Health Psych final

ch 7-onward

How does the nervous sytem register pain?

Pain originates as stimulation (neural impulse) of sense receptors on or near surface of the skin. Neural impulses (part of PNS) travel toward spinal cord and the brain.

Somatosensory system

System which conveys sensory info from the body to the brain. Includes: touch, pressure, cold, warm, tickling, movement, body position

3 types of neurons

Afferent (sensory-from sense organs to brain), efferent (motor-move muscles or stimulate organs or glands), interneurons (connect sensory to motor)

primary afferents

Afferent neurons contained in sense organs with special receptors for converting physical energy into neural impulses (travel to the brain via spinal cord and are interpreted by the brain)

Nociception

Stimulation of sensory nerve cells causing the perception of pain. Nociceptors=sense organs or receptors which respond to stimuli which cause pain (ex: cutting, burning, cold)

What’s the difference between A and C fibers?

A fibers are myelinated afferent neurons which conduct neural impulses faster. Are also larger . C fibers are more common, produce slower pain (burning or aching)

What are 2 types of A fibers (afferent neurons)?

A-beta fibers (larger) and A-delta fibers (smaller) also produce “fast” pain like pricking.

Spinal cord

Carries sensory and info between the brain and body. Also has spinal reflexes.

Nerve

Groupings of afferent fibers which form two branches: sensory (dorsal) and motor (ventral). Neuron fibers extent into spinal cord’s doral horns.

What is the route (pain) takes from body to the brain?

Pain/info travels from afferent neurons in spinal cord to the thalamus, to the somatosensory cortex (region in the brain)

Why is pain localization better for skin surface than internal organs?

Bc surface of skin is mapped onto somatosensory cortex (some areas more than others). Brain doesn’t map internal organs as well so only intense internal stimulation spreads to pathways serving the skin can cause visceral pain experience (aka referred pain)

How is emotional/social pain similar to physical pain?

Ppl who experienced social rejection were studied: both anterior cingulate cortex and right venrtal prefrontal cortex became active just like when ppl have physical pain. So meds that act on CNS can help social pain as well as physical pain

Neurochemicals involved in pain

Glutamate, substance P, bradkinin etc. Endorphins play a role in modulating pain (relieving it).

How does the immune system influence pain?

Proteins in immune system (profinflammatory cytokines) are released, signal nervous system to respond: fatigue, pain sensitivity. can worsen pain

What areas of the brain are responsible for modulating pain?

The periaqueductal gray (structure in midbrain) which causes pain relief when stimulated. Medulla is involved in pain perception (pain relief by disrupting transmission of pain info to thalamus)

What is the meaning of pain?

(C.A Strong): pain is caused by sensation and person’s reaction to that sensation. Equal importance to psychological and physical factors of pain

Pain

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

3 stages of pain

Acute (brief duration), chronic (endures over months or yrs; not adaptive), prechronic (in bw acute and chronic, point at which person may overcome pain or dev fear and helplessness leading to chronic pain)

Chronic recurrent pain

Pain marked by alternating episodes of intense pain and no pain. Ex: headache pain

How does experience of pain vary?

Depends on what the pain means to patient (psychological dimension). Ppl who believe a stimulus will be harmful experience more pain than those with diff beliefs abt situation. Variations in pain perception may be attributed to either individual differences, culture or both

How does operant conditioning affect pain experience?

People who receive attention or sympathy (are rewarded) for pain behaviors are more likely to develop chronic pain than ppl with similar injuries who receive fewer rewards.

How does social learning affect pain experience?

If a person frequently observes others’ pain and the rewards they receive for it, they may learn that pain results in rewards.

How are situational and cultural factors more influential in pain experience?

Certain cultures may discourage expression of pain behaviors more than others. Situational factors like fear, depression or anxiety can worsen experience of pain. There’s no such thing as a pain-resistant or pain-prone personality

Ethnic differences in pain experience

There are differences between African Americans and Euro Americans in sensitivity to painful stimuli, however, they’re more marked in impact and severity of chronic pain conditions.

Gender differences in pain

Women may experience different kinds of pain than men and are more likely to report it than men due to socialization (gender roles), or differences in coping strategies. Another reason for the difference: women have higher anxiety and threated related to experiences of pain

What types of pain present the biggest problems?

Chronic pain (syndromes) like headache pain, low back pain, arthritic pain, cancer pain, phantom limb pain

How can pain be measured?

PET and fMRI scans can show what regions of the brain activate when ppl have pain. However, there’s no pain center of the brain, just a variety of activation in the brain

Congenital insensitivity to pain

Rare genetic disorder in which an individual is unable to feel pain

What are 3 theories of pain?

