Chronic Pain and Wellbeing- Lecture 2

Question 1

Johannes et al (2010)

Answer 1

Chronic pain is experienced by about 1/3 of Americans

Higher in females than males

Question 2

Types of pain

Answer 2

Acute- Sharp stinging lasting short time
Recurrent- episodes of discomfort, can return for more than 3 months
Chronic- lasts 6 months or longer- long past normal healing period. Can be continuous or intermittent , moderate or severe

Question 3

Psychophysiological measures of pain

Answer 3

Electromyography (EMG)- assess the amount of muscle tension experienced by pain sufferers- indicators of autonomic arousal- using measures of heart rate, breathing rate, blood pressure

Question 4

Behavioural measures of pain

Answer 4

• Pain behaviour scale: target behaviours include vocal complaints, facial grimaces, awkward postures
• Pain response preference questionnaire (McWilliams e al., 2009)
• Self Report Measures- (Melzack & Torgerson, 1971): pain rating scales

Question 5

Perception of pain-

Early stages

Answer 5

Free nerve endings- sensory receptors found throughout the body that respond to temp., pressure and painful stimuli

Question 6

Nociceptor

Answer 6

Specialised neuron that responds to painful stimul

Question 7

Fast nerve fibers

Answer 7

Large myelinated nerve fibres that transmit sharp stinging pain
In the skin and mucus membranes

Question 8

Slow nerve fibers

Answer 8

Small un-myelinated nerve fibres that carry dull aching pain

In all body tissues but the brain

Question 9

Substantia Gelatinosa

Answer 9

Dorsal region of the spinal cord where both fast and slow fibres synapse with sensory nerves, into the brain

Question 10

Referred pain

Answer 10

Pain in area of body that is more sensitive to pain, but caused by a disease or injury in a that has few pain receptors

Question 11

Fast acute pain pathway

Answer 11

originates with fast nerve fibers in spinal cord and projects to the somatosensory cortex (in Parietal lobe)

Question 12

Slow chronic pain pathway

Answer 12

Slow nerve fibers in the spinal cord into the thalamus

Question 13

Gate control theory

Answer 13

Melzack and Wall (1965)
Neural ‘gate’ in the spinal cord regulates experience of pain
-Pain is not the result of a straight through sensory channel
- Incoming sensations are modulated by mood/attention - transmission cells
>Central control mechanism- can force the gate open or . shut according to signals from the brain
-gate opens or closes to govern the intensity of pain
- not a direct relationship between activating of nociceptors and sensation- there are modulators

Question 14

Psychosocial factors in experience of pain

Answer 14

Age
Gender
SES & stress
Culture and Ethnicity
Personality
Social learning

Question 15

Age effects on pain experience

Answer 15

-Progressive increase in pain with age
BUT- Pain threshold increases with age- reduce in pain sensitivity for lower pain intensities- dulled down (Scheel et al., 2017)
-Also an expectation of illness, so more vigilant in checking health

Question 16

Gender effects on pain experience

Answer 16

Women report more frequent episodes of pain than men, including:
-more migraines
-tension headaches
-pelvic pain
-facial pain
-lower back pain
Difference in prescribed medicines for women- higher doses and particular analgesics more effective for women than men (Edwards, 2013)

Question 17

SES and stress effects on pain experience

Answer 17

-Bacon et al. (2009)
People of lower SES have greater morbidity and mortality
-Hatch and Dohrenwend (2007) more stressful life events
-Gee and Paynes-Sturgess (2007)
Stressful environments
-Gallow and Matthews (2003)
Fewer psychological resources
>DUE TO HARMFUL EFFECTS OF STRESS (Rios and Zaura, 2011)

Question 18

Culture and Ethnicity effects on pain experience

Answer 18

> Different groups differ in how much pain is openly expressed and how it should be expressed (Pillay et al., 2015)

• Differences in pain Tolerance not so much threshold
• Should be careful when interpreting results- amount of words for pain in different languages can cause issues -lacking linguistic and semantic equivalence

Question 19

Personality effects on pain experience

Answer 19

Minnesota Multiphasic personality Inventory (Hathaway & McKinley, 1939)- measure whether there is a pain prone personality
Acute and chronic pain patients scored high in Hysteria (exaggeration of symptoms) and hypochondriasis (over concern about health and over-report symptoms)

Question 20

Mood disturbances effects on pain experience

Answer 20

People who are anxious, worried, fearful, depressed, and negative in outlook report more pain (Leeuw et al., 2007).

Question 21

3 Types of pain patients

Answer 21

-Dysfunctional patients: >high levels of pain
>psychological distress
>little control over their lives
>extremely inactive

-Interpersonally distressed patients:
>little social support
>other people don’t take pain seriously

-Adaptive copers:
>significantly lower levels of pain and psychological or social distress
>continue to function at a high level

Question 22

Social Learning effects on pain experience

Answer 22

Ppls experience of pain influenced by social and cultural factors-

• social construction of an illness (Lucire, 2003)
• Observing family members and other peoples response and experiences with pain
• TOXIC MASCULINITY and its effect on health of men(Courtenay, 2000)

Question 23

Treating pain

Answer 23

Medical or non- medical interventions

Question 24

Pharmacological treatments of pain

Answer 24

Opioid Analgesics

Non-opioid analgesics

Question 25

Opioid Analgesics

for treating pain

Answer 25

agonists that act on specific receptors in the spinal cord and brain to reduce either the intensity of pain messages or the brain’s response to pain messages- most widely used is morphine
HIGHLY ADDICTIVE
So clinicians are reluctant to prescribe high doses- leads to undermedication

Question 26

Non-opioid analgesics

for treating pain

Answer 26

Include aspirin, ibuprofen
produce several effects: -pain reduction without
-sedation
-reduction of inflammation
-reduction of body temperature when fever is present
Block the chemical chain reaction triggered when tissue is injured

Question 27

CBT treating pain

Education and goal setting

Answer 27

Tailored to the patient…
Dominant type in NHS
Usually includes:
-Education about types of pain and pathways, so can understand causes of their experiences
-Goal setting- generating examples from personal experiences and set specific and measurable goals

Question 28

Cognitive Interventions

Answer 28

Emotions, attitudes and beliefs influence our health- negative emotions tie in with coping with pain.
cognitive restructuring - >challenges maladaptive thoughts helps redefine pain as more manageable
>Irrational beliefs too

Question 29

Cognitive errors in thinking about pain

Answer 29

Catastrophising
Overgeneralising
Victimisation
Self-blame
Dwelling on pain

Question 30

Shelby et al., 2009; Wolff et al., 2008

Answer 30

Catastrophic thinking also may intensify pain because of its effects on blood pressure reactivity and muscle tension

Question 31

Cognitive distraction

Answer 31

Diverting attention from painful stimulus- diminishes pain intensity by 30-40% (Edwards et al. 2009)
Example of this: burns victims listening to music when in procedures.

Question 32

hyperalgesia

Answer 32

Sensitivity to pain experienced when sick- like when you feel aches and pain with the flu
» often actually helpful as drives recuperative behaviours