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.