Test 2 Flashcards

1
Q

How do animals experience pain?

A

Vertebraes- sense harmful send it to spine, remove hand, get rid of stimulus-
Concious recognition of pain- neurons create sensation in pain- associated with fear, stress
Hurt animasl- tend to wound, make noises, avoid future harm
Osyter, worm and jelly fish- experience nocioception and not concious pain
Those that are smarter- may experience the concious pain
Remember physical sensation- recognixe when pain is cominh

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2
Q

Why Use Animals?

A

can conduct causation experiments

can stimulate/lesion any tissue

can assay, record from, or extract any tissue
can give unapproved drugs
can alter gene expression (temporarily or permanently)
can control pre-exposures- life history
cheaper, faster, less highly regulated- gestational period= 3 weeks and make 8-12 babies
no malingering- faking it, exaggerating , no demand characteristics- don’t change response based on observation

Can do more with animals than humans
Rat used the most for pain research followed by mice

Boomed bc of transgenic mice
C57-black 6 mouse inbred- making genetic clones brain stem and dicephlon- similar to humans
Mouse brain is flat, has no folds

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3
Q

Why Use Animals?

A

can conduct causation experiments

can stimulate/lesion any tissue

can assay, record from, or extract any tissue
can give unapproved drugs
can alter gene expression (temporarily or permanently)
can control pre-exposures- life history
cheaper, faster, less highly regulated- gestational period= 3 weeks and make 8-12 babies
no malingering- faking it, exaggerating , no demand characteristics- don’t change response based on observation

Can do more with animals than humans
Rat used the most for pain research followed by mice

Boomed bc of transgenic mice
C57-black 6 mouse inbred- making genetic clones brain stem and dicephlon- similar to humans
Mouse brain is flat, has no folds

onsequentialist Ethics
The normative ethical position holding that the consequences
of one’s conduct are the ultimate basis for any judgment about the rightness of that conduct.- focus on serving greater good, grey zones

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4
Q

Pain and Utilitarianism

A

Consequentialism= subcategory of this
Maximize pleasure and minimize painPain and Utilitarianism

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5
Q

Pain and Utilitarianism

A

Consequentialism= subcategory of this
Maximize pleasure and minimize painPain and Utilitarianism

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6
Q

What are we trying to model?

A

Central sensitization- hyperactive cns- brain or spinal cord causin. Pain
non nocioceptor neuons= cns neurons
Inflamattion- meant to repair damage, causing sensitization
High threshold- need large stimulus to cause nocioception
Neuropathic and csn- pathological
Csn- fobromyalgia and only in cns, not nocioception

NOCERITA
NEUROPATHIC
CORA SENSITATION

system aystuncton
Neurons
Nociceptor and
non-nacicentor
Nociceptor and non-nociceptor
Non-nociceptor
Site
Peripheral and central
Peripheral and central
nervous system
Central nervous
SYSICE
winico
setting
Acute trauma
arthritis
Nerve lesions diabetic neuropathy,
shingles, carpet tunne
Fibromyalgia and a
volesy or outer pon
FunCLOI
healing/repair,
patholocica
ratholodice
Patholodica
rall
sensitivity
hien or low tiresnold Low tresno

Low tiresnore

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7
Q

Chronic pain models in rodents

A

Inflammatory pain
Can be modeled in rodents by the injection of chemical inflammatory agents and irritants
Common models include foot, ankle or knee joint injections of carrageenan, complete Freund’s adjuvant (CFA), capsaicin, formalin- preserves tissue, zymosan, cinnamaldehyde, mustard oil- foreign and cause immune response
Different agents induce different resolution time courses.
CFA recruits neutrophils and macrophages to the site of injection.
Cells that cause infklammation- give rise to nocioception
Cytokines and and white blood cells- cause inflammatory response
Injecting different dosed of carrageenan- seaweed extract- changes sensitixation easily

Pay attention to change in time- can tell you what test used

Inflammatory pain- last up to 8 weejs for mice
Differences in pain sensitivity based on what used and dose

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8
Q

Formalin phases mimic neuronal activity

A

Inflammatory teste
Measures- nicioceptive defensive behaiour, prevent or respond to to pain
Example= lick paw/wounds, cold water

