Role of psychological factors in the perception, experiencing & reporting of pain

Question 1

Define pain

Answer 1

An unpleasant sensory or emotional experience associated w/ actual or potential tissue damage

Question 2

Why do we feel pain?

Answer 2

Attention - we can’t ignore it and so we take action for survival.

But we also feel pain we can do nothing about:
- Hyper-vigilance (abnormal level of focus) may increase intensity.
- Distraction – may decrease intensity.

There is a relationship btw cognitions (thinking processes) & pain.

Question 3

Define acute pain

Answer 3

• Clear reason for occurrence
• Good likelihood of resolving through recovery from underlying cause.
• Good response to treatment e.g. drugs.

Question 4

Define chronic pain

Answer 4

• Less clear cause - no ongoing pathology, injury or healing. Pain continues after healing is complete.
• Poor response to treatments.
• Lasts longer than 3 months.
• Psychological component - high levels of depression, disability & social isolation.
• Extremely common

Question 5

What are the psychological factors involved in pain?

Answer 5

Psychological factors have a significant influence on pain and disability so they are stronger determinants of outcome than the biomedical factors.

1. Cognitions - thoughts- attitudes & beliefs
2. Behaviour- coping strategies
3. Emotions & distress
4. Biopsychosocial Model- for pain

Question 6

Psychological factors that affect the perception of pain?

Answer 6

Our attitudes & beliefs (cognitions) affect our perception of pain:

Individuals hold different attitudes & beliefs about:
- The origins of pain
- The seriousness of pain
- How to react to pain.

Cognitive Behavioural Mode proposes that people react to & manage their illnesses in ways which are consistent w/ their beliefs about their illness, themselves & their world.

Feelings of stress can lead to release of stress hormones, increased body tension & heightened pain experience.

Question 7

Give 3 health beliefs about how pain is perceived & explain how they change a patient’s outcome?

Answer 7

1. *Pain is externally located” → belief there is nothing they can do → passive coping → predict psychological stress & disability.
2. “Pain is malleable” → belief that action’s can improve pain → active coping → lower levels of pain, distress and disability.
3. “Pain is a sign of harm or damage” → avoidance of physical activity due to anxiety → further decrease in mobility, stiffness & disability.

Question 8

Give 7 examples of cognitions of people who are in pain?

Answer 8

1. Cataztrophizing - “The pain will never stop” - uses words like “always” & “never”.
2. Jumping to conclusions - usually negative.
3. “Should” thinking - “I should be able to do x & I can’t.”
4. Magnification– “I wonder whether something serious may happen.”
5. Helplessness - “I can’t go on.”
6. Rumination - “I keep thinking about how much it hurts.”
7. Expectations– “This should have recovered by now.”
   
   • Can be unrealistic
   • These drive behaviour
   • Has an impact if expectations are not fulfilled.

Question 9

Psychological factors that affect how pain is experienced?

Answer 9

1. Cognition:
   - Catastrophizing (believing it won’t get better) & rumination will magnify the pain.
   - Nociception recognises pain but this is linked to our limbic system = creates “emotional learning” when pain is persistent.
2. Behaviour:
   - Behaviours include coping strategies e.g. drinking.
   - Pain can be viewed as a set of behaviours e.g. taking analgesia, seeking care, resting.
   - Resting & taking analgesia may be good for short-term pain but these behaviours may cause longer term problems e.g. by reducing exercise & activity.
3. Emotions:
   - Emotions are powerful drivers of behaviour - the way we feel directly impacts how we act in relation to pain e.g. fear-avoidance.
   - Negative emotions linked to poorer outcomes - slower recovery, higher reporting of pain intensity, length of sick leave taken.
   - E.g. anxiety & depression

Question 10

How can depression lead to pain? Interventions for depression & anxiety? How does anxiety present?

Answer 10

Depression can lead to:
- Reduced engagement in activities or relationships that have positive benefits.
- Many failed interventions & chronic unresolved stressors.
- More frequently exposed to aversive events e.g. treatments.

Interventions for anxiety & depression:
1. Education - helps the patient understand that thoroughly investigated chronic pain does not indicate any underlying pathology*
2. Relaxation - e.g. diaphragmatic breathing, guided imagery, progressive muscle relaxation (PMR).
3. Cognitive Behavioural Therapy (CBT) - works to challenge unhelpful or negative thoughts.

Anxiety associated with restlessness, fatigue, difficulty concentrating, sleep disturbance, muscle tension.

Question 11

What is the persistent pain cycle?

Answer 11

Illustrates the downward spiral that feeds itself.

Things become increasingly difficult and more withdrawn.

Life is increasingly more impacted.

Question 12

Psychological factors that affect the reporting of pain?

Answer 12

Depression - leads to reduction in positive activities → further detriments life.

Catastrophizing means patient’s feel helpless so pain reported as greater.

Negative thoughts lead to slower recovery & higher reporting of pain intensity.

Frequent exposure to aversive events (pain, treatment) as well as failed interventions contribute to chronic stress associated w/ chronic pain, thus increasing reporting of pain.

Biopsychosocial model of pain:
- Pain is impacted on by psychological, social & biological factors biology.
- Along w/ nociception, cognition, suffering, pain behaviour & social environment influence our perception, experience &reporting of pain.
- Used to develop effective management strategies to help those dealing w/ chronic pain.