Psychology of pain Flashcards
what is pain
a percept
aversive and unpleasant
sign of actual or potential tissue damage
components of pain
sensory
affective
cognitive
motivational
why do we have pain
constant feedback about body enabling us to make adjustments
warning sign that something is wrong and results in protective behaviour
triggers help seeking behaviour
3 stages of pain
acute
pre-chronic
chronic
acute pain
adaptive
typically related to identifiable injury of disease
self-limited and resolves over hours to days or in time frame associated with healing
usually associated with objective autonomic features
heightened sympathetic activity
pre-chronic pain
critical time when the person either begins to heal and overcome the pain or lose hope and develop feelings of helplessness that can constitute chronic pain
chronic pain
time for normal healing has elapsed but the pain will continue
often in absence of any detectable tissue damage
vague descriptions of pain and inability to describe pains timing and localisation
lacks signs of heightened sympathetic activty
depression and anxiety common
which pathways transmit pain from periphery to brain
transduction
transmission
modulation
perception
transduction
afferent nerve endings translate noxious stimuli into pain messenger impulses
bee sting
3 types of primary afferents in transduction
A-beta
A-delta
C-fibers
A-beta
carry information related to touch
A-delta
information related to pain and temperature
C-fibers
information related to pain, temperature and itch
nociceptors
receptors in the kin and organs that sense heat, mechanical and chemical tissue damage
noiception
process of perceiving pain
transmission
process where impulses are sent to dorsal horn of the spinal cord
along the sensory tracts top the brain
2 finer systems in transmission
A-delta fibers: fast,sharp,well localised sensation, first pain
C-fibers: duller,slower onset often poorly localised, second pain
modulation
process of dampening or amplifying the pain related neural signal
descending inhibitory input dampens or entirely blocks incoming nociceptive signals at the gate of the dorsal horns
label the image of the descending pain modulation pathway
gate control theory
Melzack and Wall
neural gate in the spinal cord that regulates the experience of pain
pain isn’t result of straight through sensory channel
physiological and psychological causes
descending central influences from the brain
sends information related to the psychological state of the individual to the gate
behavioural state
emotional state
previous experience or self-efficacy in dealing with the pain
early pain theories
biomedical framework
pain is automatic response to external factor
tissue damage causes the sensation of pain
pain sensations has a single cause
psychosocial factors have no casual influence
what was pain categorised into
psychogenic pain
organic pain
psychogenic pain
considered to be all in the patients mind
was a label given to pain when no organic basis could be found
organic pain
regarded as real pain
label given to pain when some clear injury could be seen
pain perception
conscious awareness of the experience of pain
mediated by small diameter myelinated A-delta and non-myelinated C fibers
chemicals released following injury produce pain by direct stimulation of by sensitisation of nerve endings
what does perception result from
interaction of transduction, transmission,modulation, psychological aspects and other individual circumstances
how does GCT differ from earlier pain models
pain is a perception
individual actively interprets and appraises the stimuli
variations in pain perceptions is understood in terms of degreee of opening and closing gate
GCT suggests many factors involved not one cause
what opens the gate
physical factors
emotional factors
behavioural factors
physical factors for opening the gate
injury
activation of large fibers
emotional factors for opening the gate
anxiety
worry
depression
behavioural factors for opening the gate
focusing on the pain
boredom
what closes the gate
physical factors
emotional factors
behavioural factors
physical factors for closing the gate
medication
stimulation of small fibers
emotional factors for closing the gate
happiness
optimism
relxation
behavioural factors for closing the gate
focus
concentration
distraction
involvement in other activities
physiological gate open and gate closed
C/A delta fibers active
A beta fibers active
medical gate open and gate closed
extent of injury and insufficient medication
sufficient medication
cognitive gate open and gate closed
focus on pain
distraction and reinterpretation of pain
emotional state gate open gate closed
anxiety, fear, stress and depression
happy optimistic relaxed rested prior experience of pain
behavioural personality gate open gate closed
introvert
extrovert
hysteria
tendency to exaggerate symptoms and use emotional behaviour to solve problems
hypochondriasis
tendency to be overly concerned about health and to over report body symptoms
what do chronic pain suffers score high in
depression
also hysteria and hypochondriasis
factors that may affect pain
biology of pain pathways
neuroplasticity in these pathways
