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
Describe an example of how contingency management is used to treat chronic pain.
Identify 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
Describe an example of how CBT is used to treat chronic pain.
Identify and modify internal narratives that maintain or increase pain behaviors.
Evaluate in terms of what is and is not helpful.
Look for pain-related catastrophizing
What is hypnosis?
Hypnosis is an altered state of consciousness characterized by a markedly increased receptivity to suggestion, capacity for modification of perception and potential for systematic control over usually involuntary physiological functions (Barber, 1996)
T/F: Hypnosis is not a passive process
True
T/F Hypnosis can be done to you without your consent
False
What is a Hypnotic State?
A state in which a person becomes increasingly absorbed
Hypnotic Induction Includes three things…(hint remember C.I.A.)
- Communicating suggestions for a change in state of consciousness
- Imaging to assist in making the transition to a hypnotic state from a waking state
- Asking an individual to become focused of a stimuli
T/F Hypnosis changes your brainwaves
True
T/F Hypnosis amplifies slow wave activity
True
T/F Certain music slows the brain down
True
T/F Expectations of hypnosis’ efficacy matter
True
Describe an example of how Hypnosis is used to treat chronic pain.
Patients with spinal pain responded more to hypnosis than those with MS.
Hypnosis helped a patient undergoing dental surgery who was unable to take pain medication
What is a possible explanation for why hypnosis mitigates the experience of pain and suffering?
Perhaps mitigation of pain and suffering is due to changes in brain wave activity during hypnosis in which slow wave activity is amplified.
Combined with certain music that increases slow-wave activity further amplification of the hypnosis effect is theorized.
What is the point of pain?
Pain is a survival oriented alert system
Pain asks you to pay attention
Minor pains provide low-level feedback
ie shift posture, etc
What is the difference between Acute and Chronic pain?
Acute pain goes away when healed
Chronic pain persists 3-6 months after healing
What is the most common chronic pain condition?
Back pain. 70-85% suffer at some point.
Raichels’ running theory on Validation and CBT for those experiencing chronic pain
Everybody feels validated and heard for the first time, not sure if CBT outweighs the impact of having ones experience validated.