Injected into hind paw- starts to lick paw
Purple= quiescent- calms Dowm
Then picks up again in late phase(central spinal cord activity)
Interested most in late phase
First 10 minutes= activation nocioceptor
C fiber- detetcts nocioception

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9
Q

Hyperalgesic priming

A

Hyperalgesic priming
Carrageenan or CFA is injected into the paw of a group of animals. This will resolve over a couple of hours or days.
After the resolution of inflammatory sensitivity, a second inflammatory substance is
injected into the same region (i.e., PGE2- cause inflammation)
Sensitivity is significantly longer in duration than what is observed in a group of animals that did not receive the first injection (naïve). Tests neuronal pain memory and plasticity
Hyperalgesic priming- if hyperalgesia affects subsequent experience

Inject pge2, have transient pain response but if before, inject inflammation- will experience more pain for longer- bc of inflammation sensitizing neurons, have memory of pain, want to protect self, change threshold

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10
Q

Musculoskeletal pain

A

Musculoskeletal pain
Pain originating from muscle, bone or joints (i.e., OA and RA)
Most common symptom reported in pain patients
OA is modeled with injection of monosodium-iodoacetate into the joint or
surgical transection of ligaments
RA modeled with injection of collagen and CFA into the knee joint. Can cause
release of proinflammatory cytokines (IL-1, IL-6, TNFa) Inflammation causes release of inflammatory cytokines
DBAv strain- susceptible to collagen artritis- when inject it makes it more inflammatory

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11
Q

Neuropathic pain

A

Neuropathic pain
Pain caused by damage or disease of the somatosensory nervous system-MS
Surgically induced in periphery of rodents by stretching, compression, or transection of peripheral nerves (i.e., sciatic nerve)
Non-surgical models include chemotherapy-induced lesions, multiple sclerosis, diabetes and viral infection
Surgical Non-surgical
Chemotherapy Paclitaxal, oxiplatin, cause pain, chemotherapeutic induced
Diabetes  streptozotocin (STZ)- targets b cells, disrupting insulin production, causing hypogylcemia Postherpetic neuralgia  herpes varicella- zoster virus- shingles pain, this is when left with shingles pain
After a stroke- especially in thalamus
Target leg or foot- most accessible and easy to test
Spare nerve injury- cut two nerves, leaving sural nerve and it becomes hyperexcitable, causing more pain
Cci- tie off sciatica- causing slow strangulation, prevents oxygen floe, kills of nerves- chronic constriction injury
Cci and sni- used widely

Surgical- models trauma, cut nerve, car crash

Meausre sensitivity in feet
Neuropathic pain occurs first in legs bc these are longest nerves- more susceptible

Occurs after 2-3 weeks

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12
Q

Visceral pain models

A

Visceral pain models
Pain in the abdomen, chest and pelvic organs
Commonly induced using chemicals or trauma
Bowel injection of capsaicin, mustard oil or zymosan- cell wall of yeast, activates immune system- getting rid of agent causes pain or bowel distension
Researchers don’t have immediate access to the organs. Instead, will measure changes in behaviour including spontaneous pain, grooming of the region, torso constrictions. Capsaicin- chemical found in spicy things

Mustard oil- burning sensation

Rything response- mouse elongates abdomen and constricts torso – to induce, inject acetic acid
magnesium sulfate
hyper-/hypotonic saline
Bradykinin- released during inflammation, causes sensitization

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13
Q

Pain testing in rodents

A

How do we assess rodent pain
Evoked behaviour and spontaneous behaviour
Mechanical and thermal stimuli  allodynia and hyperalgesia
Spontaneous behaviour  facial expressions and quality of life

Mechanical evoked behaviour tests
Series of monofilaments applied to hindpaw (von Frey test)
Positive response  withdrawal response following application of filament
VF calculates force required to evoke withdrawal in 50% of animals
R-S calculates mechanical pressure threshold of deep tissue.
Other tests include pinprick test and brush test.
Typically use von frey test- von frey filaments applied to bottom of foot and see its response, can determine threshold and pain response- keep inc strength until it responds- then go down
Apply different force of filament until it responds then go down one level – hone in on threshold

