Reading 3 (Group 2) Flashcards
What modulates pain perception?
A variety of cognitive and emotional factors, as well as a number of sensory inputs
What 2 things might be important determinants ot the experience of pain?
mood and attention
How can negative emotions influence pain?
Negative emotions can cause or exacerbate pain, and lead to neural changes in differ ent regions of the brain
Where do all cognitive, emotional and sensory processes that affect pain perception arise? What does this include?
from the context surrounding the painful experience, such that different contextual factors might have an important role in the perception of pain.
This context includes the physical properties of the medication, such as colour, shape, taste and smell, the characteristics of the hospital room, the sight of health professionals and medical instruments and the interaction between patient and doctor.
What do context-induced positive expectation and context-induced conditioning produce?
brain changes that are associated with the activation of at least two neuro chemical systems, the endogenous opioid and endo cannabinoid systems.
What is pain modulated by? What have positive contexts been found to activate? What have negative contexts been found to activate? What might contexts with positive meanings result in?
■ Pain is modulated by a variety of contextual factors
■ Positive contexts, such as those related to placebo administration, have been found to activate a number of endogenous antinociceptive systems
■ Negative contexts, such as those related to nocebo effects, activate endogenous systems that increase pain
■ Contexts with positive meanings might even turn pain into a rewarding experience
What has Cholecystokinin (CCK) been found to do?
Cholecystokinin (CCK) has been found to reduce placebo analgesia with its anti opioid action.
From a neuroanatomical viewpoint, what is the current agreement on what the administration of a placebo along with positive verbal suggestions activates?
From a neuroanatomical viewpoint, there is now agreement that administration of a placebo along with positive verbal suggestions activates a descend ing pain modulating network, which is known to have a crucial role in modulation of the ascending nocicep tive inputs
What are the three important regions of the brain involved in the descending pain modulating network?
The dorsolateral prefrontal cortex, the rostral anterior cingulate cortex, and the periaqueductal grey , although many other areas of the brain are also activated or deactivated by the placebo response.
What is nocebo effect? What is it induced by?
The nocebo response is a phenomenon that is opposite to the placebo response and is induced by negative expectations. If a placebo is given within a negative context, for example along with a negative verbal suggestion of pain, a nocebo response can occur.
What are examples of negative contexts that lead to negative expectations?
negative diagnoses and prognoses can lead to an amplification of pain intensity, and can have impor tant effects on the emotional state of patients. Nocebo and nocebo related effects can also occur when patients distrust medical personnel or the prescribed therapy. health reports commonly issued in Western societies can have nocebo effects
Can mass media impact people’s percieved symptoms? Example?
negative warnings sent out by the mass media may have an important impact on people’s perceived symptoms. Headaches, for example, can be caused by believing that there are health risks associated with the use of mobile phones.
Similarly, some negative expectation inducing procedures, such as voodoo magic aimed at producing illness, could exacerbate symptoms.
Give short summary of placebo effect.
The positive context. A positive therapeutic context induces positive expectations, which activate different brain regions, including the DLPFC, the rACC and the PAG.
What does DLPFC stand for?
dorsolateral prefrontal cortex
What does PAG stand for?
periaqueductal grey
what does rACC stand for?
rostral anterior cingulate cortex.
Give a short summary of nocebo effects.
The negative context. A negative context induces negative expectations and activates CCK,
which has a facilitating effect on pain transmission, and the HPA, which is related to anticipatory anxiety. Negative expectations also reduce μ‐opioid receptor and dopamine receptor signalling in the NAcc
What does CCK stand for?
cholecystokinin
What does HPA stand for? .
hypothalamic–pituitary–adrenal axis
What does the NAcc stand for?
nucleus accumbens
From a pharmacological view point, what can the nocebo hyperalgesic effect be mediated by?
CCK
Does Actual discrepancy between anxietyinduced hyper algesia and stressinduced analgesia exist?
maybe not.
What neurotransmitters are nocebo effects also associated with? What does this highlight?
Nocebo effects are also associated with a decrease in dopamine and opioid activity in the nucleus accumbens, highlighting the role of the reward and motivational circuits in nocebo responses.
How does stress relate to analgesia? what plays an essential role?
Stress is known to induce analgesia and increase the pain threshold in a variety of situations, both in animal models and in humans. The nature of the stressor plays a central role.
When might hyperalgesia occur?
Whereas hyperalgesia might occur when anxiety is due to anticipation of pain, analgesia might occur when anxiety is about a stressor that shifts attention away from the pain.
In the case of anxiety induced hyperalgesia, where is attention focused? What does the biochemical link between anticipatory anxiety and the pain increase involve?
In the case of anxiety induced hyperalgesia, attention is focused on the impending pain, and the biochemical link between this anticipatory anxiety and the pain increase involves CCK.
What is stress-induced analgesia? Where might this result from?
stress induced analgesia is a general state of arousal that stems from the focus of attention on an environmental stressor. Experimental evidence exists that this type of stress induced analgesia results from activation of endogenous opioid systems
Can the meaning that a patient interprets from a symptom be crucial? Example?
yes.
Cancer related pain can be perceived as more unpleasant than postoperative pain,73–75 because of the association with the prognosis, illness or death on one hand and healing on the other, respectively
Is an individual’s interpretation of the meaning of pain always associated with prognosis? Why?
No.
Different religions and cultures attribute different meanings to pain and suffering, and this can lead to different experiences of pain.
Can pain be perceived as rewarding? When?
even pain can be perceived as a rewarding experience if it is presented within a context in which there is special positive meaning
Is the relationship between pain and reward well documented? Can the relief from pain be a form of reward? How can analgesia activate feelings of reward?
yes.
Analgesia can activate the same mesolimbic reward network as stimuli including food, money and drugs of abuse
What determines how pain is percieved?
Pain is perceived in different contexts according to special meanings.
What happens if pain is associated with a future reward?
If pain is associated with a future reward, tolerance is increased through the activation of the endogenous opioid and cannabinoid systems.
What happens when moderate pain is compared with the absence of pain? When moderate pain is compared to sever pain? What does this mean about reward mechanisms?
When moderate pain is compared with the absence of pain, it is the worst possible outcome. When moderate pain is compared to severe pain, it is the best possible outcome; accordingly, it activates reward mechanisms and can be experienced as pleasant.
