Final Flashcards
what is the purpose of pain?
-warns self or others of tissue damage/injury/disease; evokes care
negative outcomes of pain
-poor health behaviors
-loss of employment/income
-depression/fear/anxiety
-social isolation
-sleep disorders
-martial and family dysfunction
Importance of studying pain
-pain is the symptom of greatest concern to patients and most likely to lead them to use health services
-also heavily influenced by psychosocial processes
Specificity model 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 and
-the brain, where pain is perceived
Limitations to the specificity theory of pain
-short sighted: doesn’t take into account that people can have pain without any known physical damage
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
-open gate: amplifying pain signal
-close gate: decreasing pain signal
-involves inhibitor and projector neurons that respond to sensory input and send certain signals to the brain
what are some examples of what opens/closes the pain gate
-open:
-physical: extent of injury
-emotional: anxiety/worry
-cognitive: focusing on pain
-close:
-physical: medication
-emotional: social support
-cognitive: distraction
Neuropathic pain and two types
-results from current or past disease/damage in peripheral nerves; people experience pain in absence of noxious stimulus
-neuralgia: an extremely painful syndrome in which the patient experiences recurrent episodes of intense shooting or stabbing pain along a nerve; often follows infection
-causalgia: severe burning pain often triggered by minor stimuli
Phantom Limb Pain
-phantom limb pain is pain experienced in an amputated limb; classified as neuropathic pain
-generally dissipates overtime
-common: 80%-100% of individuals with amputations report phantom limb pain
Neuromatrix 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)
-pain can occur in the absence of signals from sensory nerves
-each sensation, including pain, is marked by a unique neurosignature or pattern of activation in the neuromatrix
-Key Feature: other kinds of input other than sensory can produce pain
-can explain pain when no tissue damage
How can the neuromatrix theory can explain phantom limb pain
-may be triggered by other types of input, lack of normal sensory input (which may cause a unique pain neurosignature), or incongruence between types of input due to lack of limb
How does the IASP define pain
-an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
-pain is always subjective due to its emotional component
Pain rating scales
-graphic rating scales
-numeric rating scales
-verbal rating scales
-found to be reliable and valid methods for assessing pain
Nonverbal measures of pain (pain behaviors)
-pain behaviors are observable behaviors that can occur in response to pain
-facial and audible expressions of distress
-distortions in posture or gait
-negative affect
-avoidance of activity
Neonatal facial coding scale
-brow lower
-eye squeeze
-squint
-blink
-flared nostril
-open lips
Organic vs psychogenic pain
-organic: pain that has clearly identifiable physical cause
-psychogenic pain: pain resulting from psychological processes
-today, pain is recognized to be a mix of these two factors
how do emotions impact pain
-positive emotions appear to reduce pain
-negative emotions tend to worsen and result from pain
-most people with chronic pain experience high levels of depression, anxiety, and/or anger; high levels of these emotions are associated with high levels of subsequent pain/disability
-can also obscure the memory of pain: memories of patients with high anxiety are determined by what they expected it to feel like more than what they actually felt
how does stress impact pain
-pain and stress are intimately linked…
-pain is stressful (partly bc of lack of control)
-stress can produce pain (headache)
describe the meaning of pain
-pain can be more or less intense depending on the meaning of the pain or underlying injury
-eg: enjoyment of pain during sex
describe the maladaptive methods of pain
-catastrophizing: frequent, magnified negative thoughts about pain: magnification, rumination, helplessness
Describe the appraisal model of pain catastrophizing
-primary appraisal: focusing on and exaggerating the threat value of pain
-secondary appraisal: appraisals of helplessness and of inability to cope
-catastrophizing increases with pain intensity and seems to play a role in transition from acute to chronic pain
describe adaptive methods of coping with pain
-relaxation; distraction; redefinition of pain (reappraisal); readiness to change, taking an active role
-acceptance: being inclines to engage in activities despite the pain and disinclination to control or avoid pain
role of positive reappraisal and social support in pain
-both can help alleviate intensity of pain
communal coping model of pain catastrophizing
-goal: to manage distress in a social context rather than an individual one
-when person experiences pain, they tend to catastrophize the pain which leads to worsening the pain experience
-another pathway includes having a caregiver in which increases proximity, support, empathy, and assistance
How does social support impact catastrophizing
