Week 8-Social Models of Pain Flashcards
What is the importance of considering social context?
- Human experience inextricably embedded within a social world (constantly surrounded by people)
- Social connection crucial for provision of help and support in face of threat
- Pain: a salient indictor of threat to the body (and we tend to rarely be alone during pain)
What Social factors may modulate pain? (Tracey & Mantyh, 2007)
Things which are considered include:
1. Context: pain beliefs, expectations, placebo
- Cognitive set: hypervigilance, attention, distraction, catastrophising
- Injury: Peripheral and central sensitisation
- Mood: Depression, Catastrophising, anxiety
- Chemical & Structure: Neurodegenerations, metabolic (e.g., opiodergic, dopaminergic), maladaptive plasticity
Yet there is no social context in this diagram at all! (Research neglects this despite physicians highlighting this as important)
-How is our pain shaped by helpful or threatening contexts, by supportive or invalidating contexts?
What is the importance of the Biopsychosocial models of pain? (Hadjistavropoulos et al., 2011)
Emphasises the importance of considering psychological factors and social contextual factors alongside biology (which research has rarely done now until recently)
What are the multiple levels we might consider with social context? (Kapos et al., 2024)
“Systems of inequity are human-made to
create and maintain social stratification
and inequitable hierarchies (e.g., racism,
sexism, classism, ableism, ageism, nativism, heterosexism, and gender binarism) […They] manifest across all levels of determinants and consequences of pain (e.g., institutional, interpersonal, and internalised inequities), creating generally more favorable conditions for people in positions of greater power and status” (i.e., intersectionality is equally important to consider when regarding pain)
- The psychological level: our mental representations of how we feel about others when in pain.
- The social/interpersonal level
- The group level: experiencing pain in the presence of somebody who might be in a different group to you
- The societal level:
Define Social Support and its Facets
Social Support: “Resources and interactions with others that help people cope with problems” (Masters, Stillman, & Spielmans, 2007, p. 11)
Facets of support (Schaefer, Coyne, & Lazarus, 1981):
* Emotional (empathy)
* Instrumental (tangible help e.g., opening doors for you)
* Informational (knowledge e.g., advocating for you, googling information etc.,)
Facets of support (Barrera, 1986):
* enacted support (what you are doing)
* perceived support (how the individual perceives this)
Facets of support (Brown et al., 2003):
* active
* passive (sat there as a pair of ears e.g., brought to an appointment)
What have Clinical Studies found regarding Social Support
- Most are correlational (reviewed in
Leonard, Cano, & Johansen, 2006; Che,
Cash, Ng, Fitzgerald, & Fitzgibbon, 2018) (in reality we need to conducting studies providing causal evidence such as neuroimaging) - Mixed evidence (this is a problem considering how more generalisable clinical studies are to experimental studies)
Mechanisms which could cause an increase in apparent pain behaviour:
* Operant conditioning (Fordyce, 1976)
- Communal coping model (Sullivan et al., 2001) (both this and the operant mechanism do this to elicit social support and by this working, it reinforces the idea to override pain behaviours for social support)
- Intimacy model (Cano & Williams, 2010) (the idea that portraying pain behaviours is an attempt to elicit intimacy)
Clinical Pain: What is the Communal coping model of pain catastrophising (Sullivan et al., 2001)?
- Aim to solicit help and support from others to manage pain
- Communicate need for assistance by engaging in displays of pain behaviours, such as
- wincing, moaning, or rubbing the painful area
- exhibiting general distress when in the
presence of a potentially supportive person - May be adaptive in the short term, but over time, behaviours may contribute to > threat value of pain together with positive reinforcement when others provide desired support i.e., leads to worse pain outcomes
EXPERIMENTAL ONWARDS: What have animal studies discovered about social support?
- Animals are highly sociable (and could provide us with neurobiological findings)
- Study behaviour of mouse dyads while pain is induced in one dyad member
E.g., Langford et al. (2010):
* less writhing from the mouse in pain when it was approached by a female
* beneficial effects of social contact were seen only when the approaching mouse was a cagemate rather than an unknown conspecific (thus it matters who is providing the social support in regards to pain)
E.g., D’Amato & Pavone (1993):
* interacting with siblings reduced pain sensitivity in mice, whilst interacting with stranger mice did not (thus closeness is a factor in social support)
* effects were blocked when mice received naloxone – role of endogenous opioids as an important neurobiological mechanism
What did experimental pain studies reveal about social support?
