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PSYC 302 > Lecture 5: Organismic and Experiential Factors > Flashcards

Lecture 5: Organismic and Experiential Factors Flashcards

1
Q

How are individual differences in pain sensitivity measured?

A
  • 500 people were given an identical thermal stimulus of 49 degrees.
  • They were asked to rate the pain on a VAS.
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2
Q

Why is there so much pain variability between people?

A
  • People might have different perceptual experiences.

- But it can also be due to different interpretations of the pain scale.

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3
Q

Was there any proof that the variability in pain ratings could be due to an actual perceptual difference?

A
  • Coghill made a study where there was some evidence that there are different perceptual experiences.
  • However if he did the study with more people, it wouldn’t be replicated.
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4
Q

What proportion of people with cancer have cancer pain?

A

1/3

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5
Q

What proportion of people with a stroke have shoulder pain?

A

1/4

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6
Q

What proportion of people with diabetes have painful diabetic neuropathy?

A

1/4

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7
Q

What proportion of people with trauma have causalgia?

A

about 1/5

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8
Q

What proportion of people with shingles have post-herpetic neuralgia?

A

About 10 to 18%.

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9
Q

What proportion of people with a stroke have post-stroke pain?

A

about 10%

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10
Q

What proportion of people with a fracture have complex regional pain disorder?

A

very little amount like 3%

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11
Q

What proportion of people getting surgery experience chronic post-surgical pain?

A

only 7%.

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12
Q

How many surgeries are performed every year in Canada?

A

More than half a million?

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13
Q

How were individual differences in analgesic response measured?

A
  • 3170 postoperative patients were asked by the nurse to rate their pain every hour
  • If that rating was above 40, the patients were assigned another dose of morphine.
  • FOUND: very big variability in dose required : 2-83 ug/kG
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14
Q

What would be the organismic (nature) reasons for inter individual variability?

A
  • genetic background
  • sex
  • psychological traits
  • age
  • circadian rhythms
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15
Q

What would be the environmental (nurture) reasons for inter individual variability?

A
  • past experiences
  • gender
  • psychological states
  • diet
  • legal factors
  • social factors
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16
Q

What legal factors affect reported pain levels?

A

In a lawsuit.

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17
Q

What is the biopsychological model?

A

3 factors that can influence individual differences:

  • biological
  • sociocultural
  • psychological
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18
Q

What was found in twin studies about the heritability of pain?

A
  • For clinical pain. 40% heritable on average.

- For experimental pain: 40% heritable on average.

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19
Q

What was found when studying the heritability of pain in inbred mouse strains?

A

About 40% heritable as well

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20
Q

What are monogenic pain disorders?

A
  • Pain due to dysfunction of some specific genes

- Very rare

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21
Q

What gene comes up alot in monogenic pain disorders?

A
  • SCN9A

- Variants in that gene are responsible for a number of pain disorders.

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22
Q

What does HSAN stand for?

A

Hereditary Sensory and Autonomic Neuropathy

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23
Q

What is the most important pain gene according to Mogil’s study?

A
  • COMT

- Plays a role but we don’t know what

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24
Q

In the OPPERA study, what did they find was a risk factor for developing TMD (Temporomandibular Disorder)?

A

somatization

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25
Q

How did they measure somatization in the OPPERA study?

A

2 questionnaires:

  • PILL: Pennebaker Inventory of Limbic Languidness
  • SCL 90R Somatization Subscore.
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26
Q

What was found about sex differences in chronic pain prevalence ? Berkley study

A
  • 3 columns sort out pain disorder according to what sex it’s most likely to be associated with.
  • Approx 70% of chronic pain patients are women
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27
Q

Why might their be a sex difference in the amount of chronic pain patients ?

A
  • social expectation that men are supposed to be stronger than women
  • they don’t go to the doctor as much so alot of male pain is not reported.
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28
Q

Mogil measured pain prevalence for male and female for different pain disorders. What were the findings of this study?

A
  • In every case except one, women are more likely to say they have those symptoms, by approximately 5%.
  • This might be because women are more sensitive to pain , but also because women are more likely to develop symptoms that featuring pain.
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29
Q

How do babies respond to pain stimulus?

A
  • they are allodynic, they respond to very small forces

- their response is also bilateral (if stimulus is on one leg, they will lift both legs

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30
Q

Are you more or less likely to be a pain patient as you age?

A
  • You are LESS likely

- counterintuitive

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31
Q

Why are you less likely to be a pain patient as you age?

A
  • as you age you are more careful with your health, so you have less risk of being in pain for some reason
  • there is an expectation of natural pain as you get older so you see it as “normal” and don’t go to a doctor for it.
32
Q

Older rats take longer to escape pain stimulus than younger rats. Why is that?

A
  • Widespread supposition: they don’t have as much pain

- More plausible possibility: they don’t have the same physical abilities as before.

33
Q

Do Black people have higher pain levels or lower? What could be the reasons?

A
  • higher pain levels were recorded in Black people

- This could be genetic or environmental

34
Q

When do most pains peak?

A

-In the morning

35
Q

When does osteoarthritis of the knee peak?

A

In the evening because you are active all day long

36
Q

Are you more at risk of being in pain if you are unemployed ?

A

Yes 3.1 times more risk

37
Q

Are you more at risk of being in pain if you have physical exertion at work?

A

Yes 1.5 times more at risk

38
Q

How much more at risk are you of experiencing chronic pain if your body mass index is bigger than 30?

A

1.9

39
Q

How much more at risk are you of experiencing chronic pain if you are married for the first time?

