6. Psychology of chronic pain Flashcards
Function of pain?
– Unpleasant therefore alerts us to the potential damage to the body
– May also signal onset of disease help-seeking behaviour
• People with congenital universal insensitivity to pain (CUIP) usually die at a young age because of failing to respond to illnesses of which the main symptom is pain (e.g., appendicitis) or avoid situations that risk their health
Risk of continuous pain?
But if pain continues, it becomes destructive and problematic
Pain classification?
• Acute pain • Chronic pain – Chronic recurrent pain – Chronic benign pain – Chronic progressive pain
What is acute pain?
- Often the result of some specific and readily identifiable tissue damage (e.g., a broken leg, surgical lesion, toothache)
- Lasting less than 3-6 months
- Pain disappears once the damaged tissue has healed
What is chronic pain?
- Continues more than 3-6 months
- Starts with an episode of acute pain but doesn’t improve over time
- Can have identifiable cause (e.g., rheumatoid arthritis) or unidentifiable (e.g., most back pains have no known physical cause)
What is chronic recurrent pain?
repeated, intense episodes of pain separated by periods without pain. E.g.
–migraine headaches
– myofascial pain (shooting but dull pain in the jaw and muscles of the head and neck)
What is chronic benign pain?
Long-term pain that is typically present all of the time, with varying levels of intensity
– E.g., chronic low back pain
What is chronic progressive pain?
Pain becomes progressively worse as the underlying condition worsens
– E.g., rheumatoid arthritis
What is the specificity theory as a biological model for pain?
There are pain receptors in the skin when activated transmit information to a centre in the brain that processes pain-related information
The sensation of pain is a direct representation of the degree of physical damage experienced by the individual
3 factors which contradict the specificity theory of pain?
– We experience pain in the absence of pain receptors: e.g., phantom limb pain
– ‘Pain receptors’ that do not transmit pain:
congenital universal insensitivity to pain (CUIP)
– Psychologicalinfluencesonpain:mood, attention, cognitive factors (e.g, expectations)
In the gate control theory, what is the gate?
- A ‘gate’ is used as a metaphor for the chemicals, including endorphins, that mitigate the experience of pain
- Takes into account both the sensory information and the psychological processes
Depressed or anxious individuals report the equivalent pain stimulus as ______ ________ than people who are not depressed or anxious
Depressed or anxious individuals report the equivalent pain stimulus as more painful than people who are not depressed or anxious
Relationship between attention and pain?
• Focusing on pain seems to increase its impact and focusing on other things seems to reduce it
This explains why patients suffering from back pain who take to their beds take longer to recover than those who carry on working and engaging with their lives
Bed rest is no longer the main treatment option
What is a potential explanation for acute progression to chronic pain based on attention?
Attentional bias may explain why some people with acute pain develop chronic pain in the absence of physical injury or inflammation:
– Responding acute pain with fear/worry and checking for pain sensations may lead to experiencing further pain
– May stop engaging in activities in case it triggers pain which in turn leads to disability and chronic pain
What is the relationship between cognition and pain?
Meaning of pain e.g. childbirth
Catastrophizing
Expectations of pain relief
What are the 3 components of catastrophizing?
– Rumination: focus on internal & external info. E.g., “I can
feel my neck click every time I move”
– Magnification: overestimating the extent of threat. E.g., “The bones are crumbling & I will become paralysed”
– Helplessness: underestimating resources. E.g., “Nobody understands how to fix the problem and I just can’t bear any more pain”
What emotions are associated with chronic pain?
High levels of anger, fear and sadness
(Due to worry about pain chronic pain patients described their experiences over a week period. Reported both pain and non-pain related worry. Pain-related worry was seen as more difficult to dismiss, more distracting, more attention- grabbing, more intrusive, more distressing and less pleasant than non-pain related worry (Eccleston et al., 2001))
Levels of depression are high among people with ____ _____
Levels of depression are high among people with chronic pain
• Prevalence rates for major depression:
– In pain clinics or inpatient pain programmes: 52%
– In orthopaedic or rheumatology clinics: 56%
Describe the reciprocal relationship between despression and pain?
- Depression —> focusing on bodily symptoms more and reporting pain symptoms more
- Pain –> strain of living with pain & restrictions on life depression
What are 4 pain behaviours?
– Facial or audible expression (e.g., clenched teeth and moaning)
– Distorted posture or movement (e.g., limping, protecting the pain area)
– Negative emotions (e.g., irritability, depression)
– Avoidance of activity (e.g., not going to work, lying
down)
What are 3 “gains” associated with pain?
Pain behaviours are reinforced through attention, the acknowledgement they receive, and through ‘gains’:
- Primary (intrapersonal) gain: When expressions of pain results in reduction or cessation of an aversive consequence (e.g., someone taking over a household chore)
- Secondary (interpersonal) gain: When pain behaviour results in a positive outcome, e.g., expressions of sympathy or care
- Tertiary gain: feelings of pleasure/satisfaction that the person who is helping the pain sufferer experience when they help
What are the 5 D’s
- Dramatization of complaints
- Disuse through inactivity
- Drug misuse as a result of over-medication in response to pain behaviour
- Dependency on others due to learned helplessness and impaired use of personal coping skills
- Disability due to inactivity
Social support that aids pain relief?
Discouraging avoidance of physical and social activities, offering assistance by generating multiple solutions to problems, and providing emotional support (e.g., sharing sad and pleasant events)
pain management difference between chronic and acute pain?
- Acute pain: usually with pharmacological interventions
- Chronic pain: manage pain with psychological approaches to minimise the amount of painkiller and maintain/improve quality of life