Specificity theory (pain fibers & pain pathways exist, so experience of pain=amount of damage done); gate control theory (pain perception depends on modulations beginning in spinal cord); neuromatrix theory (brain neurons responsible for pain perception; extends gate control theory)

Gate control theory

Neural mechanisms in spinal cord can open gate or close it: allowing flow of neural impulses or not. Activity of fibers in spinal cord affect whether or not impulses reach the brain and to what degree (more or less sensitivity). Thus experience of pain may be influenced by motivational & emotional components (ex: distraction can close the gate, decrease pain, whereas anxiety opens the gate, increases pain). Most influential theory of pain

Central control trigger

Neural impulses which descend from the brain and influence the gating mechanism (in spinal cord).

Syndrome

Symptoms which occur together and characterize a condition

Headache pain

Most common type of pain, experienced by 99+% of ppl.

3 types of headache pain

Migraine (recurrent attacks of varying intensity, duration and frequency), tension (muscular in origin, gradual onset, dull and steady ache on both sides of the head), cluster (severe headache that occurs in daily or near daily clusters; more brief than migraines)

Lower back pain

Usually caused by injury or stress causing musculoskeletal, ligament or neurological problems in the lower back. Fewer than 20% of back pain patients know its exact cause

Role of stress and psychological factors in chronic pain

Prechronic to chronic pain transition is caused by both physical and psychological factor (ex: history of trauma, depression, abuse)

Rheumatoid arthritis

Autoimmune disorder where joints swell and inflame; also destroys cartilage, bone and tendons. Most common in 40-70 yrs. Women more than men.

Osteoarthritis

Inflammation of joints causing degeneration of bone and cartilage. Most common form of arthritis. Common in older women.

Fibromyalgia

Chronic pain: tender points in the body. Symptoms include fatigue, headache, cognitive difficulties, anxiety, sleep disturbance

Cancer causing pain

Cancer causes pain in growth and progression of treatments to control its growth. Often goes untreated

Phantom limb pain

Condition in which amputees experience pain in removed limb. Melzack thought it was caused by activation of neuromatrix (pattern of neural activity in the brain) which creates subjective experience of pain. In this case, is let on even without PNS signals

How is pain measures?

Measures of pain include: self-report ratings, behavioral assessments, physiological measures

Self report measures of pain

Rating scales, pain questionnaires, standardized psychological tests (ex: Symptom Checklist 90, differentiates pain patients from fake ones or ppl exaggerating symptoms)

Behavioral assessments of pain

Observing behavior to assess pain. Also useful for assessing pain in ppl who cannot report themselves

Physiological measures of pain

Electromyography (measures level of muscle tension), hyperventilation measures, blood flow, heart rate, finger pulse volume.

Medical approaches to pain management

Drugs (analgesics, opiates); drugs offer effective treatment for acute pain but not chronic pain due to addiction risk; surgery (may not be effective for ppl with chronic back pain)

Behavioral treatments for pain

Relaxation techniques (effective for tension and migraine headaches); behavioral modification (shaping behavior via operant conditioning); cognitive therapy (preventing catastrophizing which worsens pain), CBT (develop positive beliefs to change behaviors), ACT, mindfulness

Traditional Chinese Medicine

Treatment approach which holds that qi/chi animates the body ad flows through meridians which connect different part of the body. If qi/chi is blocked or stops flowing, health is impaired and disease develops

What is the basis of the TCM system?  

The body is animated by qi (chi) which flows through meridians (channels which connect parts of the body to each other) and must stay in balance to maintain health. Blocked qi/chi can cause health problems & disease 

There are 2 opposing yin & yang energies. Yin is cold. Yang is hot. They must stay balanced to be healthy (but if they’re in harmony that’s better) 

What is the purpose of TCM treatments?

Imbalances are caused by physical, emotional or environmental events. Treatments are focused on unblocking or revitalizing chi and bringing yin/yang back into balance 

What are some treatments/techniques of TCM? 

Acupuncture, massage, herbal preparations, diet and exercise 

What is acupuncture?

A treatment that became known in the west in 1971 when a NYT’s journalist reported on it after receiving acupuncture in China which helped his pain. It consists of inserting needles into specific points on the skin and stimulating them continuously. 

What is acupressure?

Treatment that involves pressure instead of needles. Also for the purpose of unblocking the flow of chi/qi and restoring health 

Tui na: another massage technique to stimulate chi/qi 

How is TCM an integrated theory of health itself and a practice of medicine? 

It consists of its own system for maintaining and restoring health, has its own theories of causes of disease and treatments for disease designed to restore qi/chi and maintain the balance of yin/yang.  