-catastrophizers display increased pain behaviors in the presence of another person and engage in less effective coping
- when individuals receive a supportive response from their spouse, negative effects of catastrophizing on pain are reduced
social communication model of pain
-places primacy on the interpersonal context of pain
-both the individual in pain and the caregiver influence the pain experience
-after trauma of pain is endured, the person goes through 4 stages
-personal experience of pain
-expression of pain
-pain assessment
-pain management
-many factors affecting these processes*
how does one’s social network health affect their pain
-the health and well being of ones social network also affects their outcomes
social pain
-the experience of pain as a result of interpersonal rejection or loss, such as rejection from a social group, bullying, or the loss of a loved one
-from an evolutionary perspective, social pain is adaptive as it signals when social relationships are threatened
-usually describe linguistically as “hurt feelings”, “broken hearted”
how are social and physical pain related
-negative social experiences rely on the same neural system supporting the affective component of physical pain (dorsal anterior cingulate cortex and anterior insula)
how to treat social pain
-acetaminophen (tylenol) appears to reduce social pain
-fmri measures of brain activity found that acetaminophen reduced neural responses to social rejection in the dacc and anterior insula
clinical interventions for pain
-surgical interventions
-chemical treatments
-stimulation therapies
-physical therapy and rehabilitation
describe the effectiveness of medical treatments of chronic pain
-not sufficient for controlling pain, especially when it is chronic
-best approach for treating chronic pain may involve a combination of pharmacological and non-pharmological methods
psychological treatments for pain
-fear reduction methods
-progressive muscle relaxation, meditation and biofeedback
-cognitive methods (distraction, nonpain imagery, redefinition, promoting acceptance)
-psychotherapy (CBT): help people manage the emotional difficulties associated with pain
operant approach to treating pain
-applying operant conditioning methods to modify patients behavior
-involves extinction procedures for pain behavior and reinforcement for appropriate behavior
cognitive methods to treating pain
-passive coping: taking to bed or curtailing social activities which puts people at risk for disability
-active coping: trying to keep functioning by ignoring the pain or keeping busy with an interesting activity
what are the goals of psychological treatments of pain
-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
what are some common chronic conditions in Canada?
-44% of adults have at least 1 of 10 most common chronic conditions
-hypertension
-osteoarthritis
-mood/anxiety disorders
-osteoporosis
-diabetes
-most people are likely to develop at least one chronic condition that may lead to our death
-more common in lower income, women and seniors
describe the initial response to chronic conditions
-immediately after a chronic disease is diagnosed, patients are often in a state of crisis or shock
-anxiety, denial and anger are also common
-sense of control is lowered; secondary appraisal is common
-engage in more emotion focused coping early on
what is the crisis theory of chronic conditions
-describes factors that influence how people adjust or cope after first learning about the chronic illness
-illness related factors, background, personal factors, physical/social environments all affect coping process which impacts outcomes of crisis
adaptive tasks in coping
2 adaptive tasks:
1. tasks related to illness or treatment (coping with symptoms, adapting to hospital)
2. tasks related to general psychosocial functioning (controlling neg feelings, preserving good relationships, preparing for an uncertain future)
psychosocial factors in chronic condition management
-stress and anxiety
-stigma
-discrimination
-depression
-helplessness
-catastrophizing
-social support
-self efficacy
what coping strategies did cancer patients find most effective
-social support/direct problem solving: talked with someone to find out more
-distancing: not letting it get to you
-positive focus: learning something from the experience
-cognitive escape/avoidance: wishing it to go away
-behavioral escape/avoidance: eating, drinking, shopping
maladaptive coping strategies
-rumination: exacerbation of symptoms
-interpersonal withdrawal: linked to loneliness and low relationship satis.
-avoidant coping: associated with increased psych distress and can exacerbate the disease process; leads to poor adjustment - not taking proper care of oneself
depression as a result of chronic illness
-feelings of sadness, despair, helplessness and hopelessness
-may be delayed as patients try to understand the implications of condition; physically debilitating; direct impact on symptoms
-history of depression is associated to poorer adjustment to chronic illnesses
social challenges with cancer (and other chronic illnesses)
-patients: may have difficulty seeing family/friends due to illness or treatment. May feel socially awkward or embarrassed about the condition.