A

1.6

40
Q

How much more at risk are you of experiencing chronic pain if you are other than married for the first time or single?

A

2 times more at risk

41
Q

In the study about pain and spousal support, how was the spouses response to their spouses pain coded?

A
  • solicitousness: pity, poor baby can I do something
  • punishment: stop complaining
  • distraction: trying to change the subject
42
Q

How were the different types of responses to spouses pain correlated with levels of pain?

A
  • solicitousness: positively correlated, so more soli=more pain
  • distraction: predicted lower pain scores
43
Q

How does empathy for pain vary according to the subject that is in pain?

A
  • If the person in pain is telling a sad story about themselves, more empathic for their pain
  • If they are assholes, less empathy for their pain
44
Q

How does laboratory environment affect pain of the subject?

A

Alot of random things will affect pain in laboratories, like rhythms, ambient conditions, testing surface…

45
Q

What were the findings of the study with soy in rats?

A

-Lower pain if higher soy diet

46
Q

In mice, how does empathy influence pain levels?

A

-If two cagemates are in pain together they will have higher pain than one mice alone, or two stranger mice together

47
Q

who discovered the placebo effect and how did he discover it?

A
  • Henry Beecher, medic during WW2
  • Ran out of morphine, used saline solution, continued telling soldiers it was morphine
  • Half of soldiers reported that the solution reduced or erased their pain
48
Q

What reason is there to believe that the placebo effect is real?

A
  • According to a study the clinical problem that placebo has most effect on is pain.
  • but it was also the problem that had most participants relative to other issues studied in this study.
49
Q

How can yo have placebo with conditioning?

A
  • classical way: pavlovian
  • If you are conditioned to the idea that the pill will have a certain effect, even if the pill doesn’t do anything you will feel like it does
50
Q

How can you have placebo with expectation and desire?

A

-When you expect or want the pain to get better, some mechanisms mIght engage that make you feel like it’s better

51
Q

What exact effects does placebo block?

A

It blocks specific effects, but not non-specific effects.

52
Q

What percentage of people respond to placebo?

A

About 1/3 of people, around 30%

53
Q

What pain conditions respond better to placebo than other pain conditions?

A

HIV and phantom pain

54
Q

How do personality traits influence how you respond to placebo effect?

A
  • anxious: less likely to respond, bad expectancy.

- optimistic: more likely to respond, good expectancy.

55
Q

When are you more likely to start a treatment?

A

When you think the pain is as bad as it could get.

56
Q

How does subjectivity vs objectivity affect placebo effect?

A

The more subjective the pain is the more likely you are to have placebo effect.

57
Q

How can the nature of verbal suggestions affect the placebo effect?

A
  • More likely to have placebo if you are being told: it is a powerful painkiller
  • rather than: it can be either placebo or painkiller
58
Q

How does previous experience affect placebo effect?

A

If you take alot of analgesics in your everyday life and it works, you are more likely to have placebo effect.

59
Q

How can belief, expectation and desire of the patient and clinician influence placebo effect?

A

-If the clinician believes in what he is prescribing, it results in more placebo for the patient

60
Q

What factors in the patient-clinician interaction affects the placebo effect?

A
  • “bedside manner”: enthusiasm, reassurance, empathy, communication
  • white coats
  • deep voices
61
Q

What physical properties of the treatment can affect placebo effect?

A
  • sham surgery>i.v pleacebo>big pill>small pill

- expensive pill>cheap pill

62
Q

How is placebo opioid-mediated?

A
  • placebo effect is mediated by the release of endogenous opioids
  • this effect can be reversed by NALOXONE which is an opioid antagonist
63
Q

What is rimonabant?

A

It is an antagonist to CB1 (cannabinoid neurotransmitters).

64
Q

What is ketolorac?

A
  • An NSAID: Non-steroidal anti-inflammatory drug

- Acts as an analgesic

65
Q

What are the effects of rimonabant on placebo effect?

A
  • blocks the placebo analgesia that came with ketolorac
  • Does not block the opioid placebo
  • Does not block morphine or ketolorac
66
Q

What is a nocebo effect?

A

opposite of placebo effect: you have pain with no actual stimulus

67
Q

What is the most prevalent nocebo effect?

A
  • voodoo
  • people finding out a voodoo curse was put on them report experiencing voodoo torture
  • clinicians saying negative things to the patients can also produce a nocebo effect
68
Q

What does CCK do?

A
  • cholecystokinin

- Leads to hyperalgesia

69
Q

What is an antagonist for CCK?

A

-proglumide: makes the placebo effect even stronger

70
Q

In a clinical trial, is the placebo response solely due to placebo effect?

A
  • no

- circumstances like the nurse being nice, good service and the place being comfortable can increase placebo response

71
Q

How has placebo response been evolving overtime?

A
  • has been growing overtime

- this is true for antipsycs, antidepressants and analgesics

72
Q

How has drug response evolved overtime?

A

Drug response has remained constant overtime

73
Q

What was the biggest change in American drug trials?

A
  • Direct to consumer advertising on drug was allowed

- Makes them believe more that the drug works

74
Q

In what drug trials is placebo response bigger?

A

-bigger in trials studying diabetic neuropathy than in postherpetic neuralgia.

75
Q

How can we try to reduce placebo response?

A
  • could do trials on patients with lower placebo response

- could test people for placebo analgesia first, then exclude those with large placebo response

76
Q

Why is placebo in clinical trials lower than in the real-world?

A
  • in clinical trials: subjects might understand that they’re getting placebo
  • in real world, people get real drugs

PSYC 302 (7 decks)

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