Health Psychology (10) - The Management of Pain and Discomfort

What is the medical significance of pain?

(1) Its symptom most likely leads a person to seek treatment.

(2) It can complicated illnesses and hamper recovery from medical procedures.

(3) It often accompanies mental and other physical disorders.

(4) It can be a source of misunderstanding between a patient and the medical provider.

Beecher concluded that ...

the meaning attached to pain substantially determines how it is experienced.

Pain is also heavily influenced by the ...

context in which it is experienced.

Sympathetic arousal diminishes ...

pain sensitivity.

Stress and psychological distress aggravate ...

the experience of pain.

Patients with chronic pain disorders show ...

significant loss of gray matter in the brain regions involved in the processing of pain (prefrontal, cingular, and insular cortex)

Pain Behaviours

Behaviours that arise from chronic pain, such as distortions in posture/gait, facial/audible expressions of distress, and avoidance of activities.

Nociception

The perception of pain (that results from mechanical damage to tissues of the body).

What are the three kinds of pain perception?

(1) Mechanical nociception.

(2) Thermal damage.

(3) Polymodal nociception (pain that triggers chemical reactions from tissue damage)

Gate-Control Theory of Pain

A theory detailing how the experience of pain is reflected in sensory, psychological, and behavioural responses.

Nociceptors in the peripheral nerves first sense injury and, in response, ...

release chemical messengers, which are conducted to the spinal cord, where they are passed directly to the reticular formation and thalamus and into the cereberal cortex.

Certain regions of the brain identify the site of the injury and send messages back down the spinal cord, which lead to ...

muscle contractions, which can help block the pain, and changes in other bodily functions such as breathing.

What are the two major types of peripheral nerve fibers that are involved in nociception?

(1) A-delta fibers.

(2) C-fibers.

A-delta fibers are ...

small, myelinated fibers that transmit sharp pain.

A-delta fibers respond especially to ...

mechanical or thermal pain, transmitting sharp, brief pain rapidly.

C-fibers are ...

unmyelinated nerve fibers (because they are not myelinated, which increases the speed of transmission, it is not rapidly conducted to the cerebral cortex)

C-fibers are involved in which type of pain?

Polymodal pain, which transmits dull, aching pain.

Peripheral nerve fibers enter the spinal column at the ...

dorsal horn.

Motivational and affective elements of pain appear to be influenced more strongly by the ...

C-fibers, which project onto different thalamic, hypothalamic, and cortical areas.

The periaqueductal gray, a structure in the midbrain, has been tied to ...

pain relief when it is stimulated.

Pain sensation, intensity, and duration interact to influence the ...

experience of pain, its perceived unpleasantness, and emotional responses to it (through limbic structures/thalamus, which direct their inputs to the cortex)

In the cortical regions of the brain, nociceptive input is integrated with ...

contextual information about the painful experience.

The brain controls the amount of pain an individual experiences by ...

transmitting messages down the spinal cord to block the transmission of pain signals.

Reynolds' Stimulation-Produced Analgesia

When he electrically stimulated a portion of a rat brain, one could produce such a high level of analgesia that the animal would not feel the pain of abdominal surgery.

Endogenous Opioid Peptides

Opiate-like substances produced by the body.

Why are endogenous opioid peptides important?

They are the natural pain suppression system of the body; however it is not always in operation and particular factors must trigger its arousal.

What factor triggers the production of endogenous opioid peptides?

Stress; acute stress reduces sensitivity to pain (stress-induced analgesia).

Pain Control

A patient no longer feels anything in an area that once hurt.

Counterirritation

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

What is an example of a pain control technique that uses counterirritation?

Spinal cord stimulation; when a patient experiences pain, they activate a radio signal that delivers a mild electrical stimulus to an area of the spine, thus inhibiting pain; their effects are often only short-lived.

Biofeedback

Providing biophysiological feedback to a patient about some bodily process of which the pain is usually unaware.

Biofeedback training can be thought of as an _______ learning process.

operant

Biofeedback has been used to treat ...

a number of chronic pain syndromes: headaches, Raynaud's disease, and pelvic pain.