learning and conditioning
cognitive aspects of pain
emotional aspects of pain
memories of pain
sociocultural milieu in which pain is experiences
types of conditioning
classical conditioning
operant conditioning
classical conditioning
associating dentist with pain due to past experiences
operant conditioning
pain behaviour may be positively reinforced which may itself increase pain perception
role of cognition
catastrophising: rumination, magnification, helplessness
meaning: pain has different meanings to different people
attention: attention to pain can increase pain perception and distraction reduces pain
role of affect
anxiety
fear
anxiety in the role of affect
worry and anxiety relate to pain perception
acute pain increases anxiety
chronic pain treatment ineffective increases anxiety and increases pain
fear in the role of affect
fear of pain and fear avoidance beliefs
exacerbate existing pain and turn acute pain to chronic
psychological circle of pain
untreated pain that persists can cause fear and anxiety
if pain fails to resolve patients will become depressed and lose confidence in themselves and their doctors
sleeplessness may exacerbate the problem
age as a psychosocial factor in experience of pain
people get older there is a progressive increase in report of pain and decrease tolerance
gender as a psychosocial factor in experience of pain
women report more frequently
with more migraines, tension headaches, pelvic pain, facial pain and lower back pain
gender differences already apparent by adolescence and in medicines differential response to pain reports of women admen
pain as an interpersonal construct
pain is experience by the person
response to pain, particularly chronic pain can be influenced by these
psychogenic management strategies
placebo
hypnosis
stress
cognitive
pharmacological management strategies
opiates
spinal block
anti-inflammatory drugs
aspirin
placebo
may activate endorphin mediated pain control
sometimes inhibited by opiate antagonists
hypnosis
alters brains perception of pain
control infected by opiate antagonists
stress
both opioid and nonopioid mechanisms
clinically impractical and inappropriate
cognitive
may activate endorphin mediated pain control system
limited usefulness for severe pain
opitates
bind to opioid receptors in peri-aqueductal gray and spinal cord
severe side effects due to binding in other brain regions
spinal block
rugs block pain signals in spinal cord
avoids side effects of systemic administration
anti-inflammatory drugs
block prostaglandin and leukotriene synthesis at site of injury
major side effects
aspirin
blocks prostaglandin synthesis at the site of injury
doesn’t block leukotriene synthesis
types fo pain relief intervention
stimulaiton
surgical
psychogenic
pharmacological
types of stimulation
TENS/mechnical
acupuncture
central gray
types of surgical
cut peripheral nerve cord
rhizotomy, cutting dorsal root
frontal lobotomy
TENS
tactile or electrical stimulation of large offers blocks or alters pain signal to brain
segmental control, must be applied at site of pain
acupuncture
similar to TENS but sometimes affected by opiate antagonists
central gtay
electrical stimulation activates endorphin mediated pain control systems blocking pain signal in spinal cord
cutting the peripheral cord and rhizotomy
create physical break in pain pathway
considerable risk of failure or return of pain
frontal lobotomy
disrupts affective response to pain
irreversible and risky, severe effects on behaviour
4 distinct strands of psychological pain management
operant-behavioural therapy
cognitive behavioural therapy
mindfulness based therapy
acceptance and commitment therapy
operant behaviour therapy
focus on extinguishing maladaptive behavioural responses
fostering adaptive responses
uses reinformcenet or punishment contingencies
alters associations between threat value of pain and physical behaviour
good for: complex regional pain syndromes, chronic lower back pain and mixed chronic pain, whiplash associate disorders
cognitive behavioural therapy
biopsychosocial approach to behavioural and cognitive repossess to pain
involves psychoeducation, relaxation strategies, behavioural pacing and cognitive restricting
effective in those with chronic pain
negative in those who have pain disorders
what is CBT good for
cancer pain
complex pain syndromes
pain with HIV and AIDS
fibromyalgia
IBS
stress and pain
limbic system hypothalamic pituitary adrenal axis involved in stress response have been implicated
dysfunction has been implicated in chronic pain conditions such as rheumatoid arthritis and fibromyalgia
stress reduction
mindfullness learning
good for arthritis, chronic pain, fibromyalgia and IBS
progressive muscle relaxation, stretch based relaxation, deep breathing and autogenic training are all relaxation techniques to be learned
biofeedback to modify biological aspects of pain that produce changes in physiological parameters
ACT
acceptance and commitment therapy
developing psychological flexibility
focuses on development of acceptance of mental events and pain and learning to cease avoidance and other problematic behaviours
good for musculoskeletal paonii and whiplash