Apply pain threshold dec
Randall-Selitto test- apply pressure- done for rats, put paw in clamp and once animal makes response- threshold
Vs and rs are mechanical tests

Changes pain responses

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14
Q

Thermal evoked behaviour tests

A

Thermal evoked behaviour tests
Hot or cold temperature
More noxious the stimulus, the faster the animal’s tail will flick, paw removed,
paw licking or animal escapes
Common tests include tail flick, hot plate, cold plate, acetone evaporation test Why do we need all these- get at different pain pathways and responses

Flick tail when neuronl activation of spinal nerve
Even when disturb brain function- still occurs- spinal function
Latncy to firt response- how long for one of these responses to occur

C- expose heat once at a time, if have injured side can use non injured as control
Acetone test- dries the skin, its cold, if have injurt esp neuropathic, this turns into cold pain- flicking of paw

Apply dry ice under glass floor- cold floor

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15
Q

Spontaneous behaviour tests

A

Spontaneous behaviour tests
Can involve measuring licking in response to formalin, capsaicin, mustard oil, acetic acid – nocifensive behaviour, causes rything
Animal’s gait, weight bearing behaviour, conditioned place preference, facial
grimacing in response to an injury C- total weight sitribution- cat walk test
nocifensive be- nocioception and defensive behavoiour- escaping, licking- meant to protect anaimal

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16
Q

A Measure of Spontaneous Pain in Mice: The Mouse
Grimace Scale

A

Bulges nose, puffs cheeks, tighten ears, get pulled back

The Mouse Grimace Scale
Works For Pain of Moderate Duration
Only changes in response to specific stimuli
30 min- a day- chsnge in pain face
Secobsa- minutes probaby unable to capture the face chabge

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17
Q

Conditioning Methods to Study Pain

A

Operant Conditioning
learned escape from pain- learn to go to nonpainful area
from electric shock
from noxious heat/cold
learned analgesic self-administration
motivational conflict
between pain vs. food/water- has inury, has to obercome pain to get food or water

Classical (Pavlovian) Conditioning
conditioned place avoidance
to formalin-paired chamber
to chamber where allodynia is experienced
conditioned place preference
to analgesic-paired chamber
Relief from pain= reward, activate system when redfuce pain

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18
Q

Motivational Conflict Between Pain and Drinking

A

Injected into mouth
Have to put head in slot to acheieve reward
At slot have thermode- hot
Did in rats when have injection vs not at normal temp and high temp
Normal rats- didn’t affect them, pained rats- when inc temp, do it much less
Grey bar- apply analgesiac

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19
Q

Conditioned Place Preference to Analgesia

A

Prefer rewarding environment- drugs
Want to provide analegisiac without activating rewards system
Gabapentin- calms down neuronal firing
Sham= surgey but don’t touch nerve

Post sni- prefer pain relief chamber

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20
Q

Mice in Chronic Pain Have Anxiety/depressive-like behaviour?

A

Acetic acid-induced muscle pain
Pain thresholds and negative emotions measured
Negative emotions (anxiety/depression) reversed by pregabalin (gabapentin) Anxiety- elevated plus maze- spend more time in open space- less anxious
Induce pain- more anxioud
Forced swim- learn no way out and stop trying, pain= more immobilized

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21
Q

Burrowing as a Quality-of-Life Measure?

A

Either measures amount displaxed or time till remove it all
Naïve vs cfa- causes inflammation, models chronic inflammation- deal bacteria tht causes immune response

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22
Q

Voluntary Wheel Running (1 h/day) in Mice with Inflammatory Pain

A

only inflammatory pain
-only bilateral CFA- have to be in both feet Restricted running wheel time to one day, give cfa- will run less than control

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23
Q

Animal pain Researchers are Studying the “Wrong” Symptom!

