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Behavioural & Social Sciences > The Psychology of Pain > Flashcards

The Psychology of Pain Flashcards

1
Q

What is pain?

A

-A perception
-Aversive
-Unpleasant
-Many components:
*Sensory =
*Affective =
*Cognitive =
*Motivational =
-Sign of potential tissue damage
-Purpose = demonstrates your body is not coping w/ demands of its ext &/or int env - so is a survival mechanism

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2
Q

Why do we have pain?

A

-Gives constant feedback about body - so can make adjustments to how we sit/sleep
-Warns - sign something wrong = causes protective beh (survival mech!)
-Triggers help-seeking beh
-Psych consequences - can = fear & anxiety

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3
Q

How do psychologists view pain?

A

As learned or conditioned beh

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4
Q

How do neuroscientists view pain?

A

As a sensory phenomenon based on perception

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5
Q

How do doctors view pain?

A

As warning sign something is wrong & needs diagnosing & treating

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6
Q

Why is knowing about pain SO important?

A

-Mostly people see Drs about pain
-Aspect of many conditions
-Scale of pain to understand - different stages/types

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7
Q

Give the 3 stages of pain.

A

-Acute
-Pre-chronic
-Chronic

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8
Q

What is acute pain?

A

-Adaptive
-Often linked to objective/identifiable injury/disease
-Self-limited
-Resolves in hrs->days –> i.e, is a time frame of how long will last - until healed
*Time sensitive - start & end
-Linked to objective autonomic features
-High symp activity
e.g., burns

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9
Q

What is pre-chronic pain?

A

= critical time when person starts healing - overcoming pain/lose hope & feel helpless
-A midpoint
-Escalate or moderate

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10
Q

What is chronic pain?

A

-Normal healing time has ended - pain continues (6 months - years)
-Don’t know how long pain will continue for - unknown resolution
*Not time-sensitive
-Interferes w/ daily activities
-Often experienced in absence of detectable tissue damage
-Vague descriptions of pain & inability to describe pain’s timing & localisation
-Lacks signs of heightened symp activity
-Depression & anxiety = common
e.g., arthritis

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11
Q

What is the pain pathway?

A

Many parallel neuronal pathways carrying different aspects/types of pain –> which ascend to brain within various tracts of spinal cord

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12
Q

What are the 4 components of the pain pathway?

A

-Transduction
-Transmission
-Modulation
-Perception

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13
Q

Summarise in simple stages which order the 4 components of the pain pathway go in.***

A

1- Periphery (PNS) = transduction -> transmission
2- Spinal cord (CNS) = modulation
3- Brainstem (CNS) = descending modulation
4- Cortex & sub-cortical regions = perception, sensory & affective pain components

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14
Q

What is transduction?

A

Afferent nerve endings translate noxious stimuli (pain causing) into impulses carrying pain messages

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15
Q

What are the 3 primary afferents & what types of sensations do they carry - transduction?

A
  1. A-beta - carry info related to touch
  2. A-delta - carry info related to pain & temp
  3. C-fibres - carry info related to pain, temp & itch
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16
Q

What are the receptors that sense: heat, mech & chem tissue damage & where are they found - transduction?

A

Nociceptors
–> in skin & organs

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17
Q

What is the name of the process of perceiving pain?

A

Nociception

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18
Q

What is transmission?

A

Impulses sent to dorsal horn of spinal cord -> then along sensory tracts to brain

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19
Q

What are the 2 types of fibre systems pain impulses are transmitted by - transmission?

A

1 = fast, sharp, well localised sensation (1st pain) - conducted by A-delta fibres (in transduction) = i.e., ACUTE PAIN
2. duller, slower onset, often poorly localised sensation (2nd pain) - conducted by C-fibres (in transduction) = i.e., CHRONIC PAIN

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20
Q

What is modulation?

A

Dampen (lowers) or amplify (inc.) pain-related neural signals
(modulates = makes pain better or worse)

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21
Q

What is the descending inhibitory input of modulation?

A

Dampen (lower) of fully block incoming ascending nociceptive signals @ gate of dorsal horns (in spinal cord)
-Desc pathway attempts to block asc pathway

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22
Q

Importance of being able to block asc pathway of pain experience

A

So not continually in pain - or CNS isn’t always aware of pain

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23
Q

Expand on what the gate control theory is.

A

-Neural gate in spinal cord - regulates pain experience - perception of pain
-Pain is NOT result of straight-through sensory channel - can be blocked
-Has physiological & psychological causes

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24
Q

What are some psychological causes that can influence the gate of the dorsal horns of spinal cord?

A

-Behavioural state - attention (focus on pain source)
-Emotional state - anxiety, fear, depression
-Prev experience of that type of pain - never experienced before
–> all will open gate - amplifies pain experience/perception

(but if had experienced pain before - may close gate - dampens pain perception)

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25
Q

Outline what way the ascending & descending pain pathways go.

A

-Asc = nociceptors (skin/organs) -> periphery -> spinal cord -> brainstem -> cortex & subcortical regions ->
-Desc = cortex & subcortical regions -> brainstem -> spinal cord (desc modulation stimulated opioid-releasing cell = inhibits spinal pain signal)

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26
Q

What was the biomedical framework - as an early pain theory?

