Biopsychosocial and Pain Flashcards
In response to a stressor, ___________ and the___________ are
activated
Hypothalamic-pituitary-adrenal axis (HPA); Sympathetic adrenal medullary system (SAM)
Sympathetic adrenal medullary system is a fast response to sudden stress (fight or flight) that results in… (6 points)
- Increased CV response
- Increased respiration
- Increased perspiration
- Increased blood flow to muscles
- Increased muscle strength
- Increased mental activity
Hypothalamic-pituitary-adrenal axis stimulates what production?
Hormone
HPA stimulates hormone production which causes (3 points)
- Slower response that results in cortisol secretion – the stress hormone – which increases access to energy stores, increases protein and fat mobilization
- Suppresses immune system and increases blood pressure
- Provides a steady source of fuel to deal with stressful situation
- Good thing in general, but if stress is chronic or excessive, it can lead to illnesses such as cardiovascular disease, autoimmune diseases, affective disorders, and major depression
- Prolonged or repeated activation of the HPA and SAM systems can interfere with their control of other physiological systems, resulting in increased risk for physical and psychiatric disorders
What is Acute Stress?
Something is of short duration (ex. Car accident, being late, exam)
What is Chronic Stress?
things that are of long, and probably uncertain duration (ex. Relationships, work demands, financial demands) MOST TOXIC, leads to long-term or permanent changes in the emotional, physiological, and behavioral responses that influence susceptibility to and course of disease
What is Psychoneuroimmunology?
Association between psychological factors and susceptibility to infections (or other signs of impaired immunity)
- Basic idea: that psychological experiences can make us more vulnerable to infection or can protect us from infection (or other signs of impaired immunity)
Sheldon Cohen: ““Associations between psychological stress and disease have been established, particularly for depression, CVD, and HIV/AIDS.”
What are the 2 types of immunity?
- Cell level attack on infectious agents to kill directly
- Antibody immunity-production of cells that specifically bind to infectious agents – produced only when exposed to the agent – mechanism of vaccination
Can the influence of stress on health work through other factors?
Yes
Stress is _____________ with immune functioning. This is mostly demonstrated for _____________ immunity and less clear for _____________ immunity
Negatively associated; cell; antibody
What did Sheldon Cohen’s group found? (4 points)
Higher stress is associated with:
1. Higher incidence of illness from viral exposure
2. More symptoms
3. More and prolonged (inappropriately) immune response (Excessive immune response is associated with more/stronger illness symptoms)
4. An overactive immune system (associated with autoimmune diseases such as rheumatoid arthritis, lupus) is associated with stress
What is the relationship between stress and wound healing?
The relationship between stress and wound healing may be made worse by pain.
- In one study (McGuire et al , 2006) higher levels of post-surgical pain was related to delayed healing of a wound
Is pain a learned response? Why or why not?
Yes. Pain is a learned response. Tissue damage sends nociceptive signals to the brain. If the brain senses danger it creates more neural pathways to solve the problem. However, the pain processing pathways get larger and steal resources from other brain areas meaning the pain processing section gets bigger.
What is the 1st law of neuroplasticity?
1st Law of Neuroplasticity. Whatever you think, feel or do is hardwired in the brain.
Whiplash VS Demolition. Why do whiplash injuries sometimes last longer than demolition injuries?
Possible answer: they chose to do demolition = no danger signals, whiplash = shock, danger detected
How does the brain sense danger? (4 points)
- Emotions like fear, anger, anxiety, frustration etc.
- Unresolved trauma: interpersonal trauma - epigenetic changes, sometimes higher pain
- Personality traits: those who are highly sensitive,
emotional, high standards, put others before self send more pain signals - Women are more likely to experience epiplastic change
What is the relationship between fear and pain?
It is cyclical. Fear can increase pain and the pain can increase fear. Therefore, by learning to let go of the fear of chronic pain, pain can lessen
__________ have pain after the tissue is healed. __________ and Nociplastic DONT OVERLAP -> Different locations activated in brain but feels the same
Nociplastic people; Nociceptive
Explanation of pain modulation in the brain
We sense pain when brain tells us. Amps pain when body senses danger.
What is an example of pain modulation
Phantom Limb Pain, Athlete who continues playing despite a serious injury. 75% of amputees suffer from Phantom Limb Pain.
Solution: Neuroplasticity is both the cause and cure for chronic pain
WAYS TO HELP YOUR PAIN: Does pain = tissue damage?
No. Most people have “findings” on the MRI but they are not actually abnormalities and are normal signs of aging
- Just understanding can decrease pain by 20%
WAYS TO HELP YOUR PAIN: Understanding that _________ Do not Cause Pain.
Triggers
- Triggers like cold, smells, weather changes, foods, physical activity, and emotions cause neural conditioning which causes pain
- Trigger causes neuroconditioning, hardwired
WAYS TO HELP YOUR PAIN: Pain Caused by the Brain Is __________ from Pain Originating in Tissues
Indistinguishable.
1. Pain is pain
2. It is real and measurable
3. People with brain pain are not faking
4. It is caused by unconscious brain circuits
5. Unless you know this, you can’t change it
WAYS TO HELP YOUR PAIN: Make ___________ with your Pain
Friends.
1. Pain is your brain’s attempt to keep you safe
2. It is an opportunity to get to the root cause
3. Observe your pain mindfully
4. Meet your sensations with calm, ease, understanding, and kindness
5. Breathe into them, train yourself to face them, tolerate them and detach from them
What is Active Redirection?
A Neuron Cannot Do Two Things at Once. Try to do things you enjoy to distract from the pain keep your neurons occupied. use each awareness of pain as an opportunity to actively engage in an activity that
1. Occupies lots of neurons (focused attention)
a. Acetylcholine (ACh) only happen with attention
2. Is fun, meaningful or creative
3. Overrides pain
Examples: Self talk, soft touch, exercise, empathy, calming scents, visualize the bain cooling down
What does Danger in Me (DIMs) mean?
Refer to experiences associated with danger. DIMs increase pain perception
NOT just thinking, it requires the brain
What does Safety in Me (SIMs) mean?
Refer to experiences associated with safety. SIMs decrease pain perception
NOT just thinking, it requires the brain
Breath into the __________, breath out any __________
pain; signs of danger
How do you identify emotional or situational triggers?
- Ask yourself “why is my brain signaling danger?”
- Am I angry, sad, scared?
- Am I in a situation that is a reminder of trauma?
- Am I being kind to myself?
WAYS TO HELP YOUR PAIN: Let Go of the Feelings
- Write about the emotion or situation
- Conerse with your pain - figure out how it is trying to help you
- Talk to yourself at the age the pain started
- Talk to your future self after you are completely recovered
What Type of Pain Will Respond?
Almost all types of persistent pain not associated with acute inflammation or nerve compression
1. Fibromyalgia pain
2. Phantom limb pain
3. Migraine
4. Neuropathic pain
5. IBS
6. Arthritis
What is the General Timeline for Pain Response?
- Start Nothing
- 4 weeks: Immediate effect
- 8-12 weeks: Residual effect
- 12-24 weeks: Unplanned effect
- 6 months: Less pain overall
Days to a few weeks - can feel the effect
Practice 1 hour/day for 6 months: most will go away
People Who Do Well Will… (5 points)
- Maintain the discipline of daily practice no matter what
- Change inner and outer dialogue to focus on the life you want rather than the pain
- Commit to do something different each time you notice pain
- Do whatever it takes
- Whining may increase the pain
Chronic pain is caused by…
Caused by the brain and can be healed by the brain
- Unlike tissue damage because it may be reversible
