Psychology of Pain PDF

Pain   Purpose of pain: we need it to survive. It teaches us what to avoid to keep us safe, and it\'s how our physical body communicates with our minds by setting limits on things such as activity. - What if we couldn't feel pain? We would lose all the survival methods it provides. Often ti...

Pain   Purpose of pain: we need it to survive. It teaches us what to avoid to keep us safe, and it\'s how our physical body communicates with our minds by setting limits on things such as activity. - What if we couldn't feel pain? We would lose all the survival methods it provides. Often times people who can\'t feel pain don't live to reach their 30s. - Pain prone personality - an individual who has high levels of neuroticism, introversion and the use of passive coping strategies. Or the neurotic triage - hypochondriasis, hysteria and depression.   Pain is a psychological experience, a sensory and emotional experience of discomfort, and is subjectively determined by how it is interpreted. - A study by Beecher showed that soldiers interpreted pain as still being alive, whereas civilians found that it interrupted their activities (an inconvenience). - Critically influenced by: - context in which is happens - like during a sport. - culture - child birth. - Cues internal and externally - quiet in a movie will remind your body you have a full bladder, etc, and you are no longer unfocused on pain.   Different types of pain: - Acute pain - a useful biological response provoked by injury or disease of limited duration. Amendable to pharmacological intervention. Less than 6 months. - Chronic pain - pain persisting for over 6 months and tends not to respond to pharmacological intervention. Is now considered a disease. - Hyperalgesia - a chronic or acute pain sufferer becoming more sensitive to pain overtime.   How we experience pain   The nature of pain: it's a psychological experience different from nociception (processing of stimuli associated with the stimulations of nociceptors). Pain is the perceptual process associated with selective abstraction, conscious awareness, ascribed meaning, learning and appraisal; \"an unpleasant sensory and emotional experiences associated with actual or potential tissue damage, or describe in terms of such damage\". - Not a sensation which is defined as the process by which stimulation of a sensory receptor gives rise to neural impulses that result from an experience outside the body. A sensation is not described as painful (not pain!) until it is interpreted as so by the brain. - Motivational and psychological states are of importance in the conceptualization of pain as sometimes shown by emotions like anger, fear, and sadness and can lead to direct behavioral and psychological consequences (facial expressions of pain). - Chronic pain is associated with psychological conditions like depression, anxiety, and substance abuse, as well as a disruption of social relationships, social isolation, and reduced quality of life.   Theories of pain - earlier versions had a biophysical focus with Descartes implying a one-on-one correspondence between pain and tissue damaged referred to as specificity theory however this did not help people who have chronic pain. - The gate control theory: nerve impulses are transmitted from afferent fibers to spinal cord transmission cells modulated by a gating mechanism in the dorsal horn of the spinal cord. This gating mechanism is affected by the amount of activity in small paint pathway fibers (open the gate by facilitating transmission) and large-diameter sensory neural pathways (close the gate by inhibiting transmission). - When the output of spinal transmission cells reaches a critical level it activates the neural areas that underline the complex, sequential patters of experience and behavior that characterizes pain. - Cortisol descending signals (messages from the brain) also have the potential to inhibit nociceptive message transmission to the brain and close the gate providing a physiological basis for the role of psychological factors and validates the use of such as a treatment for pain. - The neuromatrix model emphasizes the role of the brain in pain perception. The body is perceived as a unit that it is not its surroundings is produced by the CNS; an anatomical process of body-self. Can also be described as a widespread network of neurons which form loops between the cortex and the limbic system as well as the thalamus and the cortex. These loops then separate to allow for parallel processing in different components of the neuromatrix and come together to permit interactions between processing outputs. - The nuerosignature is a repeated cyclical processing and synthesis of nerve impulses through the neuromatrix to revel a characteristic pattern, also known as the output of the neuromatrix. - Pain perception can be generated by the output of the neuromatrix as a function of sensory input and information from regions of the brain involved in affective and cognitive functions. - Pain behaviors can be generated or perpetuated by previously conditioned cues in the environment or by the expectations of pain and suffering; phantom limb pain.   