A

-Pain = automatic resp to ext factor
-Tissue damage causes pain sensation
-Pain sensation has 1 cause
-Pain either = psychogenic OR organic

27
Q

What is psychogenic pain (biomedical)?

A

-Considered as ‘all in pat’s mind’
-Label for pain when was no organic basis/cause

28
Q

What is organic pain (biomedical)?

A

-‘Real pain’
-Label for pain when was clear injury - objective - know where site of pain is (can see)

29
Q

Since having a psychological outlook on pain (1920s) what has been noted?

A

-Med treatments for pain - drugs, surgery = only for ACUTE pain (not CHRONIC = ineffective)
-Same degree of tissue damage/injury - diff perceptions in pain levels felt/reported
-Phantom limb pain - no source as limb not there

30
Q

How does perception relate to pain?

A

= conscious awareness of experience of pain - pain perception!
-Mediated by myelinated small-diameter A-delta & non-myelinated C-fibres
-Chemicals released due to injury cause pain by:
*direct stimulation OR
*sensations @ nerve endings

31
Q

What does pain perception result from?

A

Interacting: transduction, transmission, modulation, & other characteristics of individual

32
Q

How is GCT (Gate Control Theory) different from prior pain models?

A

-Pain = perception & experience (NOT sensation)
-Individual = active (NOT passive) - i.e., they play a part in interpreting & appraising stimuli
-Variations in pain perception - as pain levels = due to degree of opening/closing of the gate***
-Many factors influence pain perception (not just 1)

33
Q

In terms of GCT - is pain every just organic (real/legitimate)?

A

No –> pain = combination of physical & psych factors
-Interaction between mind & body** = GCT

34
Q

In terms of GCT - is pain every just organic (real/legitimate)?

A

No –> pain = combination of physical & psych factors
-Interaction between mind & body** = GCT

35
Q

What can open the gate (i.e., amplify pain perception)?

A

-Physical factors - injury, activation of large fibres
-Emotional factors - anxiety, worry, depression
-Beh factors - attention - focus on pain, boredom

36
Q

What can close the gate (i.e., dampen/lower pain perception)?

A

-Physical factors - meds, stimulation of small fibres
-Emotional factors - happiness, optimism, relaxation
-Beh factors - focus, concentration, distraction, involvement in other activities
-TENS therapy (Transcutaneous Electrical Nerve Stimulation) - used in labour - put pads on muscles - causes low pain level - diverts attention from main/signif pain source - as this low level pain stimulates large fast acting A fibres
-Acupuncture - needles put in afferent nerve
-CBT - help w/ anxiety, worry & depression (which are all factors that can otherwise open the gate)

37
Q

Summarise with a table - the varying factors that can open & close the spinal gate control?

A

= physiological basis for factors modulating CHRONIC pain

(emotional state = why can use CBT in pain management)
(introvert = think & internalise more - so more likely to notice & perceive pain)

38
Q

What can the pain perception be said equivalent to?

A

The degree that the gate is opened/closed

39
Q

Give 2 pain prone personalities & what they mean.

A

-Hysteria = tend to exaggerate symptoms & use emotional beh to solve problems
-Hypochondriasis = tend to be overly concerned about health & over report body symptoms
-Depression - chronic pain sufferers
–> for acute & chronic pain sufferers - characteristics measured on MMPI scales

40
Q

Give some other factors that can affect pain.

A

-Biology of pain pathways
-Neuroplasticity in these pathways (‘use it or lose it’)
-Learning/conditioning
-Cognitive aspects of pain
-Emotional aspects of pain (how we feel about pain)
-Memories of pain
-Sociocultural milieu in which pain is experienced

41
Q

How does learning influence pain perception?

A

Is a factor in why pain = subjective - how we are ‘taught’ to respond to scenarios where pain is possible
–> so conditioning occurs to cause a cognitive process of pain expectation - if people expect pain = more focus on it = more likely to open gates & have higher pain perception

42
Q

Name the 2 types of conditioning involved in pain learning?

A

-Classical conditioning
-Operant conditioning
–> both link to reinforcing of the avoidant beh

43
Q

What is classical conditioning in terms of pain learning?

A

-Learn pain by association
-Associate past experience of something with pain experienced then - influencing future anticipation of pain in same/similar situations
–> triggered by familiar cues to that past event
e.g., associate dentist w/ pain due to past experience of pain

44
Q

What is operant conditioning in terms of pain learning?

A

-Learn pain by reinforcement due to situation outcomes
+ve outcomes - introduce pleasant/desired outcome after pain = +vely reinforce - less fear of pain in future of now reinforced by +ve result
-ve outcomes/consequences - unpleasant/undesirable outcome = -vely reinforce - more fear & so more pain perception as pain reinforced -vely

45
Q

How does cognition play a part in pain?

A

*Catastrophising
-rumination
-helplessness
-magnification
*Meaning - pain means diff thing to diff people
*Attention
-attention to pain - inc pain perception
+distraction - dec pain perception

46
Q

How does emotion/affect play a part in pain?

