PSYC 3170 Final Exam

What is Pain?

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

The Significance of Pain

Some pain is critical for survival

Medical Consequences of Pain

-Pain is the symptom most likely to lead an individual to seek treatment

Congenital Insensitivity to Pain

Disorder in which cannot experience pain

-Leads to constant injury, unaware of illness and its progression and early death

Pain - Medically Significant

Pain can be a source of misunderstanding between a patient and the medical provider

Psychological Significance of Pain

-Depression and anxiety worsen the experience of pain

-Pain is very prevalent and costly to the health care system and around the world

-Millions of dollars annually are spent on remedies to temporarily alleviate pain in Canada

Why is pain difficult to study?

-Pain is a psychological experience

-Pain is influenced by the context in which it is experienced

-Pain has a cultural component

Measuring Pain

Verbal Reports

-Best way to assess pain is to ASK the patient about the pain

Pain Behaviour

-Behaviour that arises as a manifestation of chronic pain

-Assesses how pain has disrupted the lives of patients

Physiology of Pain

-Pain and emotions

-Greatly intertwined

Three kinds of Pain Perception

1. Mechanical Nociception

2. Thermal Damage

3. Polymodal Nociception

Mechanical Nociception

mechanical damage to body tissue

Thermal Damage

experience of pain due to temperature exposure

Polymodal Nociception

pain that triggers chemical reactions from tissue damage

Two major types of peripheral nerve fibres involved in pain

1. A-Delta Fibres

2. C-Fibers

A-Delta Fibers

small, myelinated fibers that transmit sharp pain

C-Fibers

Unmyelinated fibres that transmit dull, aching pain

-Several other areas of the brain and nervous system are also involved in the modulation of pain

Factors Contributing to Pain

-Physical: extent of injury

-Emotional: One's emotional State

-Cognitive: One's appraisal

Neuromatrix Theory of Pain

The body-self neuromatrix generates nerve impulse that are synthesized into a characterized pattern called neurosignature

-Each pain experience results in an experience that reflects a multitudes of sensory, emotional, cognitive factors

Stimulation-Produced Analgesia -SPA

Electrical brain stimulation with rats demonstrated that the brain can control the amount of pain by blocking transmissions of pain signals

Acute Pain

Acute pain usually results from injury

-promotes survival when it serves as a warning of injury

-But much of the acute pain people experience in today's world has little survival value

Chronic Pain

Usually begins as an acute episode but does not decrease with the passage of time

-When pain persists and becomes chronic, patients begin to perceive its nature differently

Types of Chronic Pain

-Chronic benign pain

-Recurrent acute pain

-Chronic progressive Pain

Acute Vs. Chronic Pain

-Acute and chronic pain present different psychological profiles

-chronic pain patients develop maladaptive coping strategies

-Pain techniques work with acute but not chronic pain

-Chronic pain involves the interaction of physiological, psychological, social and behavioural components

Who becomes a chronic pain patient?

- acute pain patients

- patients for whom pain interferes with life activities

Lifestyle of Chronic Pain

-Disruptions of a person's life

-Some receive compensation for their pain

pain management programs- Initial Evaluation

Perform a qualitative and quantitative assessment of pain explore how the patient has coped with the pain in the past

Pain-Prone Personality

A constellation of personal traits that predispose a person to experience chronic pain

Pain Profiles (MMPI)

the "neurotic train" : anxiety disorders, substance use disorders and other psychiatric problems

Pharmacological control of Pain: Drugs

-NSAIDS

-Morphine

-local Anesthetics

-Spinal blocking agents

-Antidepressants

Surgical Control of Pain

cutting or creating lesions in the so-called pain fibers at various points in the body

Sensory control of pain: Counterirritation

Inhibiting pain in one part of the body by stimulating or mildly irritating another area

-Exercise

Sensory Control of pain: Biofeedback

A method of achieving control over bodily processes

-Used to treat chronic disorders, temporomandibular joint pain, hypertension and a broad array of pains

Does Biofeedback Work?

Only modest for its efficacy in reducing pain

relaxation techniques

Enable patients to cope with stress, anxiety, reducing pain

What is Relaxation?

- shifting the body into a state of low arousal

- controlled breathing

- meditation

Hypnosis

One of the oldest techniques for pain

How does hypnosis work?