A

Most crhonic pain- have spontaneous pain
In rodents- study thermal hyperalgesia tge most
Spontaneous pain- hard to measure

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24
Q

Individual differences in pain sensitivity

A

Those with lower rating had less brain activity in pain area
With higer- acc and somatic sensory cortex
Causalgia- neuropathic

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25
Q

Biopsychosocial Model

A

Biological
• Age, Gender, Genetics
• Physiologic Reactions
• Tissue Health
Psychological
•Menal Meat
• Emotional Health
Expectations
Sociological
• Interpersona
Relationships
• Social Support
Onatic
• Socioeconomics

26
Q

The Heritability of Pain: Twin Studies

A

Lots of variability in what makes pain differences- variability= heritability
Higly influenced by environment

27
Q

Effects of genetic variability on pain

A

Inbred mice are brother-sister repeated matings (>20 generations).= genetic clones
Test inbred mouse strains on different pain assays.
Variability in pain sensitivity between strains is genetic.
Variability within strain is environment and susceptibility to develop
chronic conditions highly linked to variation in alleles

28
Q

Sex Differences in Chronic Pain Prevalence

A

Women- more susceptible to pain and more sensitive
Gout and back pain condition – males get it more

Men less likely to get help
Female have greater pain sensitivity

29
Q

Effect of experimenter rated subject sex

A

Did cold pressor and had opposite or same sex experimente- female rate higher in both cases
Men- opposite sex- decrease pain rating

30
Q

Sex differences in rodents

A

Hormone levels are an obvious contributor
Many ligands, receptors and cell types involved
Women report less chronic pain during pregnancy
Upregulation of opioid receptors, decrease in Th1:Th2 ratio
Females respond quicker- inc sensitivity
Ovarextomy- remove ovaries- dec pain sensitivity
Female sex hormones- inc sensitivity

When pregnant- change in immune system
Decreases tH1 cell ratio- decreases the immune response and decreases inflammation
Inc th2

Microglia- in the cns- tag the invaders and try to get rid of them have neurons and glial cells- f
Astroglial- support
Pain activates microglial- in male- chronic pain reversed by inhibiting hese cells
In female- don’t matter

Block hyperexcitability- reverse pain in both sexes
In late pregnancy- no allodynia
Reverse microglial- reverse in male and female(in pregnancy)

31
Q

H

A

H

32
Q

Descartes’ View of Pain

A

If for example fire comes near the foot,
minute particles of this fire, which you
know move at great velocity, have the power to set in motion the spot of skin on the
foot which they touch, and by this means pulling on the delicate thread which is attached to the spot of the skin, they open up at the same instant the pore against which the delicate thread ends, just as by pulling on one end of a rope makes to strike at the same instant a bell which hangs at the end.”
Descartes Signal sent to brain

33
Q

Skin Anatomy

A

Different receptors in skin for different sensations
Meissner corpuscle- touch flutter
Pacinian corpuscle vibration
Ruffinis corpuscle stretch
Merkels disks touch, pressure
Pain nerve endings - nociception)- responds to noxious stimulus

34
Q

Nociceptors

A

Nociceptors are special receptors that respond only to noxious stimuli and generate nerve impulses which the brain interprets as “pain”
Free nerve endings
Tissue damage
Tissue damage results in cells breaing, releasing toxins into the system
Prostoglandin- ege2
Causes swelling/ inflammation
White blood celss and mast cells go here and release chemicals- start to activate specific recpetors on free nerve ending- Causes an action potential- sometimes go to cell body,- neuron terminates in spinal cord- releasing substance p or glutamate but goes all ober the place- can reach other free nerve endings to release more chemicals– axon reflux- releases substance p- causes inflammation, is excitatory, causes vasodilation- spreds wuicker and releases more blood cells- sesntive nociocpetord

35
Q

Nociceptors are Unipolar Neurons

A

Dendrites found on skin, in bone, muscle- dendrites= free nerve endings and have long axon- periphial
Cell body- outside if spinal cord- in dorsal root ganglia
Multipolar- CNS

Unipolar neurons have one process from the cell body, an axon. It branches to connect to receptors and the spinal cord or brain.

Unipolar neurons are most of the body’s sensory neurons. The dendrites are found at the receptor and the axon leads to the spinal cord or brain.