Biopsychosocial models of pain are consistent with the gate control theory of pain by elaborating on social and psychological influences that affect the pain experience. - The operant model of pain stresses the importance of reinforcement in the development and maintenance of pain behavior - if pain behavior is reinforced by attention then it will persist. While the behaviors may originally help reduce pain over time they become maladaptive when associated with additional rewards. Does not take into account interpretations and appraisals of pain. - The fear avoidance model of pain is based on the idea that certain movements and behaviors become associated with pain or exacerbation of pain and when coupled with catastrophic thoughts about pain and concern about the possibility of re-injury leads to excessive avoidance. - The communications model of pain is a three step process whereby the internal experience of pain (1), which is determined by social/cultural and psychological factors is encoded into verbal and non-verbal expressive behavior (2) that can be potentially decoded by observers (3) which can be effected by interpersonal and intrapersonal determinants. - 1 - variety of processes that take place during the experience of pain including affective, cognitive, and brain correlates. - 2 - expressive behaviors vary with respect to the extent to which they are characterized by automaticity or cognitive executive mediation. - Non-verbal pain behaviors are seen as being more automatic and less under voluntary control than self-report. - Self-report is considered to be under more voluntary control but easier to decode by an observer. - 3 - characteristics of the observer and of the person expressing pain have been shown to affect the decoding process and therefore observer actions have the potential to palliate or worsen the pain experience. - Cognitive behavior conceptualization of pain focuses on the role of cognitive factors and beliefs in the pain experience and recognize the interconnections among thoughts, feelings, and behaviors. The assumption is that the difference between people who adjust well to pain and those who do not lies in their appraisals and interpretations of the situation which in turn affects emotions and behaviors. - Negative emotions and associated psychological changes can affect the thinking process which then has the persons beliefs making an impact on the manner in which they present themselves to others which in turn affects how others react to the person\'s pain.   Psychological assessment of pain   Psychological assessments tend to incorporate complete evaluations of patients psychological functioning and involve both detailed clinical interviews covering personal and psychological history and psychological tests - typically based on biopsychosocial formulations of the pain experience. - Focuses on a variety of domains capturing information about the person, psychological history, problem history, co-morbidities, coping styles, dimensions of the pain experience, functional analysis of pain behavior and the impact of pain on the quality of life.   Dimensions of the pain experience is multi-dimensional with affective, sensory, and evaluative components. - The McGill Pain Questionnaire (MPQ) consists of groups of words designed to capture the various dimensions of the pain experience such as pain descriptors, and an overall rating of pain intensity. It has been shown to be remarkably accurate. - Sensory linked to words describing the sensory quality of the experience in terms of properties such as thermal and pressure. - Affective linked to words relating to affective elements such as fear. - Evaluative whether the pain is unbearable, annoying, etc. - Cognitive evaluations are used to see which patients engage in catastrophic thinking - defined as involving a cognitive appraisal in which situations are viewed as being threatening and beyond an individual\'s ability to cope. - Used to measure whether people show certain behavioral tendencies such as to avoid activity due to fear of pain.   Pain behaviors are observed during interviews and through discussion of what the person does when they are scared. Standardized observational approaches are also often used with special populations such as children and older adults with dementia. - Antecedents are what precedes the pain behavior are examined. - Consequences of pain behavior are discussed. - Environment can sometimes serve to encourage or discourage pain behavior such as social support or the work environment and if the person is operating within an adversarial.   Effects of pain on quality of life include: - A persons mood and psychological functioning with pain leading to clinical depression or anxiety. - Social relationships where pain can result in isolation. - Intimate relationships as pain can interfere with sexual activity. - Vocational functioning as in workplace productivity and safety. - Economic circumstances from a person being less able to engage in their regular occupation. - Use of substances with an abuse factor in order to cope with the pain experience.   