-other people:may avoid patient due to feelings of vulnerability. may say wrong things or breakdown emotionally.
how can cancer stigma arise
-depends on the extent to which an individual’s’ identity and sense of self are affected by diagnosis
-perceived controllability and visibility of cancer, and whether it interferes with ADL also effect outcomes
how can cancer stigma affect the management of illness
-people with cancer have worse outcomes when it comes to stigma
-can impact the amount that people get screen for cancer
-more prominent for cancer that affects sexual functioning and lung cancers- most stigmatized types
how does adaptation affect the management of chronic illness
-adaptation is the process of making changes in order to adjust constructively to life’s circumstances
-successful adjustment to chronic conditions involves several major adaptive tasks that continue indefinitely
-minimizing physical limitations and disability
define quality of life
-the degree of excellence people appraise their lives to contain
-based on physical, psychological, vocational and social functioning; includes disease or treatment related to symptoms
-emphasis on activities of daily living
-an important indicator of recovery from/adjustment to chronic illness
how to evaluate QOL
-self reports/subjective health
-a person’s perceptions of their health
-health questionnaires/surveys with likert response scales
-accuracy of self reported health is increasing over time
subjective health relation to objective health
-subjective and objective health are associated with presence of diseases, onset of all diseases, and laboratory parameters of health (if someone thinks they are in bad health, they probably are)
-can also predict mortality, can even be more reliable than objective indices of physical health
how beneficial are cancer support groups for cancer patients (physical)
-people who attend believe they are extending their lives
-people who attended support groups saw a extension in their lives
psychosocial benefits of support groups
-improved mood
-reduced uncertainty
-improved self esteem
-enhanced coping skills
-improved QOL
prevalence of caregiving in canada
-approx. 1 in 4 canadians 15 and older provide care to someone with long term health condition
-most caregivers spend less than 10 hours a week caregiving
-mist receive some kind of support or assistance for their duties
-most are women
factors of caregiver stress
-not having time to care for oneself; feeling overwhelmed
-engaging in unhealthy behaviors due to lack of time (eating bad)
- disrupted/insufficient sleep
-poor stress management
-degrading social relationships and poor support
-also more likely to self report that stress is having neg impacts on their phys health
economic costs of caregiving
-extra expenses
-postponed education
-declined promotion
-missed days of work
-reduced hours of work
-mostly women***
health costs of caregiving
-higher levels of depression and physical health problems in caregivers
-more likely to have abnormalities in the endocrine (cortisol) and immune system functioning
-spouses who reported strain were at risk for premature mortality
-recent studies suggest caregivers may last longer: more resiliance
benefits of caregiving
-an overwhelming majority of caregivers report it being a positive experience
-providing the best care possible
-staying connected and becoming closer
-rewarding sense of accomplishment, giving back to someone who has cared for them
-sense of meaning and purpose
-passing on tradition of care in family
-learning new skills
future of caregiving
-there will be approx. 120% more older adults using home care support
-approx 30% fewer close family members who will be available to provide aid
-family members will need to increase their efforts by 40% to keep up with care needs
high mortality illness
-a high mortality disease does not typically mean a person will die in the next couple weeks or months
-still, no one can tell for sure what the course of the disease will be and these individuals and their families must adapt to the uncertainty
denial in terminal illnesses
-common in terminal illness
-some cases, denial can be extreme and persistent
-denial can also affect others as caring for someone in denial is hard, person may not want treatment
acceptance/hope in terminal illnesses
-patients often show optimistic attitudes early on but begin to view their plans for the future more tentatively
-many patients also hope they will be cured or hope for a miraculous recovery - this can lead to aggressive care which can impact the qol
denial and acceptance of terminal illnesses
denial is more common early on and acceptance is more common closer to death
-acceptance is important for both patients and loved ones
what is death
irreversible loss of circulation and respiration or irreversible loss of brain function
palliative care and hospice palliative care
-palliative: care intended to reduce pain and discomfort and improve qol in patients with chronic/terminal illnesses
-psychological and physical benefit to receiving palliative care
-hospice palliative: relief of suffering from terminal illness - provides warm, personal comfort at end of life
hospice care
may occur in palliative care units of hospitals, freestanding hospices, or in homes
-only 16% to 30% of Canadians who die have access to or receive hospice palliative care
home care
-accompanied by improved personal control and availability of support but can be problematic for family members
positive associations with palliative care
-lower pain
-improved qol
-lower anxiety and depression
-reduction in disease symptoms
-prolonged survival
goals of end of life care
