 18-44 have at least one chronic condition.

-Most of us are likely to develop at least one chronic condition that may lead to our death.
-Chronic conditions account for 2/3 of Canada’s health spending.

-Chronic conditions are more common among lower-income Canadians, women, and seniors.

Quality of life

-The degree to which a person is able to maximize his/her physical, psychological, vocational, and social functioning; includes disease or treatment related symptoms.

-Emphasis placed on daily living, such as sleeping, eating, going to work, and engaging in social activities.

-Quality of life is an important indicator of recovery from or adjustment to chronic illness.

Evaluating Quality of Life

-An important aspect of quality of life is people’s perceptions of their own health (self-report)

• Better indicator of mortality than objective measures (ex. Physiological measures)
• People overall accurate about own quality of life
• Health questionnaires/surveys with Likert response scales.

• e.g., Would you rate your health as poor, fair, good, or very good?

• Discussion: Is self-reported health, as measured by the above example, a physical or psychological variable? Psychological variable (self-reported health)

-Medical Outcomes Short Form Health survey (health in 8 different domain including social aspects)

-Satisfaction with Life Scale: indicate your agreement with each item using a scale of 1 (strongly disagree to 7 (strongly agree); less specific only 5 questions

Objective 2: Understand the limitations of the biomedical perspective in addressing pain, and

define pain according to the International Association for the Study of Pain.

Why focus on pain?

-Pain is the symptom of greatest concern to patients.→ And the most likely to lead them to use health services.

-Pain is also heavily influenced by psychosocial processes 

-pain serves a purpose…

• Intrapersonal: Warns of tissue damage, injury, disease.
• Interpersonal: Warns others; evokes empathy and care

-BUT, pain also leads to poor health behaviors, loss of employment, depression/fear/anxiety, social isolation, sleep disorders, marital and family dysfunction (biopsychosocial context)

Physiology of Pain Experience

-The signal goes to the spinal cord where it immediately passes to a motor nerve (1) connected to a muscle (e.g., arm).

-This causes a reflex action that does not involve the brain.

-But the signal also goes up the spinal cord to the thalamus (2) where the pain is perceived.

Gate control theory: Neural pain gate in spinal cord opens or closes to modulate pain signals to the brain. Involves inhibitor and projector neurons that respond to somatosensory input and send certain signals to the brain.

**specificity theory: 1:1 (amount of pain proportional to tissue damage)

[pic 1]

Biomedical approach

-Assumption of one-to-one correspondence to injury/disease.

• BUT correlations are low; pain experience is far more than activity in peripheral nociceptors.

-Unfortunate practices (e.g., blaming the patient, assuming psychiatric disorder or intentional faking of symptoms).

-Focus on pharmacological, surgical, or other medical interventions to control pain.

Pain without (known pathology)

-AMA Guides to the Evaluation of Permanent Impairment,       5th Edition (2000)

• “… in up to 85% of individuals who report back pain, no pain-producing pathology can be identified…”

-Fibromyalgia - chronic widespread pain and heightened pain response to pressure.

• Appears to result from neurochemical imbalances (including activation of inflammatory pathways in brain); results in abnormal pain processing.
• But controversy ensues, and patients are often mistreated or ignored.

-need to take biopsychosocial perspective: biology (injury, tissue damage, nervous system, somatic sensation, etc.), social (sensory, cognitive, and emotional factors), social (isolation, relationship health social support, work setting, etc.) → wellbeing

Definition of Pain (international association for study of pain)

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Biopsychosocial perspective

described in terms of such damage: recognize that people can describe pain even though there is no physical damage

“pain is always subjective”

Coping with pain

Adaptive Coping → Relaxation, distraction, redefinition; Readiness to change, taking active role (+ self-efficacy).

• Acceptance → Patients’ lives are often consumed by unsuccessful efforts to eliminate pain.

Maladaptive Coping → Destructive forms of thinking.

• Catastrophizing: magnification, rumination, & helplessness.

• Primary appraisal: focusing on and exaggerating the threat value of pain
• Secondary appraisal: appraisals of helplessness and of inability to cope

[pic 2]

[pic 3]

Objective 3: Explain the different methods for measuring pain.

self report measure of pain (psychological variable)

Wong-Baker FACES Pain Rating Scale → asks patients to rate how much something hurts

Measure of joint pain

Nonverbal measures of pain

-Pain behaviours are observable behaviours that occur in response to pain.