L8: pain, ch11, 12 - completed Flashcards
answers drawn from notes
1
Q
what are 3 reasons that the study of pain is important?
A
- is the symptom of greatest concern to patients
- is the most-likely symptom to lead to the use of health services
- heavily influenced by psychosocial processes
2
Q
what is the purpose of pain?
A
- warns self/others of tissue damage/injury/disease
- evokes care
3
Q
explain the specificity theory of pain. What are the 2 parts of the theory? how does it relate to the biomedical approach to pain?
A
- degree of pain = degree of tissue damage…directly proportional
- upon injury, pain messages originate in nerves associated with damaged tissue and travel to the spinal cord
- signal is then sent to a motor nerve and the brain, where pain is perceived
- biomedical approach to pain has a similar way of viewing pain
- and also assumes a one-to-one correspondence to injury/disease
- also overlooks psychosocial factors
4
Q
what is the biomedical approach to pain? what does it result in? what are the primary interventions used, and its limitations?
A
- assumes a one-to-one correspondence to injury/idsease
- results in unfortunate practices, such as patient-blaming, assuming psychiatric disorder, intentional faking of symptoms
- focuses on pharmacological, surgical, or other medical interventions to control pain
- limitations????
5
Q
what is the gate-control theory of pain? what does it include that was lacking in the specificity theory of pain?
A
- neural pain gate in spinal cord opens or closes to modulate pain signals to the brain
- involves inhibitor and projector neurons that respond to sensory input and send certain signals to the brain
- includes physical, emotional, and cognitive factors that can open/close the gate
- it includes an explanation for pain without a physical basis–is more holistic
6
Q
what is neuropathic pain? describe 4 conditions where this occurs. This provides counter-evidence for which theory?
A
- pain without noxious stimulus, resulting from current/past disease/damage in peripheral nerves
- counters the specificity theory
- neuralgia:
- recurrent episodes of intense shooting or stabbing pain along a nerve
- often follows infection
- causalgia:
- recurrent episodes of severe burning pain that are often triggered by minor stimuli
- AKA complex regional pain syndrome
-
phantom pain syndrome
- often experienced in an amputated limb - neuropathy: damage to peripheral nerves
7
Q
what is the neuromatrix theory? this is an extension of which theory? what is a body-self neuromatrix?
A
- extension of the gate-control theory
- there is a widespread network of neurons distributed throughout the brain and spinal cord
- this network is responsible for generating bodily sensations, including pain
- various parts of the nervous system work together to respond to stimuli from the body and/or environment, and sensory input is just one type
- body-self neuromatrix: widespread network of neurons that generates a pattern that is felt as a whole body possessing a sense of self
8
Q
what is a theory that provides an explanation for neuropathic pain and why?
A
- neuromatrix theory of pain
- pain can be felt in the missing limb because there’s no necessity for sensory input
9
Q
what are 3 things that may trigger phantom limb pain?
A
- other types of input
- lack of normal sensory input
- incongruence between types of input due to the lack of limb
10
Q
what is our definition of pain? identify the 3 key components of the definition
A
- unpleasant sensory/emotional experience associated with actual or potential tissue damage, or described in terms of such damage
- always emotional
- doesn’t always need identification of tissue damage
- always subjective
11
Q
what is the primary way that we assess pain? what are some issues with this method?
A
- primary way: self-report pain rating scales
- issues:
- answers for social desirability
- some people can’t report pain verbally
12
Q
what are 2 issues with self-reporting chronic pain and why?
A
- may not be taken seriously, since they have developed better coping mechanisms to deal with pain and only go to the doctor when the pain is really high
- chronic paid is different from acute or transient chronic pain because of how they try to adapt/cope over time
13
Q
compare organic vs psychogenic pain. what was the historical stance of these topics, compared to the contemporary stance?
A
- organic: pain with a sensory, physical root
- psychogenic pain: pain that results from psychological, non-sensory factors
- historically, the two types of pain were conceptualized as separate entities
- nowadays, scientists recognize that virtually all pain experiences involve an interplay of both physiological and psychological factors
14
Q
list 3 ways that emotions affect the pain experience
A
- negative emotions can exacerbate the pain response
- positive emotions reduce pain
- emotions can obscure the memory of pain… memories are based on what they expected, rather than what they felt
15
Q
describe the bidirectional relationship of pain and stress. what is a piece of research evidence that supports this?
A
- (1) Pain is stressful (partly due to lack of perceived control) and
- (2) stress can produce pain in addition to worsening the pain experience.
16
Q
why is meaning important in the pain experience? how does classical conditioning play into this?
A
- depending on the meaning we ascribe to the pain, it will be more or less intense
- e.g., classically condition mascochism
17
Q
what is the most problematic response to pain? describe this term. why is it so problematic?
A
- catastrophizing: frequent, magnified negative thoughts about pain
- results in higher likelihood of chronic pain
- makes pain experience worse
18
Q
describe the appraisal model of pain catastrophizing
A
- primary appraisal: focusing on and exaggerating the threat value of pain
- secondary appraisal: appraisals of helplessness and of inability to cope
19
Q
what is pain acceptance?