-informed consent: encourage involvement
-cafe conduct: act as helpful guides
-significant survival: help patient make most of their time
-anticipatory grief: aid patient and family with sense of lss
-timely and appropriate death: patient should be allowed to die when and how they want
disparities in end of life care
Racialized individuals
-have lower use of palliative care services
-experience worse symptoms control
-less likely to have end of life wished documented or respected
indigenous cultural needs
-usually go unaccommodated in Canadian hospitals
how does end of life care effect medical staff
-emotionally draining
-unpleasant custodial work
-not curative care
-less interesting/stimulating
MAID vs euthanasia
-MAID: a physician knowingly and intentionally provides a person with the knowledge or means or both required to end their life, including counselling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs
-euthanasia:deliberately ending one’s life to relieve suffering
MAID in canada
-Bill C-14: passed in 2016, permitting MAID for mentally competent individuals with hace serious and incurable illness or disability; are in advanced state of irreversible decline; and face a reasonably foreseeable death
-Bill C-7: passed in 2021, expanding MAID by removing requirement that the death be reasonably foreseeable
statistics of MAID in canada
-4.1% of deaths in Canada in 2022 were cases of MAID
-31% increase in MAID cases over 2021 (increasing across country due to people learning about this option)
-cancer, neurological issues, and respiratory diseases most common reason
-3.5% of MAID cases were unforeseeable deaths
concerns and criticisms of MAID
-incompatibility with care provider ethics
-errors in diagnosis and prognosis
-coercion by family or physicians
-Suicide contagion effect
-Disproportionate impacts on vulnerable groups
-more used by higher income canadians (lower income may have less access)
- impact on the bereaved
Elisabeth Kubler-Ross Five stages of dying
-denial: lack of belief or acceptance
-anger: expressed towards those who are closest
-bargaining: negotiation for more time
-depression: despair over the recognition of mortality
-acceptance: mortality and future embranced
death acceptance
- a ‘giving in’ and realizing of the inevitability of death; often neither happy or sad-sometimes a void of feelings.
-may involve letting go and detaching oneself from events and things we used to value
complexities of denial for those who are facing death
-denial and acceptance were interdependent and fluctuating coping strategies used by hospice patients
-denial is not always detrimental and often involves 2 opposite views of death:
-denying death and minimizing the bleakness of a prognosis of a diagnosis
-making plans for ones death (completing a will)
-prevents us from being overwhelmed
psychosocial factors and goals that become salient at the end of life
-sense of integrity
-continuity of relationships
-reduction of conflicts
-wish/goal fulfillment
-memories, reminiscence
personal meaning
-having a purpose in life, having a sense of direction, a sense of order and a reason for existence
-there are many sources of meaning at the end of life
autobiographical activites
-reminiscence: spontaneous and non-spontaneous act of recollecting memories of one’s self in the past
-life review: return of memories and past conflicts at end of life: spontaneous or structured reconciliation of one’s life
symbolic immortality
a sense of continuity or immortality obtained through symbolic means
generativity
a concern for establishing and guiding the next generation
religiosity
-endorsing or subscribing to an organized system of beliefs, practices, rituals and symbols
-extrinsic: external and self serving motivations
-internal: meaning based and altruistic motives
spirituality
-a personal quest for understanding answers to ultimate questions about life, about meaning, and about relationship to the sacred or transcendent
best ways to find acceptance in death
-meaning and purpose can help dying individuals reach death acceptance
-death acceptance related to well-being and qol
death anxiety
-worry, dread, and terror over the prospect and/or process of death
fear of death
-older adults are more likely to think about death but less likely to fear it compared to middle aged or young adults
-young adults more likely to fear death but older are more likely to fear the dying process
survivors acceptance
-accepting the reality that our loved one is physically gone and recognizing that this new reality is permanent
-involves learning to live with this reality
-not being ‘okay’ with what happened
-learning to live again
integrated grief
-the lasting form of grief in which loss related thoughts, feelings, behaviors are integrated into a person’s ongoing functioning
complicated grief
-occurs when the grieving process does not progress as expected. typical symptoms include:
-prolonged acute grief with intense yearning and sorrow
-frequent troubling thoughts about death
-excessive avoidance of reminders of the loss
prolonged grief disorder
persistent grief response following death of a loved one; yearning/longing for the deceased and/or preoccupation with the deceased for at least 12 mo after
-distress and emotional/social challenges
the nature of grief
-today, grief is largely seen as flexible and non-linear
-each person’s grieving is unique and personal
aging
the predominant risk factor for most diseases and illnesses that significantly compromise health and/or reduce life expectancy, including most leading causes of death
health-survival paradox
-despite living longer than men, women experience higher rates of disability and poor health
-why?
