L8 Flashcards
What purpose does pain serve?
warns self or others of tissue damage/injury/disease; evokes care
Consequences of pain
poor health behaviors, loss of employment/income, depression, fear, anxiety, social isolation, sleep disorders, marital and family dysfunction
Characteristics of a fish’s experience of pain
they have neurons called nociceptors, produce the same opioids (body’s innate painkillers) as mammals, and their brain activity during injury is similar to that in terrestrial vertebrates
Specificity theory of pain
pain is directly proportional to tissue damage; the body has a separate sensory system for perceiving pain
Pattern theory of pain
there is no separate system for perceiving pain, rather pain is felt when certain patterns of neural activity occur due to intense stimulation
2 stages of the experience of pain due to injury (specificity theory)
(1) pain messages originate in nerves associated with damaged tissue and travel to the spinal cord; (2) a signal is sent to a motor nerve and the brain, where pain is perceived
3 ways that the specificity theory of pain is a biomedical approach
assumes one-to-one correspondence to injury/disease; may lead to unfortunate (e.g. blaming the patient, assuming psychiatric disorder); focuses on pharmacological, surgical, or other medical interventions to control pain
Gate-control theory
pain is not directly proportional to tissue damage, rather there is a hypothetical neural pain gate in the spinal cord that opens or closes to modulate signals to the brain
Mechanisms in the gate-control theory
inhibitor and projector neurons that respond to sensory input and send certain signals to the brain
3 factors involved in gate-control theory
amount of activity in pain fibres, amount of activity in peripheral nerves, messages that descend from the brain
What opens the gate in terms of physical factors?
extent of injury, inappropriate activity level or inactivity
What closes the gate in terms of physical factors?
medication, counter stimulation (e.g. massage, heat)
What opens the gate in terms of emotional factors?
anxiety or worry, tension, depression, relationship problems
What closes the gate in terms of emotional factors?
positive emotions, relaxation, social support
What opens the gate in terms of cognitive factors?
boredom, focusing on pain
What closes the gate in terms of cognitive factors?
distraction, concentration, involvement and interest in activities
Neuropathic pain
pain in the absence of noxious stimulus that results from current or past disease/damage in peripheral nerves (e.g. neuralgia, causalgia, phantom limb pain)
Neuralgia
an extremely painful syndrome in which the patient experiences recurrent episodes of intense shooting or stabbing pain along a nerve that often follows infection
Causalgia or complex regional pain syndrome
recurrent episodes of severe burning pain that are often triggered by minor stimuli (e.g. clothing resting on the area)
Phantom limb pain
recurrent or continuous pain experienced in an amputated limb or one with no functioning nerves
Neuromatrix theory
a neuromatrix comprises a widespread network of neurons across many areas of the brain that generates a pattern felt as a whole body possessing a sense of self
What does the neuromatrix do?
generates pain and other sensations in the absence of signals from sensory nerves
Where in the brain is pain produced?
CNS (brain, spinal cord)
Pain according to the IASP
an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage; always subjective
3 ways to assess pain
self-report measures (e.g. rating scales, interviews, questionnaires), behavioral assessment approaches, psychophysiological measures (e.g. EMG, EEG)
Examples of pain rating scales
visual analogue scale, box scale or numeric rating scale, verbal rating scale
3 broad dimensions involved in pain
affective (emotional-motivational), sensory, and evaluative
2 types of situations for assessing pain behaviors
everyday activities and structured clinical sessions
Pain behaviors
observable behaviors that occur in response to pain; part of the sick role and are often unknowingly strengthened or maintained by operant conditioning
4 types of pain behaviors
facial and audible expression of distress, distortions in posture or gait, negative affect (mood, anxiety, depression), avoidance of activity
Organic vs psychogenic pain
pain that has a clearly identifiable physical cause (e.g. tissue damage or pressure); pain resulting from psychological processes
Factors that affect pain
physiological and psychosocial factors
What do people with chronic pain experience?
high levels of depression, anxiety, anger, which are associated with high levels of subsequent pain/disability
Examples of maladaptive coping
destructive thinking and helplessness
How are pain and stress linked?
