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Case 1 > Psychology of Pain > Flashcards

Psychology of Pain Flashcards

1
Q

What does the experience of pain serve as

A

A protective and adaptive role

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2
Q

What does acute pain teach us

A

To recognise and avoid things with potential to produce injury.

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3
Q

What does adversive quality of pain in the case of deep tissue injury, infection or bone fracture promote

A

Immobilization of affected limb and promotes healing

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4
Q

What happens if you have a congenital insensitivty to pain

A

You have a reduced life expectancy

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5
Q

What is the most common response when patients are asked what they fear most about illness and treatment

A

Pain

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6
Q

What is a common reason for euthanasia requests

A

Inadequate pain relief

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7
Q

What can pain lead to when experienced or anticipated

A

Distress

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8
Q

What is pain according to the international association for the study of pain (IASP)

A

An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of tissue damage, or both

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9
Q

What did Beecher find about the elusive nature of pain

A

No direct one-to-on correspondence between tissue injury and experience of pain

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10
Q

How is pain classified by duration

A

Acute or chronic

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11
Q

How is pain classified by nature

A

Nociceptive or non-nociceptive

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12
Q

Describe acute pain

A

Acute pain is transient. Typically results from specific injury that produces tissue damage (broken limb, wound)

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13
Q

What may inadequately treated acute pain evolve into

A

Chronic pain

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14
Q

Describe chronic pain

A

It lasts much longer and is beyond the normal expected healing time for injury

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15
Q

What are the types of nociceptive pain

A

Somantic or visceral

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16
Q

What are the types on non-nociceptive pain

A

Neuropathic or sympathetic

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17
Q

Describe nociceptive pain

A

Arises from any actual or threatened damage to non-neural tissue and is due to activation of nociceptors

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18
Q

Describe neuropathic pain

A

Arises from a leison or disease of the somatosensory nervous system. Disease can be central (e.g. multiple sclerosis) or peripheral (e.g. diabetic neuropathy)

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19
Q

What is more important in transitioning to chronic pain

A

Functional disability plays more of a role than pain intensity

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20
Q

What can chronic patients experience which helps maintain pain behaviours

A

Secondary gains such as increased attention form family members or compensation

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21
Q

What can be used to measure pain

A

The McGill pain questionnaire

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22
Q

What does the verbal report of pain do

A

Draw on large, informal vocabulary people use to describe pain- throbbing pain; shooting pain, a constant dull ache

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23
Q

What do pain questionnaires take into account

A

Nature of pain; intensity of pain; emotional components and functional impact of pain. “Gold standard” but subject to bias and cultural variation.

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24
Q

What are two subjective measurements of pain

A

Verbal report and pain questionnaires

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25
Q

What is a non-verbal assessment of pain

A

IASP- inability to communicate verbally does not negate the possibility that an individual is experiencing pain and in need of appropriate pain-relieving treatment

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26
Q

How does pain serve its protective functions

A

By not only warning the sufferer but also by impelling expressive behaviours that warn and solicit help from others

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27
Q

How can we see pain experience of those who cannot communicate pain through language e.g. infants, dementia

A

Use facial behaviour as a window of pain

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28
Q

What is the process through which potentially damaging stimuli is detected

A

Nociception

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29
Q

What are examples of noxious stimuli

A

Thermal, chemical and mechanical stimuli capable of causing tissue damage

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30
Q

What are specialised sensory neurones that are activated by noxious stimuli called

A

Nociceptors

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31
Q

How are nonceptive signals transmitted to the CNS

A

Via glutamate

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32
Q

What is activation of nociceptors modulated by

A

Inflammatory influences in local extracellular environment

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33
Q

What are the four main phases of nociception

A

Transduction, transmission, perception and modulation

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34
Q

Describe transduction

A

Exposure to noxious stimuli produces action potential

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35
Q

Describe transmission

A

Travels along fibres from point of transduction to dorsal horn and subsequently to the brain

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36
Q

Describe perception

A

Experience of discomfort, pain. Concious, emotional and subjective

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37
Q

Describe modulation

A

Response to pain, facilitation or inhibition of nociceptive input

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38
Q

What are the 3 primary types of afferent nerve fibres

A

A-delta fibres, C fibres and A-beta fibres

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39
Q

Describe A-delta fibres

A

Fast, myelinated- respond to heat and pressure

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40
Q

Which type of fibre is responsible for the first sharp pain

A

A-delta fibres

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41
Q

Describe C fibres

A

Slow, unmyelinated- polymodal, respond to thermal, mechanical and chemical stimuli

