Pain Flashcards
What are the four layers to the ‘Onion of Pain’?
Order begins from center outwards:
Nociception-The Pain Signal
The Feeling/Sensation of Pain
The Emotional Consequence of Suffering
Pain Behavior
Describe the gate control theory of pain
A physiologically induced stimulus is subsequently regulated by a theoretical gate which behaves much like a rheostat.
\+Open = +Suffering -Open = -Suffering
The gate does not adjust the amount of pain only the perceived/felt/experienced amount suffering.
Can a person experience pain without nocieception?
Yes. Consider the example of phantom limb pain.
What are some limitations of the Gate Control Theory of Pain?
Limitations to this theory include the existence of top down psychologically stimulated/generated pain sensations.
Other psychological factors include:
Expectations: ie suggestions change ones experience of pain
What pain means matters: ie WW2 soldiers vs civilians
What psycho-social factors ‘open the gates’?
Learning History: observing how others in family and community demonstrate how to experience pain.
Perception of severity
Social Environment: Private vs Public, Cultural
Gender
Stress
Assigned Meaning
What psycho-social factors ‘close the gates’?
Learning History
Distraction and Distracting Activities
What physiological/biological factors ‘open the gate’?
Nerve fibers conduct information quickly
Nerves in the brain can turn up the volume on pain
Narcotic medications while providing short-term relief contribute to increase in pain sensation and suffering over the long term due to negative reinforcement dependency and tolerance buildup.
Negative Emotions
Excessive resting
What physiological/biological factors ‘close the gate’?
Physical Therapy
Rubbing and Massage
Exercise
Distracting Activities
Relaxation
Name two examples of psycho-social factors that are related to pain outcomes:
- Pain related catastrophizing
2. Reinforcement pain behaviors
Pain interference and Mental health issues affect which ‘slice of the onion’ and how?
Both pain interference and mental health issues affect pain intensity as it relates to the suffering piece of the onion.
How would one test correlation/causation variable relationships in pain related catastrophizing?
By utilizing an experimental design in which a control group receiving education is compared with a variable group which receives CBT.
Is Pain Related Catastrophizing distinct from depression?
Yes
Can Pain behaviors and disability be influenced by social factors?
What did Dr. Bill Fordyce (1976) propose?
That the presence and strength of pain behaviors are influenced by an individuals learning history.
Dr Fordyce describes how environmental factors maintain pain behaviors and tells us what we can do about them.
Fordyce taught and practiced the use of operant-conditioning in treating chronic pain.
Describe an example of using operant conditioning to treat chronic pain?
Identify unpleasant activities avoided by the patient when pain behaviors appear in addition to contingency factors that maintain or increase pain behaviors (attention from a spouse, disability payments)
replace with new behaviors and environmental contingencies that successfully support coping with chronic pain and illness.
Define Operant Conditioning
Behavior learned though conditioning by means of an association with it’s consequences.
Examples include:
+/- reinforcement
+/- punishment
Reinforcement in operant conditioning?
Increases Behavior
Positive Reinforcement in Operant Conditioning…
Adds a appetitive stimulus following correct behavior.
ie give the dog a treat when it sits
Two Types of Negative Reinforcement in Operant Conditioning…
Escape: removes noxious stimuli following correct behavior.
ie turning off an alarm clock after waking
Active Avoidance: behavior avoids noxious stimulus
ie studying to avoid a bad grade
Punishment in Operant Conditioning…
decreases behavior
Positive Punishment in Operant Conditioning…
adds a noxious stimuli following behavior
ie spanking a child for hitting their sibling
Negative Punishment in Operant Conditioning…
removes an appetitive stimulus following behavior.
Grounding a child for hitting their sibling
To the extent that analgesic (pain relieving medications) are reinforcing, what is being reinforced and what type of operant conditioning is at play?
Taking pain medication is the reinforced behavior
Negative Reinforcing Operant Conditioning is at work due to the removal of a noxious stimuli (pain) after engaging in the behavior (taking the medication).
What areas of the ‘Onion’ do pain treatment options target?
Pain Intensity
Pain Interference
Emotional Suffering
Name three examples of pain treatment options:
- Contingency Management
- CBT
- Hypnosis
