PSYCH 441 - Understanding and Managing Pain

pain

an unpleasant sensory and emotional experiment associated with, or resembling that associated with, actual or potential tissue damage

why do we feel pain?

• nociception

• signals travel from the body > spinal cord > brain

• the brain decides: is this dangerous

• pain is the brain’s best guess about a threat

• congenital insensitivity

nociception

he physiological process by which the nervous system detects and transmits information about harmful or potentially damaging stimuli (noxious stimuli) to the brain

congenital insensitivity

a rare genetic disorder where individuals are not able to feel pain

significance of pain

• protective role of pain

• leads to seeking treatment

• inadequate relief has significant consequences

why does pain vary so much?

the degree to which pain is felt depends on:

• how it is interpreted

• context in which it is experienced

• cultural component: members from some cultures react more intensely to it than those from other cultures

• gender differences: women show great sensitivity to pain

• emotion (fear, anxiety, mood)

nocebo effect

• opposite of the placebo effect

• negative expectations increase pain

gate-control theory of pain

• developed scientific understanding of pain

• nociceptors sense injury and release chemical messengers to the spinal cord

• messages are then passed directly to the reticular formation and thalamus and into the cerebral cortex

• two major types of pain fibers:

  • A-delta fibers

  • C-fibers

A-delta fibers: small, myelinated fibers

• respond to mechanical or thermal pain

• transmit sharp, brief pains rapidly

C-fibers: unmyelinated nerve fibers

• involved in polymodal pain

• transmit dull, aching pain

Acute pain

Results from a specific injury that produces tissue damage

• disappears when the tissue is repaired

• short in duration, lasting for three months or less

chronic pain

begins with an acute episode but does not decrease with treatment and the passage of time

what are the three types of chronic pain?

chronic benign pain, recurrent acute pain, chronic progressive pain

chronic benign pain

• persists for 3 months or longer

• relatively unresponsive to treatment

• severity of pain varies

recurrent acute pain

• intermittent episodes of pain that are acute in character but chronic in condition

• recurs for more than 3 months

chronic progressive pain

• persists longer than 3 months and increases in severity over time

• associated with malignancies or degenerative disorders

common sources of chronic pain

• back pain, headaches, cancer, arthritis, neurogenic, psychogenic

chronic pain outcomes

lifestyle:

• may quit jobs and abandon leisure activities

• may withdraw from families and friends

• may require public assistance

work and self:

• experience loss of self-esteem

• receive compensation, which increases pain because it provides an incentive for being in pain

relationships:

• family relationships get affected

• positive attention from spouse may maintain the pain

pain-prone personality

predisposes a person to experience chronic pain

personality attributes associated with chronic pain

• neuroticism, introversion, use of passive coping strategies

how is pain measured?

through verbal reports and pain questionaries

there are also questionaries that address the psychosocial components of pain

• how much fear it cases

• how much it has taken over a person’s life

neuroscience can be used to gain insights about pain

pain behaviors

arise from chronic pain

• help in assessing how pain has disrupted a patient’s life

• conducted disability evaluations for adults who reported being injured at work.

effective pain management is ______

biopsychosocial

pain control 1 - drugs

types of drugs:

• local anesthetics: after the transmission of pain impulses from peripheral receptors to the spinal cord

• spinal blocking agents

• antidepressants: affect the downward pathways from the brain that modulate pain

pain control 2 - surgical

• cutting or creating lesions in the pain fibers

• disrupts the transmission of pain from the periphery to the spinal cord

• interrupts the flow of pain sensations from the spinal cord upward to the brain

pain control 3 - sensory

counterirritation: inhibiting pain in one part of the body by stimulating or mildly irritating another area

• exercise and other ways of increasing mobility help the chronic pain patient

• ex: heat/cold therapy, massage, acupuncture, TENS

pain control 4 - psychological

relaxation techniques: shifting the body into a state of low arousal by progressively relaxing different parts of the body using controlled breathing

• meditation, slow breathing, mindfulness reduce pain sensitivity and produce analgesics effect (e.g., childbirth)

• beneficial physiological effects are due to the release of opioids

distraction: turning attention away from pain by 1.) focusing on an irrelevant and attention-getting stimulus 2.) distracting oneself with a high level of activity

cognitive behavioral therapy: encourages patients to reconceptualize a problem from overwhelming to manageable