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42
Q

Which type of fibre is responsible for the second ‘throbbing’ or ‘burning’ pain sensation

A

C-fibres

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43
Q

Describe A-Beta fibres

A

Respond to non-noxious stimuli, detect light, touch, vibrations

44
Q

Describe ascending pain pathways

A

Nociceptive inputs enter CNS at spinal dorsal horn where primary afferent terminal synapse with second-order projection neurons. Substantia gelatinosa (SG) of the dorsal horn receives input from A𝛿 & C-fibres & also receive inputs from large-diameter myelinated A𝛽 fibres, which transmit innocuous sensory inputs. Beyond the peripheral nociceptor and dorsal horn, pain related information ascends in the contralateral spinothalamic tract. Also direct connections to medulla and brain stem via spinoreticular and spinomesencephalic tracts, and to hypothalamus via spinohypothalamic tract.

45
Q

What does chronic noxious stimulation result in

A

Hyperalgesia and allodynia

46
Q

Where may chronic noxious stimulation sensation occur

A

Peripherally or locally

47
Q

What does localised inflammation lead to

A

Hyperexcitability of peripheral nociceptors

48
Q

What is hyperalgesia

A

Hyperexcitability of peripheral nociceptors- exaggerated responsed to noxious stimuli (hyperalgesia)

49
Q

What does central sensitization result in

A

Sensitisation may occur centrally (dorsal horn) enabling non-nociceptive A-beta fibres to evoke pain sensations

50
Q

What is allodynia

A

Non-nociceptive A-beta fibres evoking pain sensations

51
Q

What describes the blocking of pain sensation

A

Gate control theory

52
Q

What does the gating mechanism within SG allow/ prevent

A

Passage of nociceptive signals from periphery to brain. Influences by relative degree of excitatory activity in spinal cord transmission cells

53
Q

What opens the gate

A

Excitation along the A-delta and C-fibres

54
Q

What closes the gate and what is this known as

A

A-beta fibres, known as counterstimulation

55
Q

What influences gating mechanism

A

Descending input from brain regarding current cognitive/ affective state

56
Q

What occurs beyond the gate

A

Neuromatrix theory and the multidimensional nature of pain

57
Q

In the neuromatrix theory and the multidimensional nature of pain where does pain arise from

A

A neural network with sensory, affective and cognitive components

58
Q

What is the role of the sensory component of pain

A

Transmits basic sensory information e.g. location of pain in body, pain;s sensory qualities (burning, piercing)

59
Q

What is the role of the affective component of pain

A

Emotional and motivational (fight or flight) reactions to pain

60
Q

What is the role of the cognitive-evaluative component of pain

A

Meaning of sensory experience

61
Q

What is the cortical processing of pain and what does it consist of

A

The pain neuromatrix conceptualised of consisting of a medial and lateral pain system originating from medial and lateral thalamic nuclei.

62
Q

What does the medial pain system consist of

A

Medial thalamic nuclei, anterior cortex (ACC) and insula

63
Q

What does the medial pain system do

A

Mediates affective-cognitive-evaluative aspects of pain

64
Q

What does the lateral pain system consist of

A

Primary (SI) and secondary (SII) somatosensory cortices and lateral thalamic nuclei

65
Q

What does the lateral pain system do

A

Mediates sensory/ discriminative aspects of pain

66
Q

How can you have an affective response in SI and SII without pain sensation

A

When the sematonsensory discrimination was absent due to stroke, the unpleasantness associated with noxious stimuli remained

67
Q

What did PET scans reveal activated when healthy volunteers received noxious thermal stimuli

A

Activation of S1. S2, insula and ACC

68
Q

Where is the affective component coded

A

In the ACC but not S1.

69
Q

Describe the descending endogenous pain modulatory system

A

Brain does not passively receive pain info from body but actively regulates sensory transmission via descending influences on spinal dorsal horn. Pain inhibition. Contributes to environmental and opiate analgesia. Some descending pathways can facilitate pain and may contribute to chronic pain. Variety of high cortical brain systems contribute to descending pain modulatory patwhay

70
Q

What forms a key part of the pain-inhibition system

A

Periaqueductal gray (PAG)

71
Q

What is the role of the periaqueductal gray

A

Integration of ascending pain stimuli and descending influences from high cortical regions

72
Q

Describe the psychological modulation of pain

A

Attentional orienting to painful sensation and its course. Cognitive appraisal of the meaning of sensation. Subsequent emotional, psychopathological and behavioural reactions. Which in turn feedback to influence pain and perception

73
Q

What receive preferential neural processing and are likely to govern behaviour

A

Attended stimuli

74
Q

How does pain automatically and involuntarily capture attention

A

By virtue of its significance.