Relaxation anf Suggestion

Hypnotherapy has Successfully controlled

- irritable bowel syndrome, acute pain due to surgery, childbirth, dental procedures, burns, headaches and medical procedures

Acupuncture

Developed in China over 2000 years ago

-Long, thin needles are inserted into designated areas of the body

Distraction

Focusing attention on an irrelevant and attention-getting stimulus in order to reduce pain

Strategies of Distraction

-Focus on another activity

-Focus directly on the events but reinterpret the experience

Coping Techniques

Increasingly used to help chronic pain patients manage pain

Guided Imagery

-A patient is instructed to conjure up a picture that he or she holds in mind during the painful experience.

-Induced relaxation can control slow-rising pains

cognitive behavioural therapy: Seven Objectives

-Re-conceptualize the problem

-Expect that this training will be successful

-Re-conceptualize patients own role

-Monitor thoughts, feeling and behaviours

-Teach adaptive responses

-Attribute success to patient's own effort

-Prevent relapse

The Toll of Pain on Relationships

-Affects marriage and other family relationships

-Social relationships can be threatened

Chronic Pain Behaviours

-Avoiding loud noises and brightens lights

-Reducing physical activity

-Avoiding social contacts

Components of Chronic Pain Management Programs:

-Education, training and group therapy

-Involvement of family

-Relapse prevention

-evaluation of pain management program

Adaption

Refers to the process of making changes in order to adjust constructively to life's circumstances

Quality of Life

Is the degree of excellence people appraise their lives to contain

What is Quality of Life?

-Physical functioning

-Psychological status

-Social functioning

-Dieseas or treatment-related

Symptomatology

Interference with activities of daily life

Why study Quality of Life?

-Provides basis for interventions

-Can help pinpoint which problems are likely to emerge for patients with diseases

-Assesses the impact of treatments

-Is used to compare therapies

-Can inform decision-makers about care

Denial

A defence mechanism by which people avoid implications of an illness

Anxiety

Patients become overwhelmed by potential changes in their ives and/ or the prospect of death

Depression

-Debilitating reaction to chronic illness

-Medical significance being recognized

-Sometimes a delayed reaction to chronic illness

Significance of Depression

-Has an impact on the overall prospects for rehabilitation or recovery

-Has been linked to suicide among the chronically ill

-Can be a long-term reaction

Assessing Depression

-Can be problematic

-Depression may go untreated

-Can lead patients to make extreme decisions about their care

Who gets depressed?

-patients experiencing pain and disability

-patients with physical limitations

Body Image

_body image plummets during illness

-Poor body image related to self-esteem and an increased likelihood of depression and anxiety

-In most cases, body image can be restored except for those with facial disfigurements or extensive burns

Goals and Self-Image

Achievement is important to self-esteem and self-concept

The Social Identity

Important aspect of readjustment after chronic illness

Goals and Self-Image

Achievement is important to self-esteem and self-concept

Coping Strategies and Chronic Illness

-Social support/direct problem-solving

-Distancing

-Positive focus

-Cognitive escape/avoidance

-behavioural escape/avoidance

Which coping strategies work?

Active coping and coping with positive responses

Beliefs about the nature of the Illness

Patients adopt an inappropriate model for their disorder

Belief about the cause of Illness

Patients blame stress, physical injury, disease-causing bacteria and god's will for their illness

-Self-blame can lead to guilt, self-recrimination or depression

Vocational Issues in Chronic Illness

Discrimination against the chronically ill (job)

-Financial impact of chronic illness - insufficient insurance can lead to enormous financial responsibilities

Pharmacological interventions

Antidepressants used to treat depression.

Individual Therapy

-Therapy likely to be episodic

-Collaboration with patient's physician and family is critical-Requires respect for patient's defence

-Therapist must have a comprehensive understanding of the patient's illness and its modes of treatment

Brief psychotherapeutic interventions

- telling patients and their families what to expect during treatment alleviates anxiety

- group coping skills training can be successful

- more novel techniques, such as music, art and dance therapies, have improved patients' emotional and behavioral responses to pain

Patient Education

-Internet

-Provides interventions in a cos-effective manner

-Many websites offer information to patients -Expressive writing

-Has benefits, especially for the terminally ill

Relaxation, Stress Management and Exercise

-Relaxation training is widely used with the chronically ill

-Mindfulness- based stress reduction (MBSR) has been used to improve adjustment to medical illness

-Exercise can improve quality of life

Social Interaction problems in Chronic Illness

-Negative responses from others

-Acquaintances, friends and relatives may not adjust to the patient's altered conditions

