4 - Stress/Coping, Addiction, Behavioral Pain Flashcards
(Pain)
Two Main Pathways
Sensory/Discriminative Pain = Where
Affective-Motivational Pain = How much pain*
*Detrimental during chronic situations
(Pain)
Periaqueductal Gray
Modulate pain
(Pain)
Amygdala
Anxiety in psychiatry, fight or flight, etc.
(Pain)
Modulation Pathway
Periaqueductal Gray
I
Dorsal Raphe Nucleus (Serotonin)
I
- Ascending to Thalamus
- Descening to Spinal Cord (turn down pain signal)
(Pain)
Allodynia
Hyperalgesia
Allodynia - Painful non-noxious stimuli
Hyperalgesia - Mildly painful stimuli become much more painful
SUNBURN:
Allodynia = putting on your shirt
Sunburn gives you Hyperalgesia
(Pain)
Pain Tolderance Spectrum
Motivation Pathways ?
Increased Activation ?
Anterior Cingulate Cortex (ACC), PreFrontal Cortex (PFC)
Somatosensory Cortex
(Pain)
What gene may govern pain sensitivity?
COMT
(Pain)
What areas of brain play a role in Placebo?
Dorsolateral Prefrontal Cortex - Cognitive Control
Orbitofrontal Cortex - Evaluative/Reward
Periaqueductal Gray - Enkephalin neurons, modulation of dorsal raphe nucleus (serotonin–down regulate pain)
(Pain)
Stress-Induced Analgesia
Under extreme stress, pain sensors can be shut down
(Pain)
Chronic Pain
Neuropathic Pain dervies from nerve injury, not tissue damage
(Pain)
Pain Memory - Phantom Pain
After amputation, patients sometimes continue to experience pain that was present prior to the surgery
Local anesthesia in affected limb prior to surgery can help
(Pain)
Gray Matter Loss
Chronic pain can cause brain atrophy; hinder ability to down regulate pain
(Pain)
Early vs Late Stages of Pain
Early: Acute, Fear, Anxiety
Middle: Learned helplessness, depression, anger, substance abuse
Late: Acceptance of “sick role”, excused from socual obligations
(Pain)
Depression & Antidepressants
Target Serotonin / Norepinephrine
(Pain)
Addiction in Patients with Pain
Those in pain are vulnerable to addiction, esp. Optiates, gain addiction following trauma
(Pain)
Aberrant Behaviors in Patients with Pain
Selling RX drugs
Forging RX
Stealing drugs
Using other non-prescribed drugs
(Addiction)
Dependence
Tolerance
Withdrawal
Addiction
Dependence: Need for drug to avoid withdrawal
Tolerance: Repeated use requires more for same effect
Withdrawal: Physical/psychological symptoms, keep people form quitting
Addiction: Inability to control drug use, impulsive/compulsive behavoiors
(Addiction)
Dependence vs Addiction
Dependence: includes withdrawal
Addiction: impulsive behaviors
(Addiction)
Reward center of brain?
Neurotransmitter?
Nucleus Accumbens
Dopamine
(Stress)
Define Stress
Any emotional experience accompanied by predictable biochemical, physiological and behavioral changes
(Stress)
Purpose
Focuses attention toward problem resolution, orients to threat or demands
(Stress)
Fight or Flight
Predictable cognitive, emotiona, and physiological reactions to stress
(Stress)
Major brain areas?
Amygdala in temporal lobes, hypothalamus
Hypothalamus communicates information through nervous system
(Stress)
Autonomic Nervous System
Divisions
Controls involuntary body functions (homeostasis)
Sympathetics (epinephrine) - Fight or Flight
Parasympathetics (norepinephrine) - Rest and Digest
(Stress)
What is the primary and secondary activations in stress?
Primary: Epinephrine (Fight or Flight)
Secondary: HPA Axis - Hyptothalamus, Pituitary, Adrenal
Sympathetic will remain engaged if threat perceived
(Stress)
General Adaptation Syndrome
- Alarm: React, First: SNS, Second: HPA Axis
- Resistance: Adaptation to stress, Cortisol
- Exhaustion: Resources depleted
(Stress)
Completion of threat?
Cortisol decrease
Parasympathetic Nervous System engaged
(Stress)
Danger of chronic cortisol release
weight gain
(Stress)
Dysfunctional Stress - Adverse Child Experiences
Abuse, neglect, ill parent, drug/alc abuse, divorce, violence
(Stress)
Diathesis-Stress Model
Diathesis: Biological/Social/Psychological Factor
+
Stress: Biological/Social/Psychological Trigger
=
Disorder