A
- being inclined to engage in activities despite the pain
- being disinclined to control or avoid the pain
20
Q
what is the relationship between positive reappraisal and pain? explain with reference to the cold-pressor task
A
- positive reappraisal can reduce pain IF the subjects receive explanations of how self-statements can help
- people’s beliefs about the purpose of using self-statements affect their experience of pain
21
Q
name and describe the model that emphasizes the role of catastrophizing in managing distress in a social environment. what is the end result?
A
- communal coping model of pain catastrophizing
- expressing pain catastrophizing results in increased social support by caregivers, which reduces the effects of catastrophizing on pain
- catastrophizing still has a negative effect overall, even with the benefit of social support
22
Q
name and describe the model that emphasizes the interpersonal influences in pain
A
- social communication model of pain
- individual in pain and supportive other bring unique qualities and characteristics that interact to influence the pain experience
- this dynamic interplay continuously influences the pain experience
- influences:
- personal experience of pain
- expression of pain
- pain assessment
- pain management
23
Q
what is social pain? why does it exist, from an evolutionary perspective?
A
- pain resulting from interpersonal rejection or loss
- alerts us to when our social relationships are threatened and we need to search out support
24
Q
how is social pain experienced in the brain, compared to physical pain? what implications does this have for treatment?
A
- same neural systems are used for both types of pain
- same parts of the brain light up
- however, the pattern of activation from physical and social pain is a little different
- implies that medications for physical pain may be helpful for social pain
25
name 4 different clinical (not psychological) interventions for pain. what is the best approach to treating chronic pain and why?
- best approach to treating chronic pain is a mix between pharmacological and non-pharmacological approaches
- medical methods alone are usually insufficient
- psychosocial factors play a huge factor in the pain experience! so we gotta also treat psychological factors
1. surgical interventions
2. chemical (pharmacological) treatments
3. stimulation therapies
4. physical therapy and rehabilitation
26
name 4 common psychological treatments for pain. what are their 4 aims?
- **psychological treatments**
- Fear reduction methods
- Progressive muscle relaxation, meditation, and biofeedback
- Cognitive methods (Distraction, nonpain imagery, redefinition, promoting acceptance)
- Psychotherapy
- **4 aims**
- reduce frequency and intensity of pain
- improve emotional adjustment to pain they have
- increase social and physical activity
- reduce drug use
27
what is somatic symptom disorder?
- experience of long-term pain as a part of excessive concerns for their physical symptoms or health
28
compare acute and chronic pain. how long do they last and what is its psychological impact?
- **acute**
- discomfort people experience with temporary painful conditions, < 3 months
- higher than normal levels of anxiety while the pain exists
- distress subsides as their conditions improve and their pain decreases
- **chronic**
- last longer than its expected course, or more than a few months
- high levels of anxiety
- develop feelings of hopelessness and helplessness
29
what is the relationship between sleep and pain?
- a day with a lot of pain tends to be followed by a night of poor sleep, which is then followed by heightened pain
- long-term sleep deprivation increases people's negative affect, sensitivity to pain, and amount of pain experienced in future weeks
30
what are the 3 types of chronic pain? what are the factors that categorize it?
- **factors**:
- benign (harmless)
- malignant (injurious) and worsening
- continuous or in episodes
- **types**
- **chronic-recurrent pain**: benign causes, repeated and intense episodes of paid separated by periods without pain
- **chronic-intractable-benign pain**: continuous discomfort, varying levels of intensity, not related to an underlying malignant condition
- **chronic-progressive pain**: continuous discomfort, associated with malignant condition, becomes increasingly intense as the underlying condition worsens
31
how might someone begin to enjoy pain?
- classical conditioning
- e.g., masochism
32
what is the pattern theory of pain? how does it relate to the specificity theory of pain? what is the main issue with these theories?
- receptors for pain are shared with other senses (e.g., touch)
- no separate system for perceiving pain
- people feel pain when certain patterns of neural activity occur (e.g., intense stimulation)
- similar to the specificity theory theory of pain since both link tissue to pain directly
- both don't address the psychological factors involved in the pain exprience
33
what are 2 common methods to induce pain in laboratory research?
- **cold-pressor task**: have someone submerge their hand into cold water
- **muscle-ischemia procedure**: reduces blood flow to the muscles of the arm to assess the individual's pain threshold
34
what are the 3 factors involved in the gate-control theory that adds nuance to the matter?
1. the amount of activity in the pain fibres: the stronger the noxious stimulation, the more active the pain fibres
2. the amount of activity in other peripheral fibres: activity here tends to close the gate
3. messages that descend from the brain:
35
what are 2 triggering conditions of pain reduction caused by placebos?
1. expectancies: reduction of stress
2. conditioning: trigger the release of endogenous opioids in the person's bady
36
what are the 4 categorizations of pain behaviours?