One reason for teaching pain patient relaxation techniques is that it ...

enables them to cope more successfully with stress and anxiety, which may ameliorate pain.

What is relaxation?

An individual shifts their body into a state of low arousal by progressively relaxing different parts of the body (controlled/slow breathing, meditation, mindfulness)

Relaxation is modestly successful for controlling ...

some acute pains and chronic pain when used with other methods of pain control.

Distraction

Either focusing on a stimulus irrelevant to the pain experience or reinterpreting the pain experience.

What are the two different mental strategies for controlling discomfort?

(1) Focusing on another activity.

(2) Focus directly on the events but reinterpret the experience.

Distraction is most effective for coping with (low/high)-level pain.

low; patients cannot distract themselves indefinitely and the process itself lacks analgesic properties.

Pain Management Programs

Coordinated, interdisciplinary efforts to modify chronic pain by bringing together neurological, cognitive, behavioral, and psychodynamic expertise concerning pain; such programs aim not only to make pain more manageable but also to modify the lifestyle that has evolved because of the pain.

What are the several common features of pain management programs?

Patient education, training in a variety of measures to reduce pain, group therapy, changing distorted negative perceptions about pain.

The incidence of relapse following initially successful treatment of persistent pain ranges from about ...

30 to 60 percent.

Pain-Prone Personality

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

What makes the hypothesis of a pain-prone personality too simplistic?

(1) Pain itself can alter personality and behaviour.

(2) Individual experiences of pain are too varied and complex.

What certain personality attributes are reliably associated with chronic pain?

Neuroticism, introversion, and the use of passive coping strategies.

Acute Pain

Typically results from a specific injury that produces tissue damage (ex. a wound or broken limb); pain that goes on for 6 months or less.

Chronic Pain

Typically begins with an acute episode, but does not decrease with treatment and time.

Chronic Benign Pain

Typically persists for 6 months or longer and is relatively unresponsive to treatment (ex. chronic low back pain)

Recurrent Acute Pain

Intermittent episodes of pain that are acute in character but chronic inasmuch as the condition recurs for more than 6 months (ex. migraine headaches, temporomandibular disorder, trigeminal neuralgia)

Chronic Progressive Pain

Persists longer than 6 months and increases in severity over time (ex. cancer, rheumatoid arthritis)

How do acute and chronic pain differ?

(1) Psychological distress often accompanies chronic pain.

(2) Most pain control techniques work well to control acute pain.

(3) Chronic pain involves the complex interaction of physiological, psychological, social, and behavioural components.

Inadequate relief from pain is the most common reason for a patient's request for ...

euthanasia or assisted suicide.

Some chronic pain patients develop ...

maladaptive coping strategies (ex. catastrophising their illness, engaging in wishful thinking, withdrawing socially)

Chronic pain may result from a predisposition to ...

react to a bodily insult with a specific bodily response (ex. tensing one's jaw or altering one's posture)

Why may chronic pain patients experience pain especially strongly?

(1) High sensitivity to unpleasant stimulation.

(2) Impairment in pain regulatory systems.

(3) Overlay of psychological distress.

Chronic pain patients typically show elevated scores on three MMPI subscales:

hypochondriasis, hysteria, and depression ("neurotic triad")

What has been the most popular painkiller for decades but has strong disadvantages?

Morphine; individuals can become addicted and/or build up a tolerance.

Surgical treatment involves ...

cutting/creating lesions in the so-called pain fibers at various points in the body so that pain sensations can no longer be conducted; the effects are often short-lived.

Sensory aspects of pain are heavily determined by activity in the …

A-delta fibers (project onto areas in the thalamus and sensory areas of the cerebral cortex)

Neurons in the periaqueductal gray connect to the reticular formation in the medulla, which ...

makes connections with the neurons in the substantia gelatinosa of the dorsal horn of the spinal cord.

Processes in the cerebral cortex are involved in …

cognitive judgements about pain, including evaluation of its meaning, which contributes to the strong emotions often experienced during pain and which can themselves exacerbate pain.