Chronic Illness: Impact on Family

-Intimate others may be distressed by the loved one's condition

-New responsibilities may fall on other family members

Sudden Infant Death Syndrome (SIDS)

-Causes are not entirely known

-Infant simply stops breathing

-Gentle death for child

-Enormous psychological toll for parents

-Sleeping position has been reliably related to SIDS

Causes of Death

-Death between ages 1 to 15 years

-#1 cause of death is accidents (40%)

-#2 cause of death is cancer (especially leukaemia)

Death ages 15 to 24

-#1 unintentional injury (car accidents)

-#2 Homicide

-#3 suicide

-#4 Cancer

Premature Death

-Death before the projected age of 77

-Usually occurs due to heart attack or stroke

-Most people say they would prefer a sudden, painless, non-mutilating death

Death in Olde Age

-Dying is not easy, but it may be easier in old age

-Initial preparations may have been made

-Some friends and relatives have died

-May have come to terms with issues

-Typically die of degenerative diseases

-Psychosocial factors predict declines in health

Continued treatment and advancing illness

treatments may have debilitating side effects, patients find themselves repeated objects of surgical or chemical therapy

Is there a Right to Die?

-Do Not Resuscitate (DNR) order -Receptivity of suicide and assisted suicide

Psychological and Social Issues related to Dying

-Changes in the patients self-concept

-Difficult in maintaining control of biological functions

-Mental regression, inability to concentrate

-Fear that their condition will upset visitors

The Issue of Nontraditional Treatment

-When health deteriorates and communication deteriorates:

-patients may seek alternative remedies

-Life savings may be invested in hopes of a "miracle cure"

Kubler-Ross's 5 Stages of Adjustment to Death

-Denial

-Anger

-Bargaining

-Depression

-Acceptance

Differing evaluations of Kubler-Ross's theory

-Her work is invaluable

-Her work has not identified stages of dying

-There is not a predetermined order

-Some patients never go through a particular "stage"

-Her work does not fully acknowledge the importance of anxiety

Medical staff and the terminally Ill Patient

-The significance of hospital staff to the patient

-Dying need help for simple things, such as brushing teeth or turning over

-They assist with pain management

-They are the patient's source of realistic information

-They are privacy to a most personal and private act: Dying

Risks of terminal care for staff

-Emotionally and physically straining for the hospital staff

-They provide palliative care, care designed to make the patient comfortable, rather then curative care, care designed to cure the patient's disease

Individual counselling with the terminally ill

Therapy for dying patients is becoming an increasingly available and utilized option

Thanatologists

those who study death and dying, suggest behavioural and cognitive-behavioural therapies

-Clinical thanatology involves symbolic immortality

Family Therapy with the Terminally Ill

Family and patient may have different ways of adjusting to the illness

The management of terminal illness in children

-Most stressful of all terminal care

-Hardest to accept and psychologically painful

-Family may nee counselling as well

Grief - Psychological response to bereavement

-Feeling of hollowness

-Preoccupation with image of deceased person

-Expressions of hostility towards others

-Guilt over death

The Child Surviver

-May expect the dead person to return

-May believe a parent left because the child was "bad"

-May feel "responsible" for a sibling's death

Death Education

Courses on dying, which may include volunteer work with dying patients, have been developed for college students

-Provides realistic expectations about what modern medicine can achieve and the kind of care the dying wants and needs

Hospice Care

Designed to provide palliative care and emotional support to dying patients ad their families

-May be provided in the home, but commonly provided in free-standing or hospital-affiliated units called hospices

-Oriented toward improving a patients social support system

Home Care

-Care for dying patients in the home

-Choice of care for many terminally Ill patients

-Psychological factors are reasons for home care

-very stressful for family members

What is Coronary Heart Disease (CHD)

-a general term referring to illnesses caused by atherosclerosis, the narrowing of coronary arteries, the vessels that supply the heart with blood

-may be caused by inflammatory processes, high

blood pressure, diabetes, cigarette smoking, obesity, high serum cholesterol level and low levels of physical activity

Roles of Stress

-Chronic and acute have been linked to CHD

-CHD more common in individuals low in socioeconomic stress

Job factors linked to CHD

-Balance of demand and control in day life is associated with CHD

-Social instability tied to higher rates of CHD

Women and CHD

-leading killer of women in Canada

-women seem to be protected at younger ages relative to men;

-higher levels of HDL estrogen diminishes sympathetic nervous system arousal

-higher risk of cardiovascular disease after menopause