75
Q

What can pain experience vary according to and why

A

Locus of attention: when attention is focused on pain it is perceived as more intense, whereas when attention is distracted from pain it is perceived as less intense

76
Q

Where does attentional distraction reduce pain related brain activity

A

In S1, S2 and thalamus

77
Q

Where does distraction increase activity

A

Prefrontal cortex, ACC and PAG

78
Q

What happened to spinal cord activity under high working memory load

A

Neuronal responses to painful stimulation in the dorsal horn were reduced

79
Q

What does attentional distraction related to spinal process involve

A

Endogenous opioid neurotransmission and possibly top-down modulation involved in cognitive control of pain

80
Q

What does the fact that pain involves a degree of cognitive appraisal mean

A

Individual (consciously or unconsciously) evaluated meaning of sensory signals emanating from bosy

81
Q

What does the manner in which bodily sensation is appraised influence

A

Whether it is experienced as unpleasant or not

82
Q

When is pain intensity reduced in relation to cognitive appraisal

A

When pain is perceived to be controllable e.g. re-interpret pain as harmless sensation of warmth

83
Q

What predicts the development of chronic pain problems in relation to cognitive appraisal of pain

A

Pain catastrophising is associated with greater pain intensity and predicts development of chronic pain problems

84
Q

How can activity in the brain pain matrix be changed

A

By changing the meaning of pain

85
Q

How may acute fight or flight response dampen pain

A

Via release of noradrenaline and activation of PAG and endogenous opiods

86
Q

What effect can chronic stress and negative emotional states (e.g. anxiety) have on pain

A

Intensify pain intensity, pain unpleasantness and reduce sense of perceived control over pain

87
Q

What do pain affect and negative emotions activate

A

Overlapping brain circuits e.g. ACC- heightened activity related to negative emotione (e.g. sustained anxiety) may ‘prime’ subsequent perception of pain

88
Q

What is fear of pain in chronic patients associated with

A

Hyper-vigilance for and sustained attention pain-related stimuli

89
Q

What effect does emotion influences on pain have in young depressed adults

A

Increased pain sensitivity

90
Q

What is a placebo

A

Any medical procedure that produces an effect in a patient because of its therapeutic intent and not its specific nature, whether chemical or physical

91
Q

What can the expectation of pain relief exert

A

A powerful analgesic effect even when pain is severe

92
Q

Where do mechanisms for placebo analgesia operate within

A

The neural circuit for the descending control of pain, including the PAG and opioids

93
Q

What prefrontal areas of related to cognitive modulation of pain

A

DLPDC. VLPF. ACC

94
Q

What cortical regions are associated with modulation activation of pain

A

ACC, SI, SII, insula, thalamus, brainstem and dorsal horn (e.g. PAG)

95
Q

Explain the effect of treatment expectation on drug effiacy

A

Positive expectation activated descending pain inhibition systems (including PAG), whilst negative expectation activates regions involved in negative emotion

96
Q

What are changed in the descending pain modulatory network implicated in

A

Chronic pain and functional pain disorders. Brain imaging reveals altered structure, function and neurochemistry within descending pain modulation circuitry in chronic pain patients

97
Q

Alterations in which higher level brain systems are implicated in generation and maintenance of central sensitisation states and hyperalgesia/ allodynia

A

Prefrontal cortex, ACC, PAG and dorsal horn

98
Q

How are changes in the brain defined in patients with chronic pain

A

Either a dysfunctional descending inhibitory system or an activated/ enhances descending faciliatory system

99
Q

What changes in grey matter density were observed in chronic back pain patients

A

Neocortical grey matter volume reduced by 5-11% compared with controls, equivalent to loss in 10-20 years of normal ageing

100
Q

What is chronic pain accompanied by in the brain

A

Brain atrophy

101
Q

Pain is not a hard wired system, instead it is

A

A system in which noxious input is passively transmitted along sensory channels to the brain

102
Q

What components does pain comprise

A

Sensory, affective and cognitive components

103
Q

Explain how pain is complex

A

It is a subjective experience nor linearly related to nociceptive input

104
Q

What is nociceptive information processing and consequent pain perception subject to

A

Multiple modulating influences

105
Q

What necessary survival function do psychological modulations of pain provide

A

They allows pain experience to be tailored to situations

106
Q

What is chronic pain associated with

A

Alterations in multidimensional pain systems

Case 1 (10 decks)

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