36
Q

Afferent Fiber Classes

A

Aa- proprioception, skeletal muscle, gives body space awarness feedback

Ab- connected to mechanorepetors- touch – attaches to corpuscles and transmit sensory info

Ad- convey pain and temp info- nocioceptors

C- pain ,temp, itch, sweating – unmyelinated

Larger fobre and more myelin- faster

37
Q

Nerve Bundles

A

Packaged into sheet- have many axons- blood supply

Axon collection- endonerium

Nocioceptors packaged together to transmit info

38
Q

Fast and slow pain

A

Bump knee- first notice sharp pain- very quick- Ad fibres
Have lasting throbbing- C

39
Q

DRG basics

A

DRG – dorsal root ganglion – cells bodies of sensory
neurons
Sensory neurons – axons sent to periphery and to dorsal horn of spinal cord
All sensory info when reaches close to spinal nerve- eneters through dorsal root of spinal nerve

Have spinal roots- send projection into dorsal spinal cord
Also have ventral part- motor info goes out this way to leave spinal cord
But sensory and motor info- packaged in same spinal nerve

40
Q

Cell content

A

Neuropeptides
Paracrine- released and work on other cells to activate them and autocrine actions- works on cell released from
Peptidergic- contains neuropeptide CGRP, substance p vs. non-peptidergic- use glutuamte

Substance P
Released from sensory nerve terminals (C fibers) upon injury or infection – causes inflammatory response
Mediates actions through the neurokinin 1 (NK1) receptor
NK1 expressed by endothelial cells, keratinocytes, spinal neurons and glial cells
Can be released antidromically- opposite direction then normal – from dendrites where it contributes to plasma extravasation, mast cell degranulation and neurogenic inflammation
Activation of NK1 by substance P causes receptor to become internalized and
upregulated. Causes nk1- to make nucleus make more transporters, inc sensitivity for substance p
Mast cells release content- paracrine
Found in DRG cells, can be releases into dorsal spinal cord to transmit and continue pain signal
Cells release chemicals into spinal cord- when cut yourself etc- mostly neuropeptides(transmit nerve signal)-

Substance P

41
Q

Calcitonin gene-related peptide (CGRP)

A

Expressed by neurons in the peripheral and central nervous system
Most abundantly expressed by subset of nociceptors in the dorsal root ganglion (DRG) and trigeminal ganglion- facial pain. Not found in spinal neuron cell bodies.- released from DRG
Importantly involved in vasodilation, resulting in swelling, increased blood
flow and recruitment of inflammatory cells to area of injury.
CGRP receptor not found in cells that express CGRP- doesn’t act in autocrine fashion

CGRP is released in the spinal cord of rats with chronic injury- injure nerve then measure levels= higher

42
Q

Spinal Cord Anatomy: Directions and Dermatomes

A

What is “afferent”- toward vs. “efferent”?- away What is “medial” towards middle versus “lateral”?- to side
What is “ipsilateral”- same side vs. contralateral”? Opposite sides
Rostral- towards head]
Caudal- towards tail
Dorsal towards back -above
Ventral towards tummy – below

Shingles lays dormant in DRG- reactivate the virus, expresses in the body where innervated by DRG

Upper thigh- l2, l3
Have as many drg as vertebrae- at every level of vertebrae
Shingles reactivated- upper shoulder- innervated by c3 and 4- where drg virus is reactivated

Dermatome map

43
Q

Spinal cord gross anatomy

A

Meninges- membrane surrounding brain and spinal cord
Grey- cell bodies and neurons v s. white matter- tract system Vertebral segments
S pinal cord encased in bone
Affererent comes in through drg activates neuron and sends ap along white matter

44
Q

Sex differences in rodents

A

Hormone levels are an obvious contributor
Many ligands, receptors and cell types involved
Women report less chronic pain during pregnancy
Upregulation of opioid receptors, decrease in Th1:Th2 ratio
Females respond quicker- inc sensitivity
Ovarextomy- remove ovaries- dec pain sensitivity
Female sex hormones- inc sensitivity

When pregnant- change in immune system
Decreases tH1 cell ratio- decreases the immune response and decreases inflammation
Inc th2

Microglia- in the cns- tag the invaders and try to get rid of them have neurons and glial cells- f
Astroglial- support
Pain activates microglial- in male- chronic pain reversed by inhibiting hese cells
In female- don’t matter