- Pain induction in healthy volunteers (including: heat pain stimuli, laser creating sharp pin-prick like sensations effective to combine with EEG as it is short, cold pressor and a pressure ergometer which puts pressure on your nail bed to feel as though your finger is trapped in a door)
Social context manipulations (Krahé et al., 2013; Krahé & Fotopoulou, 2018; Che et al., 2018) include:
1. The type of interaction: verbal (e.g., empathic comments), non-verbal (supportive touch), presence, primed (e.g., pictures of a partner vs a stranger), perception varied (deceive participant about the trustworthiness)
- The type of relationship: stranger, friend, partner, parent
What’s the link between social support and pain? (Che et al., 2018; Krahé et al., 2013; Krahé & Fotopoulou, 2018)
Behavioural experimental evidence in humans initially mixed – purportedly “supportive” interactions did not
always reduce pain, but sometimes increased pain…
- Social support reduced pain intensity more than being alone or free interaction (i.e., two other people but no clue what they are talking about) (Brown et al., 2003)
- Holding partner’s hand reduced pain unpleasantness than holding stranger’s hand or holding an object (Master et
al., 2009) - Presence of a same-sex friend increased pain intensity in women (but not men) than experiencing pain alone (McClelland
& McCubbin, 2008)
What key factors are important regarding social support for pain? (Che et al., 2018; Krahé et al., 2013; Krahé & Fotopoulou, 2018)
How ambiguous the social interactions were:
* Structured and unambiguously positive interactions tend to reduce pain -> signal (relative) safety of the stimulus or the environment (think salience); also rewarding nature of close relationships
* Effects of more ambiguous (e.g., mere presence) contexts are shaped by personality traits (e.g., attachment style i.e., if you don’t know someone, you will activate what you know about social relationships based on past experiences)
Possibility for action:
* Social interaction during pain vs. interaction beforehand (interactions during pain had a more pain attenuating effect)
* So, when designing interventions, think unambiguous, close and safe during painful experience
What are the neurobiological findings for supporting social support for pain?
The Role Of Oxytocin:
* Neuropeptide synthesised in the hypothalamus; acts centrally as neurotransmitter and peripherally as a
hormone
* “Love hormone“, “cuddle hormone“…?
* Onset of maternal behaviour; formation of pair bonds (i.e., close social bonds)
* More broadly involved in allostasis (Quintana & Guastella, 2020) (allostasis is maintaining our body integrity in changing environments)
* Not always linked to pro-social stuff
Effects of oxytocin on pain:
* Animal studies show that oxytocin reduces pain and increases pain relief (Boll et al., 2018)
* Humans: Intranasal oxytocin associated with reduced pain report and pain-related neural responses (Paloyelis, Krahé et al., 2016)
Works how?
Peripheral and direct nerve effects, effects on pain-related emotional states, interactions with the opioid system, increases the salience of social cues (i.e., what is important and what we should be paying attention to; which works in both positive and threatening contexts) etc.,
What are the Oxytocin findings regarding social support from a meta-analysis? (Lopes & Osório, 2023)
- This meta-analysis did not look at the context in which the oxytocin was administered e.g., “other important
variables at individual/dispositional and
environmental/situational levels were not
considered” (Lopes & Osório, 2023) - E.g., Kreuder et al. (2019) showed that during partner hand-holding, oxytocin augments beneficial effects of partner support in anterior insula (important for integrating contextual information with sensory information)
What is the role of Oxytocin regarding social support for pain? (Pfeifer et al., 2020)
- Couples received blister wound
- Randomised to either complete postive interaction or not (3x)
- Randomised to either self-administer oxytocin or placebo 2x/day for five days
- Reported pain through ecologically momentary assessment (answering questionnaires which are randomly sent to your phone at random times of the day)
- Couples’ pain was related (Joint homeostasis managing both your bodies in the same environment? Empathy which leads to synchronisation of pain levels?) i.e., the blister pain correlated the same amount of pain in the couples
- Intranasal OT reduced pain in men but increased pain in women. This suggests that women benefitted from the positive social interactions, while men did not show any difference in pain based on the interactions
What have studies found about Reward as a mechanism?
- fMRI studies to initially primed social context using photographs
Younger et al. (2010):
* Students in early stages of romantic relationships received painful stimuli while viewing pictures of their partner or acquaintance matched in terms of length of acquaintance and attractiveness
- Also did a distraction task (to essentially justify whether the presence of someone is a distraction or acts as genuine social support)
- Partner task and distraction task both reduced pain, contrasted with viewing acquaintance photographs
- Pain relief in the partner condition was positively related to activation in reward- related neural regions e.g., the bilateral caudate head, bilateral nucleus accumbens
- Therefore, reward is another way in which interactions with our close ones can reduce the pain experience (important for future research to investigate whether this changes with a longer relationship e.g., 10 years)