Psychological treatments or management for chronic and acute pain   CBT is widely used complementary to medial and physical treatments. The best approach to chronic pain is interdisciplinary as CBT targets a variety of psychological consequences of pain such as depression or anxiety. It not only incorporates cognitive techniques but also a wide range of behavioral procedures including pacing of activity, building coping skills, problem-solving, relaxation training and biofeedback. Note: many pain problems are highly resistant to treatment and CBT gives at best modest benefits. - Cognitive techniques such as cognitive reconstruction and problem-solving that challenge negative thoughts and maladaptive beliefs through Socratic dialogue. Given that thoughts, emotions, and behaviors can affect one another targeting maladaptive beliefs has a positive impact on behavior. - Relaxation training, pacing and behavioral activation are breaking up tasks into smaller components and performing them or pleasant activity scheduling. - Supportive educational techniques that offer support and provide information about the nature of pain. - Biofeedback - a procedure that helps clients become more aware of specific physiological functions using psychophysiological measuring instruments helps to develop coping skills and identify triggers in an effort to prevent relapse. - Different types like thermal or electromyography are used depending on the type of pain experienced.   Acceptance and commitment therapy has found that acceptance of pain rather than changing one\'s thoughts about pain as the focus of the treatment emphasizes the manner in which someone relates to distressing thoughts and incorporates mindfulness (mental state of awareness that has commonalities with meditations and involves being intentionally present in the moment without judgement and while having an orientation that is characterized by openness, curiosity, and acceptance). - The assumption is that suffering is unavoidable and trying to control thoughts about pain can increase distress. Instead be encouraged to be mindful and to notice, observe, and accept events rather than fight them and this is expected to help them experience life mor fully.   Acute pain usually has psychological interventions such as hypnosis ( a state of consciousness that involves attention being diverted away form the pain and onto a narrowly focused area), cognitive procedures like distraction, and psycho-education (providing information about the steps involved in the procedure to reduce unrealistic anxiety).   Pediatric psychology and pain   Coping with chronical medical conditions always involves stress that affects the whole family, especially if there is a delay in diagnosis and treatment. The main stressor for children is disruption to routines and daily activities. The level of stress by a stressor is dependent on many factors and makes it so not all coping responses equally effective but we do know that they must be intertwined with development. - Disability-stress-coping model of adjustment and the stress and coping model of adjustment present a control-based model of coping that includes primary control or active coping. - Kidcope is used as children rate commonly used coping strategies but also the degree of anxiety, unhappiness, and anger experienced in dealing with stressful situations related to their condition. - Psycho-education in the form of psychological interventions include basic knowledge about disease management as well as instructions in specific cognitive behavioral coping skills.   Adherence to pediatric treatment regimes is difficult with children even when there are life threatening consequences to not following the regimen. Reinforcement is used to increase adherence along with behavior-management techniques. It is also important to address barriers to adherence.   Coping with medical procedures including the fears that persist over time as a result can make a child less likely to seek health care in the future. This part due as most children do not receive pain relieving interventions during medical procedures. Another factor is the family - parents reassurance is like a cue to a child that something is wrong. - Face pains scale-revised is used by children to report their pain along with broadband behaviors or fine grained facial movements. It is important that the scale starts with a neutral face to a painful face. - Pharmacological, psychological, physical, and combined pain management strategies can reduce procedure related pain in children, as well as addressing barriers. Such includes distraction, hypnosis, and other interventions. - Knowledge translation efforts aimed at communicating evidence-based strategies to reduce pain in children.   Pediatric chronic pain is a serious health concern and can occur as a result of associated medical conditions or in the absence of any identifiable organic pathology. Not all children who experience chronic pain are disabled by it but the ones that do have negative consequences of their pain that are far reaching, affecting emotional functioning, school performance, peer relationships, sleep, and family functioning. - Core outcome domains for assessment of chronic pain include pain intensity, physical functioning, emotions functioning, role functioning, and sleep. - Often needs psychological interventions combined with intense multidisciplinary interventions.