Block hyperexcitability- reverse pain in both sexes
In late pregnancy- no allodynia
Reverse microglial- reverse in male and female(in pregnancy)

45
Q

Pain and Aging

A

Biological variable- contributes to pain development and sensitivity
First graph-
X axis- age groups
Open box= population, filled= pain centre

Don’t see young ppl getting chronic pain treatment
During middle age- have more getting treatment although population is less

Shows you population prevelance vs those getting treated at pain centre
As age decline in both categories

Pain gets worse up until your middle years then goes back down
As age may get more sensitive but have more pain experience, same pain experience may not lead you to get treatmenet
Xould have a biological relationship between age and pain reduction but could be psychological- expecting to hurt more so don’t go to clinic

Rat pain- trying to avoid pain from heated surface- rat can escape and go into other area

8- 16 months- have quickest escape response- more sensitive to pain
As age escpae duration becomes longer
As we age may be greatwe insensitivity to pain

Older rats may just be slower

46
Q

Environmental Enrichment and Pain

A

Environemt modulates recovery from environemnt
Rats went under surgery- CCI- nerve injury- SNI and CCI- tie suture around nerve to constrict it- sensitivity develops
Can measure recovery

Had regukar vs enriched environment
In enriched- recovery is faster
Could be related to exercise as well
Environment matters

47
Q

Pain and Spousal Support

A

Social environment is important for persistence and recovery of pain and chance to get chronic pain

Looked at married couples- one with chronic pain
Wanted to understand social development and how it affects development of chronic pain
Used wimpy- measures spousal responses and social dynamics- in pain patient
Had spouse write diary- solicitiousness- led to chronic pain
Someone whos very supporting and kind- in both diary and spouse- led to inc pain
More caring spouse= more pain
Spouse is reinforcing pain behaviour

To improve pain- spouse can engage in distraction techniques- distract from pain

48
Q

Empathy for Pain

A

Empathu studied with pain as output measure

Feel empathy, pain sensitivity changes

Activates same pain responses when watching someone you love experience pain
Enhancing pain sensitivity
Meausured thermal responses- when it hurts and how much

Did this while watching video

Positive group- watch empathetic inducing video
Negative group- inducing lack of empathy/ disgust

In positive group- more perceived intensity- sensitivity and unpleasentness- perception of pain
Positive group felt more empathy

49
Q

Empathy for Pain in Mice

A

Can have mice watch other mice going through pain
Inject acetic acid into mice- does writhe response extend and cotorse torso

If take both mice and inject both- writhing goes up- pccurs more
This only occurs if the mice are familiar

Stress blocks empathy- when meet stranger a little stressed

50
Q

The Placebo Effect: Discovery

A

Henry Beecher discovered the placebo effect as a medic in World War II. After running out of pain-killing morphine, he replaced it with a simple saline solution but continued telling the wounded soldiers it was morphine to calm them. To his surprise, almost half of the soldiers reported that the inert saline solution actually reduced or erased their pain.
Beecher- world war 2 medic- civilian vs war pain narcotic request- stress induced analgesia

Ran out of morphine- had saline and told them it was morphine
Caused improvements in perceived pain

51
Q

Placebo Effect: Is It Real?

A

meta-analysis

Binary- have it or don’t
Continuous- on a spectrum
Confidence interval cant pass 0

Placebo effect may be more pronounced for pain- but has more participants and trials

Binary- harder to have placebo effect- yes or no, harder to show an improvement

52
Q

What is the placebo effect?

A

Inert substance or treatment that activates endogenous body systems and brain networks- counteracts condition you have
Expectation influences bodily response to treatment and anticipates outcomes- what you anticipate influences it, don’t believe in treatment- less likely to work

Covert-Overt Paradigm
Protocol where the patients are either informed about the drug effect or given it in a hidden way- tell patient youre giving them an effective drug- high pain reduction, don’t tell= no pain reduced
Can be done in open context- informed patient and still work if participant believes in actual drug

Patient expectation- causes more pain reduction= placebo effect

What is the Placebo Effect?

conditioning?

