Chronic Pain and Wellbeing- Lecture 2 Flashcards
Johannes et al (2010)
Chronic pain is experienced by about 1/3 of Americans
Higher in females than males
Types of pain
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
Psychophysiological measures of pain
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
Behavioural measures of pain
- 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
Perception of pain-
Early stages
Free nerve endings- sensory receptors found throughout the body that respond to temp., pressure and painful stimuli
Nociceptor
Specialised neuron that responds to painful stimul
Fast nerve fibers
Large myelinated nerve fibres that transmit sharp stinging pain
In the skin and mucus membranes
Slow nerve fibers
Small un-myelinated nerve fibres that carry dull aching pain
In all body tissues but the brain
Substantia Gelatinosa
Dorsal region of the spinal cord where both fast and slow fibres synapse with sensory nerves, into the brain
Referred pain
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
Fast acute pain pathway
originates with fast nerve fibers in spinal cord and projects to the somatosensory cortex (in Parietal lobe)
Slow chronic pain pathway
Slow nerve fibers in the spinal cord into the thalamus
Gate control theory
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
Psychosocial factors in experience of pain
Age Gender SES & stress Culture and Ethnicity Personality Social learning
Age effects on pain experience
-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
Gender effects on pain experience
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)
SES and stress effects on pain experience
-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)
Culture and Ethnicity effects on pain experience
> 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
Personality effects on pain experience
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)
Mood disturbances effects on pain experience
People who are anxious, worried, fearful, depressed, and negative in outlook report more pain (Leeuw et al., 2007).
3 Types of pain patients
-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
Social Learning effects on pain experience
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)
Treating pain
Medical or non- medical interventions
Pharmacological treatments of pain
Opioid Analgesics
Non-opioid analgesics
Opioid Analgesics
for treating pain
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
Non-opioid analgesics
for treating pain
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
CBT treating pain
Education and goal setting
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
Cognitive Interventions
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
Cognitive errors in thinking about pain
Catastrophising Overgeneralising Victimisation Self-blame Dwelling on pain
Shelby et al., 2009; Wolff et al., 2008
Catastrophic thinking also may intensify pain because of its effects on blood pressure reactivity and muscle tension
Cognitive distraction
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.
hyperalgesia
Sensitivity to pain experienced when sick- like when you feel aches and pain with the flu
» often actually helpful as drives recuperative behaviours