-sex hormone changes in women are more accompanied by increased inflammation and decreased immune functioning
-women maintain more social connections over life which can mitigate effects of disease
-men engage in more risky behaviors
key factors to prevent physical and cognitive decline
-increasing physical activity and exercise
-increasing cognitive activity
-best outcomes when you combine these
-stress reduction
-social activity
-healthy diet
well being paradox
-despite the changing landscape of stress in old age, studies have found that older adults report less stress, more happiness, and higher life satis, compared to younger adults
-older adults appear to cope with stress more effectively
-better emotional regulation and wisdom
successful aging
successful aging is a positive perspective on aging
-optimizing life expectancy
-minimizing physical/psych./social morbidity
factors of successful aging
-physical activity
-income
-health
-social interactions
-sense of purpose
-self acceptance
-personal growth
-autonomy
-environmental mastery
factors of life satisfaction
-physical activity
-income
-health
-social interactions
-a precursor to successful aging
selective optimization with compensation model
-successful aging involves maximizing positive outcomes and minimizing negative ones
-compensation for loss of ability by engaging in new strategies
-optimizing existing abilities through practice and technology
goal disengaging in old age
-goal disengagement appears to be adaptive in old age, protecting older adults from the effects of depression and disability
Erikson’s belief on stress
-focus of old age is reflection on one’s life and past events
-success is marked by feelings of wisdom, acceptance of death
-failure involves regret, bitterness
wisdom
the coordination of knowledge and experience to improve wellbeing
socioemotional selectivity theory
-people are increasingly motivated to find meaning as they shift their priorities in the 2nd half of life
-successful aging can be thought of as a redirected focus on what matters most in life
predictors of successful aging
-earlier reports of successful aging
-financial status
-physical functioning
-social support and social resources
-happiness and satisfaction with life
-personal meaning
-sense of purpose
telomeres and stress
-link between high stress and shorter telomeres
-exercise can help prevent shortening of telomeres
-good nutrition related to telomere growth
aging and dying as diseases
-many labs are working to make chronic aging a condition we can treat
how does stress impact our overall well-being
-around the world, we are more stressed out than ever
-resulting in rising anxiety, depression and loneliness
-causing rising rates of substance abuse
how does media improve and worsen our health
-great way to keep people connected
-also linked to greater stress, reduced connectivity in areas of the brain related to control, withdrawal symptoms when stopped
how is climate change a threat to health
-increased death, injury, or illness due to flooding, storm surge and sea level rise
-increased mortality and morbidity during periods of extreme heat, droughts and fires
-breakdown of infrastructure, water supply
-reduced agricultural productivity
-increased malnutrition
-changes in range of infectious and insect-borne disease
-loss of ecosystems and biodiversity
how does climate change relate to social health
-less rainfall and higher temps and drought have been linked with increased violence and crime
climate change and ineqaulity
-disproportionate impacts of climate change on vulnerable and socially marginalized people
-climate change will worse economic inequality