1. facial or audible expression of distress
2. distorted ambulation or posture
3. negative affect
4. avoidance of activity
37
how do men and women differ or stay the same in their experience of pain?
- M and W are similar in their pain thresholds
- differ in their reactions to pain
38
what are the 2 types of coping strategies used by adults and children with chronic pain
- **overt behavioural**
- getting rest
- using relaxation methods
- taking medication
- **covert**
- hoping/praying the pain will get better
- saying calming words to oneself
- diverting one's attention
39
what are 3 findings of testing patients with the Minnesota multiphasic personality inventory?
- chronic pain sufferers show a profile with high scores on the neurotic triad: hypochondriasis, depression, hysteria
- pattern holds regardless of whether it has a organic or psychogenic basis
- for acute pain: moderately elevated scores in the neurotic triad scales, but these scores and those for the remaining MMPI scales are generally well within the normal range
40
list 3 types of self-rating scales for pain
1. visual analogue scale: rate pain by choosing a point on a line with labels only on the end
2. numeric rating scale: 1-10, boxes
3. verbal rating scale: choose a word/phrase that matches their feelings
41
what are the 3 broad dimensions of pain, according to the McGill Pain Questionnaire? What is the main limitation of the MPQ?
1. affective (emotional-motivational)
2. sensory
3. evaluative
- main limitation: it requires a fairly strong English vocabulary
42
what is psychophysiology? what are 3 ways that this has been attempted to be measured?
- *study of mental or emotional processes as reflected by changes they produce in physiological activity
1. using an electromyograph to measure muscle tension
2. measurements of autonomic activity (not very useful)
3. electrical activity of the brain using an EEG
43
why is muscle tension important to measure in the pain experience, and over what period of time? which psychophysical measure assesses this?
- muscle tension is associated with various pain states
- reflects pain intensity only when assessments are taken over an extended period of time
- electomyograph
44
how is electrical activity measured in the brain? what are electrical changes caused by stimuli called?
- **evoked potentials**: electrical changes produced by stimuli
- show up in EEG recordings as sharp surges/peaks in the graph
45
what is clinical pain?
- any pain that receives or requires professional care
- may be acute or chronic
- calls for treatment in and of itself
46
how effective are surgical methods for treating pain?
- not really
- rarely provide long-term relief
- often have side effects
47
what are 5 advantages of using group psychotherapy over individual therapy in treating pain?
- more efficient, since chronic pain sufferers tend to face common difficulties
- reduced isolation
- increases credibility of feedback for patients
- new reference group for patients
- different perspectives for therapist
48
how can operant conditioning be used to modify patient's (pain) behaviour? for what kind of patients is this approach usually applied to? what are the 2 main goals?
- **operant approach**
- usually applied with patients whose chronic pain has already produced serious difficulties in their lives
1. reduct patient's reliance on medication
2. reduce disability that generally accompanies chronic pain conditions
49
how can fear result in a worsening of health conditioning? use operant conditioning to explain this. what is this term called?
- **fear reduction**
- fear results in the avoidance of certain activities, which is negatively reinforced since they don't experience their feared pain
- this results in the fear persisting, and them engaging in less activity
50
name and describe the 3 types of cognitive techniques used for active coping
- **distraction**: focusing on something in the environment to distract oneself
- **nonpain imagery**: creating a mental scene to distract oneself
- **pain redefinition**: person substitutes constructive/realistic thoughts about the pain experience for ones that arouse feelings of threat or harm
51
what are the 3 aspects of the distraction task that affects how well distraction works as a coping mechanism?
1. amount of attention the task requires
2. extent to which the task is interesting or engrossing
3. task's credibility
52
compare and contrast distraction and non pain imagery as coping mechanisms
- distraction: imagery in actual immediate environment
- non pain imagery: imagery conjured up mentally
53
what are the two forms that pain redefinition can occur in?
- **coping statements**: emphasize the person's ability to tolerate the discomfort
- **reinterpretive statements**: negative the unpleasant aspects of the discomfort
54
what are two ways that therapists can help the effectiveness of coping with pain?
1. providing info about what sensations to expect
2. help chronic pain patients see that some of their beliefs are illogical and making the discomfort worse
55
what is acceptance and commitment therapy? what does it teach?
- teach clients to experience their conditions and emotions directly, without the negative implications that have usually accompanied them
- teaches pain patients coping skills
- has them perform activities to see that they can enjoy activity even when some pain is present
56
what is the difference in the effect of active coping on acute vs. chronic pain? which methods are more effective than others for chronic pain?
- all active coping strategies effectively reduce *acute* pain
- redefinition may be more effective in relieving chronic pain than distraction is
57
can hypnosis reduce pain? how does It vary by person?
- can reduce intensity of acute pain
- not highly effective for all people, since people vary in their ability to be hypnotized
58
what is the underlying theory behind interpersonal therapy? what do these therapy sessions involve?
- people's emotional difficulties arise from the way they relate to others, particularly family members