What is ayurveda/ayurvedic medicine?

A system of health and medicine that is ancient to India: the goal is to integrate and balance the body, mind and spirit which are believed to be an extension of the relationship among all things in the universe. Humans are born in balance and meant to stay in balance, otherwise imbalance endangers health.  

How do ayurvedic practitioners operate?

They diagnose patients via exams (observing physical characteristics, asking abt lifestyle and behavior) then make a treatment plan (consult both patient and family) with goal of treatment being to eliminate impurities and increase harmony and balance via changes in exercise and diet.  

How is ayurveda similar/different compared to TCM?

Ayurvedic medicine also uses massaging vital points on the body to improve pain. They also use herbs and oils and spices.  

Ayurvedic medicine requires the use of changes like yoga and special diet and fasting to eliminate bodily impurities. It’s also less common in the U.S than TCM. 

What are considered “natural products”?

Supplements, probiotics and functional foods which, when suggested by physicians, are part of conventional treatment. Other natural products are considered alternative medicine. Natural products are also classified as food (evaluated only for safety, not effectiveness) for the purpose of preserving health/promoting wellness.  

What is the most common natural product supplement?

Omega-3 fatty acid supplements, meant to reduce the risk of cardiovascular disease.  

What are functional foods?

Components of a normal diet that have biologically active parts like soy, chocolate, cranberries & foods containing antioxidants.  

What are common diet plans?

Vegetarian, macrobiotic, Atkins, Pritikin, Ornish, Zone and DASH (to stop hypertension). DASH: veggies, fruits, whole grains, low-fat dairy, limited red meat & sugar & sodium. Less restrictive than others (so easier to follow) 

Why do some diets restrict meat?

Diets restrict meat in order to help people with cholesterol levels and prevent heart disease.  

What is the most common reason people diet?

To lose weight. Only 3% and lower follow special diets for health reasons.  

What are manipulative practices?

Practices to treat symptoms or disease conditions such as chiropractic treatment and massage.  

What are 2 common manipulative practices?

Chiropractic: focus on spinal alignment and joints to correct misalignments which underlie health problems. Includes: hands, machines, heat, ice, electric stimulation, rehab, dietary changes or supplements. Originally fought ag physicians but has since become part of conventional medicine. Usually for: bac, neck and headache pain 

Massage: focus on soft tissue. Alternative therapy to control stress and pain. Diff types exist: Swedish, TCM, Ayurveda, naturopathy, tui na, shiatsu.  

What is mind-body medicine?

Concept that mind and body are a dynamic system which affect health overall. Ex: meditation, tai chi, qi gong, yoga etc. Component that is common: deep, controlled breathing.  

What is meditation? (what’re different types)

A quiet location, specific posture, attention and openness. 2 types are transcendental (focus on a single thought, no distractions) and mindfulness (awareness of thoughts without judgement).  

What are common uses for mindfulness meditation?

To reduce stress, control anxiety and manage chronic disease and pain conditions. Also to help with anxiety and depression and boost the immune system 

What is biofeedback?

Controlling physiological processes. Most common: EMG (reports info to individuals allowing them to increase muscle tension in rehabilitation or decrease it in stress management). Thermal biofeedback: cool skin indicates stress, warm indicates calm. Provides info about physiology for individuals to understand and control responses.  

How is mind-body medicine effective in changing physiology?

Mind-body (meditation, mindfulness, qi gong) have the capacity to boost cognitive processing, slow brain changes, and boost components of immune efficiency.  

Why has there been an increase in usage of CAM (complementary/alternative medicine)?

In order to manage pain that is not appropriately addressed via conventional medicine.  

Most people use alternative treatment along with conventional treatments. Unresponsive chronic conditions make people more likely to seek alternative treatments  

Where/who uses CAM more?

More CAM in Australia (due to high accessibility, integrated into health care). In Europe & U.S, women were more likely than men, higher SES & education. Lower SES was more likely to use CAM when integrated into healthcare  

More likely to be female, rich and well-educated 

How is CAM dependent on factors for effectiveness?

Patients’ expectations may affect outcomes. CAM’s effectiveness can’t be assessed using randomized blind and control studies.  

How is CAM effective for treating anxiety and depression?

Evidence from studies show that mindfulness meditation is an effective treatment for managing anxiety and depression.  

A variety of alternative (CAM) medicine approaches have been shown to be effective for treating anxiety, stress and depression.  

How is guided imagery effective for controlling pain?

Studies found guided imagery decreases pain sensitivity, helps manage chronic and postoperative pain as well as pain in childbirth and pregnancy.  

