Chronic Pain Psychology

Question 1

What relevance does pain have to the BPS model?

Answer 1

Health is the product of biology, psychological and social elements of life. Pain challenges the distinction between mind and body with the concept of cure often being the goal of medical practice

Question 2

What is pain?

Answer 2

unpleasant sensory and emotional experience associated with actual or potential tissue damage or described by the patient in terms of such damage 


Question 3

What is chronic pain?

Answer 3

Pain which has persisted beyond normal tissue healing time

Question 4

What is the main difference between acute and chronic pain?

Answer 4

The official 12-week duration (arbitrary) + management 



Acute pain: Address cause of pain



Chronic pain: Addressing the effects of pain + finding ways to maximise function + QOL

Question 5

List the individual burdens associated with chronic pain.

Answer 5

- Maintaining relationships

- Driving

- Sexual relations

- Independent lifestyle 

- Working outside home

- Attending social activities 

- Walking 

- Lifting 

- Exercising 

- Sleeping

Question 6

List the employment/economic burdens are associated with chronic pain.

Answer 6

• Depression
  
- Changed job
  
- Changed job responsibility
  
- Lost job

Question 7

What are the theories of pain?

Answer 7

1) Specificity Theory: Direct causal relationship between pain stimulus and pain experience 

- What about phantom limb theory?

- What about the absence of a stimulus?

2) Pattern theory: Stimulating pain receptors produces pattern of impulses which must pass threshold to relay to cortex and perceive pain: Stimulation —> Pain receptor —> impulse pattern —> pass certain threshold —> cortex —> perception of pain 
- What about the absence of a stimulus?
3) Gate Control Theory: Pain is multidimensional and subjective experience of perception involving both ascending physiological inputs and descending psychological inputs. Gating mechanism in the dorsal horn of SC opens (permits) or closes (inhibits) the transmission of pain impulses.
i. Opening of the gate achieved by: physical (inactivity/poor fitness), behavioural (poor pacing), emotional (anxiety, depression and hopelessness) and cognitive (worrying about the pain). 

ii. Closing of the gate: behaviour (medication use, massage, heat/cold), emotion and cognition (positive coping strategies, relaxation), physical (exercise) 
+ Physiological explanation for how psychological factors affect pain perception 
+ Focus on perception not sensation 

- Mixed evidence 
- Lack of direct evidence of ‘gate’

Question 8

What are cognitions? List the three components.

Answer 8

= Thoughts, beliefs and the way we think which impacts our experience of pain

• Attention: Increased attention ≈ increased pain perception e.g. patients with LBP who are bed bound longer ≈ longer recovery time
- Patterns of thinking and beliefs: meaning + catastrophising

• Self-efficacy 


Question 9

What is meant by meaning and catastrophising in pain? List the components of catastrophising.

Answer 9

Meaning of pain: context e.g. childbirth

Catastrophising: element of pain with three components

i) Rumination: focus on internal and external info e.g. feel my neck click every time I move


ii) Magnification: Overestimation of pain e.g. bones are crumbling 


iii) Helplessness: Underestimating resources e.g. no one can help me or fix my problem 


Question 10

List the emotions felt in pain.

Answer 10

1. Anxiety
2. Depression
3. Fear

Question 11

What are behavioural processes and pain?

Answer 11

Pain behaviours are actions and mannerisms in response to perceived pain. These pain behaviours are reinforced through attention and acknowledgement received thus may lead to lack of activity and diseases through muscle wastage, reduced social contact

Question 12

What is conditioning? What are the two types of conditioning?

Answer 12

training or adjusting a person to behave in a certain way or to accept certain circumstances

1. Classical conditioning: associate environment with experience of pain e.g. dentist
2. Operant conditioning: pain behaviours to pain stimuli which may be positively reinforced by surrounding people giving sympathy and attention e.g. grimacing and limping and others being nicer to you

Question 13

What is the importance of social support?

Answer 13

Discouraging avoidance of physical and social activities, offering assistance by generating multiple solutions and providing emotional support. Those with good social support report less pain and better physical functioning

Question 14

List self-report measures for pain.

Answer 14

Self-report measures: individual reports their own perception of pain through various questionnaires

i. McGill Pain Questionnaire: 78 items in 20 groups: sensory, affective, evaluative, miscellaneous
ii. Verbal rating, box and visual analogue scales: Grading system on a spectrum from no pain to excruciating pain