A

*Anxiety
-Worry & anxiety = inc pain perception
-ACUTE pain = increases anxiety = increases pain
-CHRONIC pain treatment shown ineffective = increases anxiety = increases pain
*Fear
-Fear pain = avoidance
-Exacerbate current pain so ACUTE -> CHRONIC

47
Q

Give the relationship between pain, fear & health outcomes.

A

-Injury or something else = pain - pain experience
*Pain perception:
1 - fearful (fear pain) - avoid activity = disuse, disability, depression - as pain gate was opened - pain perception maintained high or increased
2 - not fearful (don’t fear pain) - confrontation = recovery - as pain gate remained closed - pain perception allowed to diminish

48
Q

Give some emotions felt when in pain & reasonings behind some.

A

-Anxiety (that the pain will get worse)
-Fear (may ultimately kill OR severely mutilate them)
-Depression (pain may never go away or improve)
-Aggression
-Anger - due to activation in symp NS
-Guilt
-Sexual arousal

49
Q

How can pain, pain perception (characteristics of an individual & psychological aspects specifically) & gate opening/closing be summarised?

A

= vicious circle of pain that dominates the patient’s life both in ACUTE & CHRONIC pain states

50
Q

What role do behavioural processes play in pain perception?

A

–> beh response to pain can inc/dec pain perception
-Ongoing pain -> emotional response e.g., depression -> can then impact beh e.g., sleeplessness –> MORE PAIN (exacerbates)

51
Q

Give 2 psychosocial factors in pain experience.

A

-Age
-Gender

52
Q

How can age influence pain perception (psychosocial factor)?

A

-Social construction of pain - as get older (physical degeneration) = is an expectation for people to experience more & more pain = decreasing tolerance to pain but inc reports of pain
-BUT pain is not expected in young individuals

*Are other factors responsible for age diffs - e.g., overall health, coping resources, diffs in socialisation

53
Q

How can gender influence pain perception (psychosocial factor)?

A

-Women = report more frequent pain than men
-Social construction - women are ‘allowed’ to be in pain & express this = higher pain acceptance for women vs men who are expected to have high pain tolerance & not to feel pain so much
-Also hormones may influence pain perceptions of women

54
Q

What is meant by the interpersonal construct of pain?

A

-Pain = experienced wider than by the individual alone - also by family & local society
-Response to CHRONIC pain can therefore be influenced by ‘rubbish life syndrome’ - breakdown/lack of social support, stability & opioid prescription crisis

55
Q

What are some psychogenic pain relief interventions?

A
56
Q

What are some pharmacological pain relief interventions?

A
57
Q

What are some stimulation pain relief interventions?

A
58
Q

What are some surgical pain relief interventions?

A
59
Q

What are the 4 distinct strands to psychological pain management?

A

-Operant-behavioural therapy
-CBT
-Mindfulness based therapy
-Acceptance & commitment therapy

60
Q

What is operant behaviour therapy (psychological pain management)?

A

-Focus = removing maladaptive beh responses
–> by fostering adaptive responses
-Uses reinforcement OR punishment
-Alters associations between threat value of pain & physical beh
-Good for:
*Complex regional pain syndromes
*Chronic lower back pain & mixed chronic pain
*Whiplash associate disorders

61
Q

What is CBT (psychological pain management)?

A

-Biopsychosocial pain therapy
-Involves: psychoeducation, relaxation strategies, behavioural pacing, cognitive restructuring***
-Effective for CHRONIC pain
-ve/catastrophic thoughts = trend in pain disorder pats - correlates to high pain
-CBT = restructures -ve got thought schema -> into realistic appraisal
-Gain perspective of past, present, future - so can then deal w/ pain
-Good for:
*Cancer pain
*Complex pain syndromes
*Pain associated with HIV/AIDS
*Fibromyalgia
*IBS

62
Q

How do stress & pain link?

A

Some CHRONIC pain conditions (e.g., rheumatoid arthritis, fibromyalgia) = dysfunction of limbic system-hypothalamic-pituitary-adrenal axis (HPA) - this is involved in stress response –> means CHRONIC pain can result in stress system being activated unnecessarily

63
Q

What can be used to address stress linked to pain (psychological therapy above & what does this involve)?

A

= Mindfulness based therapy
–> involving: progressive muscle relaxation, stretch-based relaxation, deep breathing, and autogenic training - & also biofeedback relaxation techniques (= modify pain that causes changes in physiological parameters e.g., temp) - & also attention/distraction strategies (creates separate image or reinterpret pain - lowers pain perception)
-Learn non-judgemental approach to pain
-Focus on uncoupling physical & psych aspects of pain
-Good for:
*Arthritis - low back pain
*Chronic pain syndromes (back / headache/ migraine)
*Fibromyalgia
*IBS

64
Q

What is ACT (Acceptance & Commitment Therapy) - (psychological pain management)?

A

-Based on developing psychological flexibility
-Focus on developing acceptance of mental events & pain & learning to stop avoidance & other problematic behaviours
-Good for:
*Musculoskeletal pain
*Whiplash associated disorders

Behavioural & Social Sciences (16 decks)

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