Chapter 8: Pain Flashcards
Organic Pain
pain that has a clearly identifiable physical cause
psychogenic pain
pain resulting from psychological processes
today’s scienfitic perspective on pain
today’s scientists recognize that virtually all pain experiences involve an interplay of both physiological and psychosocial factors
The effect of emotion on pain
- positive emotions appear to reduce pain
- negative emotions tend to worsen pain
- most ppl w chronic pain experience high lvls of depression, anxiety and/or anger
- emotions can also obscure the memory of pain (ex. anxiety patients’ memories of pain are determined more by what they expect than by what they actually feel
2 ways pain and stress are linked
- pain is stressful (partly due to lack of perceived control)
- stress can produce pain in addition to worsening the pain experience
Pain and meaning
pain can be more or less intense depending on the meaning of the pain underlying the injury
- ex. enjoyment of pain during sex
classical conditioning and pain meaning
classical conditioning can be one means by which the meaning of pain changes
maladaptive coping with pain
destructive thinking; helplessness
catastrophizing
frequent, magnified negative thoughts about pain; magnification, rumination, helplessness
One of the WORST ways to cope
- catastrophizing increases with pain intensity and seems to play a major role in the transition from acute to chronic pain
primary appraisal in pain
focusing on and exaggerating the threat value of pain
secondary appraisal and pain:
appraisals of helplessness and of inability to cope
adaptive coping with pain
relaxation, distraction, redefinition of pain, readiness to change, taking an active role
acceptance of pain
being inclined to engage in activities despite the pain and disinclined to control or avoid the pain
- ppl with high lvls of pain acceptance pay less attention to their pain, have greater self-efficacy for performing daily tasks, function better, and use less pain medication than those with low pain acceptance.
positive reappraisal
makes pain less severe
ex. positive self-statements - kinda like the placebo effect
social support and pain
social support reduces feelings of pain
ex. verbal support during the cold-pressor task more strongly reduced participant pain ratings compared to the mere presence of other ppl or the person being alone
social communication model of pain
when a person experiences pain they have
1. a subjective experience
2. they express that pain to a certain degree (that then has an impact on the subjective experience of the pain)
3. the other person present will be assessing that pain (formal or informal assessment)
4. the other person then may engage in some attempt to help the person manage their pain (will have an impact on their assessment - they will reassess, AND it may affect the person’s subjective experience of their pain)
social communication and pain
the social communication model places primacy on the interpersonal context of pain
- both the person in pain and the caregiver bring to the table unique qualities and characteristics that interact to influence the pain experience
- the dynamic interplay between patient and caregiver continuously influences the pain experience
- also consider: contextual factors (ex. participants exposed to pain in lab adjust their pain responses to match those of others who are present at the time)
Communal coping model of pain catastrophizing
goal: to manage distress in a social context rather than an individual one
- experiences of pain in a social context lead a person to be more likely to catastrophize (as a result, person appears less able to cope with pain)
- increased attention to pain and pain behaviour still tend to worsen the pain experience (whatever social support and benefit is not worth it to mediate the pain from catastrophizing
- the caregiver then provides support, empathy, assistance
catastrophizing and social support
- high catastrophizers display increased pain behaviour in the presence of another person (and engage in less effective coping)
- when ppl receive a supportive response from their spouse, the negative effects of catastrophizing on pain are significantly reduced
- catastrophizing tends to be harmful nonetheless
Treating the social network
the health and well-being of one’s social network also affects pain outcomes
-ex. in ppl with arthritis, spouse depression predicted increasing pain and disability over one year, controlling for their own depression
-solution? treat the social network too!
Social Pain
the experience of pain as aresult of interpersonal rejection or loss, such as rejection from a social grouo, bullying, or the loss of a loved one
- from an evolutionary perspective is adaptive - signals when social relationships are threatened
- linguistically, we describe social pain and physical pain in similar terms “hurt feelings”, or “broken-hearted”
similarities between social pain and physical pain
negatve social experiences rely on the same neural system supporting the affective component of physcial pain (dorsal anterior cingulate cortex -dACC and Anterior insula -AI)
fMRI research shows that the dACC is associated w a degree of distress/pain; the AI is associated with emotional processing
treatment of social pain
acetaminophen appears to reduce social pain
- lowers daily self-reported social pain (better than placebo)
- fMRI measures of brain activity found that acetaminophen reduced neural responses to social rejection to the dACC and anterior insula
Clinical interventions for pain
- surgical interventions
- chemical treatments
- stimulation therapies
- physical therapy and rehab
Medical methods enough for pain?
no! Medical methods alone are usually not sufficient for controlling pain, particularly when it is chronic
- bc psychosocial factors play such an important role in the pain experience and in the transition from acute to chronic pain, treating psychological factors and challenges can be essential
best apprach to treating chronic pain
a combination of pharmacological and psychological treatments!
