Chapter 8: Pain

Question 1

Organic Pain

Answer 1

pain that has a clearly identifiable physical cause

Question 2

psychogenic pain

Answer 2

pain resulting from psychological processes

Question 3

today’s scienfitic perspective on pain

Answer 3

today’s scientists recognize that virtually all pain experiences involve an interplay of both physiological and psychosocial factors

Question 4

The effect of emotion on pain

Answer 4

• 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

Question 5

2 ways pain and stress are linked

Answer 5

1. pain is stressful (partly due to lack of perceived control)
2. stress can produce pain in addition to worsening the pain experience

Question 6

Pain and meaning

Answer 6

pain can be more or less intense depending on the meaning of the pain underlying the injury
- ex. enjoyment of pain during sex

Question 7

classical conditioning and pain meaning

Answer 7

classical conditioning can be one means by which the meaning of pain changes

Question 8

maladaptive coping with pain

Answer 8

destructive thinking; helplessness

Question 9

catastrophizing

Answer 9

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

Question 10

primary appraisal in pain

Answer 10

focusing on and exaggerating the threat value of pain

Question 11

secondary appraisal and pain:

Answer 11

appraisals of helplessness and of inability to cope

Question 12

adaptive coping with pain

Answer 12

relaxation, distraction, redefinition of pain, readiness to change, taking an active role

Question 13

acceptance of pain

Answer 13

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.

Question 14

positive reappraisal

Answer 14

makes pain less severe
ex. positive self-statements - kinda like the placebo effect

Question 15

social support and pain

Answer 15

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

Question 16

social communication model of pain

Answer 16

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)

Question 17

social communication and pain

Answer 17

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)

Question 18

Communal coping model of pain catastrophizing

Answer 18

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

Question 19

catastrophizing and social support

Answer 19

• 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

Question 20

Treating the social network

Answer 20

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!

Question 21

Social Pain

Answer 21

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”

Question 22

similarities between social pain and physical pain

Answer 22

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

Question 23

treatment of social pain

Answer 23

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

Question 24

Clinical interventions for pain

Answer 24

• surgical interventions
• chemical treatments
• stimulation therapies
• physical therapy and rehab

Question 25

Medical methods enough for pain?

Answer 25

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

Question 26

best apprach to treating chronic pain

Answer 26

a combination of pharmacological and psychological treatments!

Question 27

Goals of psychological treatments

Answer 27

• 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

Question 28

psychological treatments for pain

Answer 28

• 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

Question 29

Specificity theory of pain

Answer 29

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)

Question 29

Gate-control theory of pain

Answer 29

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

Question 30

Pain without known pathology

Answer 30

85% of individuals who report back pain, no pain-producing pathology can be identified

Question 31

Neuropathic pain

Answer 31

results from current or past disease/damage in peripheral nerves; ppl experience pain in absence of noxious stimulus

Question 32

neuralgia

Answer 32

extremely painful syndrome in which patient experiences recurrent episodes of intense shooting or stabbing pain along the nerve; often follows infection

Question 33

causalgia

Answer 33

recurrent episodes of severe burning pain that are often triggered by minor stimuli

Question 34

phantom limb pain

Answer 34

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

Question 35

neuromatrix theory

Answer 35

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

Question 36

assessing pain

Answer 36

-graphic rating scales
- verbal rating scales
-numerical rating scales

Question 37

nonverbal measures of pain

Answer 37

• facial and audible expression of distress
• distortions in posture or gait
  -negative affect
• avoidance of activity