6. Psychology of chronic pain

Question 1

Function of pain?

Answer 1

– 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

Question 2

Risk of continuous pain?

Answer 2

But if pain continues, it becomes destructive and problematic

Question 3

Pain classification?

Answer 3

• Acute pain
• Chronic pain
– Chronic recurrent pain
– Chronic benign pain
– Chronic progressive pain

Question 4

What is acute pain?

Answer 4

• 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

Question 5

What is chronic pain?

Answer 5

• 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)

Question 6

What is chronic recurrent pain?

Answer 6

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)

Question 7

What is chronic benign pain?

Answer 7

Long-term pain that is typically present all of the time, with varying levels of intensity
– E.g., chronic low back pain

Question 8

What is chronic progressive pain?

Answer 8

Pain becomes progressively worse as the underlying condition worsens
– E.g., rheumatoid arthritis

Question 9

What is the specificity theory as a biological model for pain?

Answer 9

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

Question 10

3 factors which contradict the specificity theory of pain?

Answer 10

– 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)

Question 11

In the gate control theory, what is the gate?

Answer 11

• 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

Question 12

Depressed or anxious individuals report the equivalent pain stimulus as ______ ________ than people who are not depressed or anxious

Answer 12

Depressed or anxious individuals report the equivalent pain stimulus as more painful than people who are not depressed or anxious

Question 13

Relationship between attention and pain?

Answer 13

• 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

Question 14

What is a potential explanation for acute progression to chronic pain based on attention?

Answer 14

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

Question 15

What is the relationship between cognition and pain?

Answer 15

Meaning of pain e.g. childbirth
Catastrophizing
Expectations of pain relief

Question 16

What are the 3 components of catastrophizing?

Answer 16

– 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”

Question 17

What emotions are associated with chronic pain?

Answer 17

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))

Question 18

Levels of depression are high among people with ____ _____

Answer 18

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%

Question 19

Describe the reciprocal relationship between despression and pain?

Answer 19

• Depression —> focusing on bodily symptoms more and reporting pain symptoms more
• Pain –> strain of living with pain & restrictions on life  depression

Question 20

What are 4 pain behaviours?

Answer 20

– 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)

Question 21

What are 3 “gains” associated with pain?

Answer 21

Pain behaviours are reinforced through attention, the acknowledgement they receive, and through ‘gains’:

1. Primary (intrapersonal) gain: When expressions of pain results in reduction or cessation of an aversive consequence (e.g., someone taking over a household chore)
2. Secondary (interpersonal) gain: When pain behaviour results in a positive outcome, e.g., expressions of sympathy or care
3. Tertiary gain: feelings of pleasure/satisfaction that the person who is helping the pain sufferer experience when they help

Question 22

What are the 5 D’s

Answer 22

1. Dramatization of complaints
2. Disuse through inactivity
3. Drug misuse as a result of over-medication in response to pain behaviour
4. Dependency on others due to learned helplessness and impaired use of personal coping skills
5. Disability due to inactivity

Question 23

Social support that aids pain relief?

Answer 23

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)

Question 24

pain management difference between chronic and acute pain?

Answer 24

• 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

Question 25

modes of pain measurement?

Issues and benefits..

Answer 25

• Numerical rating scales: 0 (no pain) to 100
(the most pain you could imagine)
• Descriptive adjectives: mild, distressing, excruciating so on
Good: Easy to administer
Difficult to quantify pain and miss the subtleties in pain experiences
Simplistic
Measure only the sensation but pain is multi- dimensional
Bad:

Question 26

What does the McGill pain questionnaire look at?

Benefits of this measurement technique?

Answer 26

1. Type of pain: throbbing, shooting, hot, tender, etc
   using a 4-point scale (none to severe)
2. Emotional responses: tiring, fearful, punishing etc.
3. Intensity of pain: ‘no pain’ to ‘worst possible pain’
4. Timing of pain: brief, continuous, or intermittent

More difficult to administer but captures a multidimensional nature of pain

Question 27

Name examples of specific aspects of pain under the following categories:

1. Verbal/vocalisation
2. Motor behaviour
3. Taking meds
4. Functional limitations

Answer 27

1. Verbal/vocalisations (e.g. sighs, moans)
2. Motor behaviour (e.g. limping, facial grimacing)
3. Taking medication (e.g. use of cane etc)
4. Functional limitations (e.g. resting, reduced activity)

Question 28

Behavioural interventions Fordyce (1976): Based on operant conditioning processes.

• ->We can’t truly understand the pain experience of others but we can ______ their ‘pain behaviour’.
• ->Pain behaviour is established and controlled not only by the experience of pain but also by how others ______ to it
• ->E.g., being ‘let off’ tasks at home, given analgesia etc.

Answer 28

Behavioural interventions Fordyce (1976). Based on operant conditioning processes

• ->We can’t truly understand the pain experience of others but we can observe their ‘pain behaviour’.
• ->Pain behaviour is established and controlled not only by the experience of pain but also by how others respond to it
• ->E.g., being ‘let off’ tasks at home, given analgesia etc.

Question 29

Name 3 examples of behavioural interventions used for pain treatment?

Answer 29

1. Reinforcement of adaptive behaviours
2. Withdrawal of attention or other rewards that were previous responses to pain behaviour
3. Providing analgesic medication at set times rather than in response to behaviour

Question 30

Goals of cognitive-behavioural interventions?

Answer 30

– Help Ps alter their beliefs that their problems are manageable,
– Help Ps identify how catastrophic or other negative thoughts can lead to increased perceptions of pain, distress, and psychosocial difficulties,
– Provide Ps with strategies to manage their pain, emotional distress and psychosocial difficulties and help them develop effective and adaptive ways of thinking, feeling, and behaving

Question 31

Name 2 cognitive based interventions?

Answer 31

• Positive self-talk: to change the commentary into a positive one
• Treating thoughts and distress as hypotheses, not as truths

Question 32

Role of relaxation in pain management?

Answer 32

• Can be used to relax the whole body or specific muscle groups (e.g. on forehead or backs)
• Systematic and methodical approach to learning deep muscle relaxation
• Controlled breathing: from short/shallow breathing to deeper/longer breaths

Question 33

What is biofeedback?
Name 2 examples
Use in pain management?

Answer 33

Method of achieving control over bodily processe

E.g. EMG, galvanic skin response

Pain use:
• Help make changes guided by auditory or visual feedback on any physiological changes
• P learns how to relax their muscle tension
• Used successfully with chronic headaches