Goals of psychological treatments
- reduce their frequency and intensity of pain
- improve their emotional adjustment to the pain they have
- increase their social and physical activity
- reduce their use of analgesic drugs
psychological treatments for pain
- fear reduction methods
- progressive muscle relaxation, meditation, and biofeedback
- cognitive methods (distraction, redefinition, promoting acceptance)
- psychotherapy (CBT) - help ppl manage the emotional difficulties associated with pain
Specificity theory of pain
pain is directly proportional to the amount of tissue damage
1. upon injury, pain messages originate in nerves associated w damaged tissue and travel to the spinal cord
2. a signal is then sent to
- motor nerve
- the brain (perceived)
Gate-control theory of pain
pain is not directly proportional to tissue damage
- a neural pain gate in the spinal cord opens or closes to modulate pain signals to the brain
look at chart on p 11 in powerpoint
Pain without known pathology
85% of individuals who report back pain, no pain-producing pathology can be identified
Neuropathic pain
results from current or past disease/damage in peripheral nerves; ppl experience pain in absence of noxious stimulus
neuralgia
extremely painful syndrome in which patient experiences recurrent episodes of intense shooting or stabbing pain along the nerve; often follows infection
causalgia
recurrent episodes of severe burning pain that are often triggered by minor stimuli
phantom limb pain
pain experienced in an amputated limb - neuropathic pain
- may be triggered by other types of input, lack of normal sensory input, or incongruence between types of input due to lack of limb
neuromatrix theory
widespread network of neurons generates a pattern that is felt as a whole body possessing a sense of self
- responsible for generating bodily snesations (incl. pain produced by CNS)
- each sensation is marked by a unique neurosignature or pattern of activation of the neuromatrix
assessing pain
-graphic rating scales
- verbal rating scales
-numerical rating scales
nonverbal measures of pain
- facial and audible expression of distress
- distortions in posture or gait
-negative affect - avoidance of activity
What symptom is the greatest concern to patients
Pain - and the most likely to lead themselves to use health services
Specificity Theory of Pain
Pain is directly proportional to the amount of tissue damage
1. Upon injury, pain messages originate in nerves associated with damaged tissue and travel to the spinal cord
2. A signal is then sent to
- a motor nerve
- the brain where pain is perceived
Biomedical Approach to Pain
- assumption of one-to-one correspondence to injury/disease
- unfortunate practices (ex. blaming the patient, assuming psych disorder or intentional faking of symptoms)
- focus on pharmacological, surgical, or other medical interventions to control pain
Gate-Control Theory
Pain is not directly proportional to tissue damage
- a neural pain gate in the spinal cord opens up or closes to modulate pain signals to the brain
- involves inhibitor and projector neurons that respond to sensory input and send certain signals to the brain
Gate control theory (what opens and closes the gate) - PHYSICAL
Physical
- opens: extend of the injury, inappropriate activity level; inactivity
- closes: medication, counter stimulation
Gate control theory (what opens and closes the gate) - EMOTIONAL
Emotional
Opens: anxiety or worry, tension, depression, relationship problems
closes: positive emotions, relaxation, social support
Gate control theory (what opens and closes the gate) - COGNITIVE
opens: focusing on pain, boredom
Closes: distraction, concentration, involvement and interest in activities
Pain without (known) pathology
in many cases of pain conditions, no clinically significant correlation to pain levels can be found
Neuropathic Pain
results from current or past disease/damage in peripheral nerves; people experience pain in absence of noxious stimulus
Nueralgia
Extremely painful syndrome in which the patient experiences recurrent episodes of intense shooting or stabbing pain along a nerve; often follows infection
Causalgia
- “complex regional pain syndrome” involves recurrent episodes of severe burning pain that are often triggered by minor stimuli (ex. clothing resting on the area)
Phantom Limb Pain
pain experienced in an amputated limb, classified as neuropathic pain
Neuromatrix theory
extension of the gate-control theory
A widespread network of neurons (distributed throughout the brain and spinal cord) generates a pattern that is felt as a whole body possessing a sense of self
This network is responsible for generating bodily sensations, including pain (pain is produced in the CNS)
Each sensation, including pain, is marked by a unique neurosignature or pattern of activation of the neuromatrix
Phantom limb pain
may be triggered by other types of input, lack of normal sensory input (which may cause unique pain neurosignature) or incongruence between types of input due to lack of limb
Self reported measures of pain
graphics rating scales, verbal rating scales, and numerical rating scales have been found to be valid and reliable methods for assessing pain
Pain Behaviours
observable behaviours that occur in response to pain
- facial and audible expression of distress
- distortions in posture gait
- negative affect (mood, anxiety, depression)
- avoidance of activity