How does acupuncture treat pain? 

It slows brain activity consistent with decreases in pain perception, produces complex reactions in the somatosensory system and alters the CNS neurochemistry, causing an analgesic effect comparable to analgesic drugs.  

Acupuncture is more and less effective for treating certain kinds of pains than others.  

What is Raynaud’s disease? 

A disorder involving the painful constriction of peripheral blood vessels in the hands and feet.

Why are CAM and other alternative therapies limited? 

There is a lack of information on their effectiveness due to a lack of research (not necessarily lack of effectiveness in itself).  

Therefore, alternative medicine should only be complementary to conventional treatment, not replacing it.  

However, CAM may also be inaccessible due to cost, limited number of qualified practitioners, geography etc.  

What is integrative medicine?

Integrating conventional and alternative medicine within the medical care system. It is more common in some areas of practice than others. For example, pain, cancer and mental health: integrative medicine is more common.  

What are the structures of the cardiovascular system?

The heart, arteries and veins. The heart contracts/relaxes to pump blood throughout the body, carrying oxygen to body cells and removing carbon dioxide/waste.  

How is the cardiovascular system integrated with other systems?

When healthy, the cardiovascular, respiratory & digestive systems are integrative with digestive system producing nutrients, respiratory system furnishing oxygen which circulate through body via cardiovascular system.  

What path does an oxygen-deprived red blood cell take? 

It goes from the vena cava to the right atria, then right ventricle, to the pulmonary artery, to the pulmonary vein, to the left atrium to the mitro valve. 

Blood flows from the right (atria then ventricle) to the lungs (hemoglobin gives it oxygen) 

What path does an oxygenated red blood cell take? 

An oxygenated blood cell goes from the left atrium to the left ventricle, to the arteries, then the arterioles, capillaries and finally to the cells. 

Oxygenated blood travels from the lungs back into the left (atria then ventricle) to the rest of the body. 

What is the difference between an artery and an arteriole?

Artery is larger. Arterioles are vessels of smaller diameter which receive oxygenated blood from the arteries. Capillaries are tiny & connect arteries and veins  

How does blood return to the heart (minus oxygen)? 

Oxygen diffuses out to body cells from arteries, leaving the blood which returns to the heart via the veins, beginning with tiny venules and ending w/ 2 larger veins which empty into upper right chamber of the heart.  

What is included in the term cardiovascular disease (CVD)? 

Coronary artery disease, coronary heart disease, stroke. 

What is the myocardium?

The heart muscle. Myocardial infarction: heart attack.  

What are the coronary arteries? (Why do they become damaged? How do they heal?) 

Main arteries which supply blood to the heart 

They are often damaged & under strain because of the twisting motion associated with the heart. 

It can be healed with small amounts of scar tissue (good) or by forming atheromatous plaques (bad) bc it can cause atherosclerosis (hardened plaques block arteries) 

What is arteriosclerosis?

Arteries lose elasticity which makes the system less capable of tolerating increases in cardiac blood volume=dangerous if exercising strenuously 

Why are issues with coronary arteries bad?

Because it affects the heart’s oxygen supply 

What is coronary artery disease (CAD)? 

Damage to coronary arteries (atherosclerosis & arteriosclerosis). Restricted blood supply to the heart (myocardium) 

What is ischemia?

Restriction of blood flow to the myocardium (usually caused by deposits of plaque obstructing arteries and thus blood flow) 

What is coronary heart disease (CHD)?

Any damage to the myocardium caused by insufficient blood supply. No blood supply=no oxygen, no oxygen=death of myocardial tissue/infarction (heart attack) 

What are signs of CHD?

Signs of heart attack/myocardial infarction: weakness, dizziness, nausea, cold sweating, difficulty breathing, pain in the chest 

What are outcomes of CHD?

Outcomes: damaged myocardial tissue does not repair itself, becomes scar tissue which makes heart pump blood less efficiently. This means people can’t exercise vigorously or raise heart rate at all  

What is angina pectoris?

Disorder with symptoms of crushing chest pain & difficulty breathing. Less serious than infarction 

What are treatments for angina pectoris?

Coronary bypass to replace blocked portion of coronary artery(ies) with grafts of healthy arteries 

What is angina?

Increased demand in heart, when blood supply is restricted, leads to signs of obstruction in coronary arteries (which only last a few minutes) 

What is a stroke?

Damage to the brain from lack of oxygen (similar obstruction in arteries but leading to the brain, rather than the heart). Oxygen deprivation causes brain tissue death. May be caused by a clot (more common)  May also be caused by an artery bursting (hemorrhagic)