pain is stressful (partly due to lack of perceived control) and stress can produce or worsen pain
Catastrophizing
frequent, magnified negative thoughts about pain (e.g. magnification, rumination, helplessness); increases with pain intensity and plays a major role in the transition from acute to chronic pain
2 stages of the appraisal model of pain catastrophizing
primary appraisal and secondary appraisal
Primary appraisal
focusing on and exaggerating the threat value of pain
Secondary appraisal
appraisals of helplessness and of inability to cope
2 types of coping strategies
overt behavioral and covert
Examples of overt behavioral coping
getting rest, using relaxation methods, and taking medication
Examples of covert coping
hoping or praying the pain will get better, saying calming words to oneself, diverting one’s attention
Examples of adaptive coping
relaxation, distraction, redefinition of pain/reappraisal, readiness to change, taking an active role
Pain acceptance
being inclined to engage in activities despite the pain and disinclined to control or avoid the pain
What traits do people with high levels of pain acceptance possess?
pay less attention to pain, have greater self-efficacy for performing daily tasks, function better, and use less pain medication than those with low pain acceptance
What reduces pain ratings following a cold-pressor task?
positive self-statements with explanations of how they can help; verbal support
Communal coping model of pain catastrophizing (CCMPC)
in a social context, the person in pain catastrophizes and appears less able to cope with pain in order to elicit proximity, support, empathy, and assistance from caregivers
When is catastrophizing detrimental?
it may be less adaptive during chronic pain, leading to social conflict and rejection
What behavior do high catastrophizers display?
increased pain behavior in the presence of another person and engage in less effective coping
Goal of CCMPC
to manage distress in a social context rather than an individual one
Social communication model of pain
primarily focuses on the interpersonal context of pain wherein the dynamic interplay between the unique qualities of the patient and the caregiver (e.g. personal histories, pain expression, pain management) influence the pain experience
Social pain
the experience of pain as a result of interpersonal rejection or loss (e.g. being an outcast, getting bullied, losing a loved one)
What areas of the brain do negative social experiences rely on?
the same neural system supporting the affective component of physical pain (dorsal anterior cingulate cortex and anterior insula)
In what ways does acetaminophen or tylenol treat pain?
reduces daily self-reported social pain, neural responses to social rejection in the dACC and AI
4 clinical interventions for pain
surgical interventions, chemical/pharmacological treatments, stimulation therapies, physical therapy and rehabilitation
Examples of chemical treatments
peripherally active analgesics (e.g. acetaminophen), centrally acting analgesics or opioids (e.g. morphine), local anaesthetics (e.g. novocaine)
4 aims of psychological treatments for pain
to reduce the frequency and intensity, improve emotional adjustment, increase social and physical activity, reduce the use of analgesic drugs
Common psychological treatments for pain
fear reduction methods (e.g. systematic desensitization); progressive muscle relaxation, meditation, and biofeedback; cognitive methods; psychotherapy (e.g. CBT)
Examples of cognitive methods to treat pain
distraction, non-pain imagery, redefinition, promoting acceptance
Goal of CBT in treating pain
to help people manage the emotional difficulties associated with pain and encourage acceptance
Somatic symptom disorder
long-term pain due to excessive concerns for physical symptoms or health that are usually medically unexplained
Acute pain
discomfort experienced with temporary painful conditions that last less than about 3 months
Chronic pain
painful condition lasts longer than its expected course or more than a few months
3 types of chronic pain
chronic-recurrent pain, chronic-intractable-benign pain, chronic-progressive pain
Chronic-recurrent pain
stems from benign causes and involves repeated and intense episodes of pain separated by periods without pain
Chronic-intractable-benign pain
discomfort that is typically always present with varying levels of intensity and is not related to an underlying malignant condition
Chronic-progressive pain
continuous discomfort due to a malignant condition and becomes increasingly intense as the underlying condition worsens
Gender differences in the experience of pain
men and women have similar pain thresholds but women giver higher pain ratings
Neurodic trial scales
hypochondriasis, depression, hysteria
Relationship between chronic pain and psychological maladjustment
chronic pain is more likely to lead to maladjustment than vice versa
Psychophysiology
study of mental or emotional processes as reflected by changes they produce in physiological activity
