The Psychology of Chronic Pain

Question 1

What is the definition of pain?

Answer 1

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described by the patient in terms of such damage”

Question 2

What is the definition of chronic pain?

Answer 2

“Pain which has persisted beyond normal tissue healing time”

Question 3

What are the main differences between acute and chronic pain?

Answer 3

• Acute to Chronic Pain: 12-week duration = arbitrary
• Main difference is management

Question 4

What is the management method in acute pain?

Answer 4

Addressing the cause of pain

Question 5

What is the management method in chronic pain?

Answer 5

Addressing the effects of pain and finding ways to maximise function and quality of life

Question 6

What is the burden associated with chronic pain?

Answer 6

High Burden

Question 7

How many chronic pain sufferers have co-morbid depression?

Answer 7

20-50% of chronic pain sufferers have co-morbid depression

Question 8

What percentage of patients with chronic pain have other chronic illnesses?

Answer 8

• 88% of patients with chronic pain have other chronic illnesses
• Most common = cardiovascular disease and depression

Question 9

What are the two main theories of pain?

Answer 9

• Specificity Theory
• Pattern Theory

Question 10

Describe the specificity theory of pain

Answer 10

Direct causal relationship between pain stimulus and pain experience

Question 11

Describe the pattern theory of pain

Answer 11

Stimulation of pain receptors produces a pattern of impulse and only if they pass a certain threshold, they are transmitted to the cortex which leads to pain perception

Question 12

Describe the Gate Control Theory of Pain

Answer 12

• Both ascending physiological inputs and descending physiological inputs are involved
• ‘Gating’ mechanism in the dorsal horn of the spinal cord that ‘opens’(permits) or ‘closes’ (inhibits) the transmission of pain impulses

Question 13

What opens the gate in the gate control therory of pain?

Answer 13

e.g. inactivity/poor fitness (physical); poor pacing (behavioural); anxiety/depression/hopelessness (emotional), catastrophising, worrying about the pain (cognitive)

Question 14

What closes the gate in the gate control therory of pain?

Answer 14

e.g. appropriate use of medication; massage; heat/cold; positive coping strategies; relaxation; exercise

Question 15

What are the pros of the gate control theory of pain?

Answer 15

providing a physiological explanation for how psychological factors affect pain perception

Question 16

What are the cons of the gate control theory of pain?

Answer 16

Evidence is mixed

Question 17

What are the psychological aspects of pain?

Answer 17

• Pain behaviour
• Anxiety
• Previous experience and conditioning
• Self-efficacy
• Fear
• Secondary gains
• Meaning

Question 18

What is meant by cognitions and pain?

Answer 18

Our thoughts, beliefs, the way we think impact our experience of pain

Question 19

What is meant by attention and pain?

Answer 19

Increased attention to pain has been associated with increased pain perception

**Bed rest is no longer the main treatment option

Question 20

What is meant by self-efficacy and pain?

Answer 20

“Pain self-efficacy refers to one’s confidence regarding one’s ability to function effectively while in pain

Question 21

What are the main components of catastoprhising pain?

Answer 21

• Rumination:
• Magnification:
• Helplessness:

Question 22

Definine rumination

Answer 22

focus on internal and external info

e.g. “I can feel my neck click every time I move”

Question 23

Define magnification in terms of pain

Answer 23

overestimating the extent of threat

e.g. “the bones are crumbling and I will become paralysed”

Question 24

Define helplessness in terms of pain

Answer 24

underestimating resources

e.g. “nobody understands how to fix the problem and I just can’t bear any more pain”

Question 25

What are the main emotions associated with pain?

Answer 25

anxiety, depression, fear

Question 26

Describe the effect of anxiety in acute pain

Answer 26

• Anxiety increases acute pain but when acute pain is treated the anxiety drops and that further leads to reduction in pain
• Cycle of pain reduction

Question 27

Describe the effect of anxiety in chronic pain

Answer 27

• Tx has little impact on chronic pain which leads to increased anxiety which then leads to increased pain
• Cycle of pain increase

Question 28

What are the links between depression and chronic pain?

Answer 28

• Common to have hopelessness, helplessness and despair
• Direction of the relationship between pain and depression is not always clear cur. It’s more likely that depression is an outcome of chronic pain rather than the cause of it

Question 29

What is the connection between fear and pain?

Answer 29

• Extensive fear of increased pain or pain recurring is very common
• This can lead to avoidance of a range of activities
  
  • fear-avoidance model of pain
• The fear of pain –> amplified perception (hypervigilance) –> pain avoidance behaviours –> disability and disuse –> higher pain

Question 30

Define classical conditioning

Answer 30

We might associate certain environment with the experience of pain

An association of pain with going to the dentist  enhanced pain perception –> anxiety plays a role too

Question 31

Define operant conditioning

Answer 31

We may slow ‘pain behaviours’ in response to pain stimuli

E.g. grimacing, limping –> positively reinforced by those around us giving sympathy and attention

Question 32

Describe some pain behaviours associated with secondary gains

Answer 32

• Facial or audible expression (e.g. clenched teeth and moaning)
• Distorted posture or movement (e.g. limping, protecting the pain area)
• Negative emotions (e.g. irritability, depression)
• Avoidance of activity (e.g. not going to work, lying down)

Question 33

What can pain behaviours result in?

Answer 33

• Pain behaviours are reinforced (doesn’t mean ‘caused’) through attention and acknowledgement they receive (e.g. being let off tasks)
• Pain behaviours can lead to lack of activity and disuse through muscle wastage, reduced social contact

Question 34

What does SIGN 136 for the management of Chronic Pain detail about the assessment of pain?

Answer 34

• history examination and biopsychosocial assessment
• pain type, severity, functional impact and context should be identified

All guide treatment and management

Question 35

What are the limitations of self-report measures of pain?

Answer 35

• too long for use in consultation
• english should be first language
• advanced verbal skills
• misrepresentation can occur - exaggeration or downplay of pain

Question 36

How would the management of chronic pain be described?

Answer 36

complex and multidimensional

pharmacological and physiological

Question 37

What are the goals of pain management programmes?

Answer 37

• Improving physical and lifestyle functioning (improving muscle tone, self-esteem, addressing pain behaviours and secondary gains)
• Decreasing reliance on drugs
• Increasing social support and family life

Question 38

What are the two main componenets of pain management programmes?

Answer 38

pharmacological and physiological

Question 39

What are the three main strategies used to psychological management of pain?

Answer 39

• cognitive methods
• behavioural strategies
• respondant methods

Question 40

Desribe behvaioural strategies to pain

Answer 40

• Based on principles of operant conditioning
• Pacing to break the ‘overactivity-rest” cycle

Question 41

What is the aim of cognitive methods of pain management?

Answer 41

to help individual identify and understand their thoughts/beliefs about pain and modify their ‘cognitions’ that may be exacerbating their pain experience

Question 42

What is the aim of respondant methods to pain management?

Answer 42

• to modify the physiological system directly by reducing muscle tension
• Decreasing stress and anxiety and therefore decreasing pain
• Progressive muscle relaxation
• Biofeedback