Expectation- expectation to what will work?

desire?- desire to get better

natural history? (regression to the mean)- when it feels worse than before or different
Conditioning- stick to same drug- know it works- history with medication- type,colour, size’

When have pain reduction- not all because of drug, part of it is due to placebo effect

53
Q

Hidden vs. Open Drug Administration

A

Active treatment- drug- has an effect that causes outcome
If have knowledge abt treatment- causes a non specific effect that influenceds the outcome

Treating with placebo- want to remove active treatemnet- tell them itll do something- give them the knowledge

Or give active treatment but don’t tell them abt the drug

In this study- told remifentanil- improves pain and gets worse when stop administering

Used VAS scale
No expentancy- reduces pain a bit
Have positive expectations- reduces pain even more

Negative expectation- stopped it even if you didn’t- pain intensity goes close to baseline

With expentancy- combined drug and placebo effect

54
Q

Factors Affecting the Placebo Effect

A

subjectivity vs. objectivity of measure
(pain or depression- more placebo effect vs. wound healing or Parkinson’s)
the nature of the verbal suggestions
(compare “It can be either a placebo or a painkiller” to “It is a powerful painkiller”)
previous experience
belief/expectation/desire of patient and clinician
patient-clinician interaction (the “therapeutic context”)
-“bedside manner” (enthusiasm, reassurance, empathy, communication)
-white coats- positive effect
-deep voices- greater placebo effect
physical properties of placebo itself
-sham surgery > i.v. placebo > big pill > small pill
-expensive pill > cheap pill
personality variables (esp. “ego-resiliency” and “agreeableness”)
More invasive surgery= greater placebo effect

55
Q

Placebo Neurochemistry

A

Placebo effect mediated by opiods- endogenous opioid system
Follow pain intensity of open injection of saline- decreases pain sensitivity

Administer drug in hidden fashion- over tume pain sesnitivty reverses to baseline- because of nonspecific opiod blocker

56
Q

Placebo Anatomy

A

Placebo effect mediated by endogenous opiod system

PAG, amgydala, Vpfc
Activated in response to placebo and release endogenous opiods and dopamine to reduce pain but also generate experience of pain

57
Q

Nocebo Effect

A

Nocebo- negative expectations – makes things worse

Driven by the fear, anxiety of pain

58
Q

Repeated pain sensitizes male but not female mice

A

Mice tested for thermal thresholds using Hargreaves test.
Mice injected with acetic acid and then placed in context for 30 min
24 hrs later mice returned to same context or different context
Thermal thresholds measured using Hargreaves test.
When mice returned to pain environment- have negative association that enhances pain sensitivity

59
Q

Vulnerability factors for chronic pain

A

Fear avoidance model
Persistent pain  fear, avoidance and physical deconditioning
Fear-avoidance model  pain may be chronically maintained through cognitive appraisals
Avoidance of activity may act as negative reinforcement for the fear-avoidance cycle.

Trauma
PTSD is higher in chronic pain populations
Higher pain at time of injury is associated with PTSD
Chronic pain and PTSD  hypervigilance to threats

Depression
Chronic pain populations have a higher prevalence of depression
”Chicken and egg” problem; what’s the causal direction – both may be true
Learned helplessness as a model to conceptualize depression in the context of chronic pain

Catashprophizing- leads to more fear, more pain, more depression enhancing pain experience

60
Q

Resilience factors for chronic pain

A

Pain self-efficacy
One’s belief in controlling events of situations
Associated with lower perceived pain, reduced depression, improved physical function
Considered a contrasting factor to catastrophizing
High social component (positive expectations from your Dr.)
Acceptance- better outcome
Individual’s willingness to engage in valued goal-directed behaviour despite the pain
Mental struggle is not evident in these people
Focus on the positive (life events, social, hobbies).

Psychology in treatment of chronic pain
Interdisciplinary care is best approach
Cognitive behavioral therapy educates patient on the biopsychosocial nature of pain to reinforce different thinking about pain conditions
Acceptance and commitment therapy (ACT) and mindfulness improve protective factors and promote resilience
Reduces the negative thoughts and feelings getting people to think differently about
their pain
Drugs alone wont work