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Flashcards in Health Psychology Final Exam Deck (123)
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Definition Pain

  • Unpleasant sensory and emotional (huge component) experience associated with actual or potential (maybe have not assessed it yet) tissue damage or described in terms of such damage 


Reasons we need pain

  1. survival - feedback to protect muscles, skin, organs
  2. Acute pain - goes to motor part of brain to tell us to withdraw
  3. Good way to learn what not to do - from the "pain experience"


Why we study pain

  1. Most prevalent reason to seek health care (80%)
  2. Most common disability
  3. Economic effect on society - work absence, lost productivity
  4. Low QOL - contributes to suicide rate (chronic pain)


Acute / Chronic Pain Def.

  • Acute pain: temporary - less than 3 month
  • Chronic pain: more than 3 months or "longer than expected" (also: chronic pain has no "protective function" - no purpose for the pain, can't do anything)


3 types Chronic Pain

  1. Chronic-intractable-benign: relatively unresponsive to treatment, not malignant, deadly or progressive (e.g. organ damage, low back pain)
  2. Chronic progressive: increases in severity, can be deadly or degenerative (rheum. arthr., cancer)
  3. Chronic-recurrent: intermittent (migraines, tmj, trigeminal neuralgia - suicide disease)


4 Aspects Chronic Pain

  1. Pain control not too effective - need individualized / multidimensional approach(often undermedicated)
  2. Widespread effects: interferes with daily life, world becomes very small
  3. Interplay: physio, psycho, social and behav
  4. Psych profile: high anxiety, hopelessness


Pattern of chronic pain 

  1. develop the pain 
  2. wait it out 
  3. try somethings you think might work
  4. go on short term medication (NB: still motivated)
  5. if not working start to avoid anything think will cause the gets very small
  6. financial implications if leave job - depression (less motivated, helplessness)


Neurotic Triad

  1. high hypochondria
  2. depression
  3. hysteria (if interpreting body signals wrongly)


Video: Artist (Biopsychsoc)

  • Bio: chronic pain from a stroke, sharp pains body
  • Psych: felt "cut in half", "never going away", stuck and frustrated
  • Soc: tries to hide it from friends so not complainer
  • Work? Less mobility, can't do same things


Nociceptors and Pain

  • nerve endings that respond to pain stimli & injury
    • A delta: small, myelinated fibers that transmit sharp pain- resp to heat/cold/mech - knife
    • C-fibers: unmyelinated, dull or achy pain, longer lasting - more likely to affect mood
    • A-beta: suppress effect of aching pain or experience of pain


Gate Control Theory of Pain

  • A-delta and C fibres signal transmission cells with Substance P to send the signal to the brain - notify brain of the pain
  • a "neural gate" can open or close to let those signals through (in spinal cord) - so can modulate the pain
    • intensity of pain - high might open
    • if other peripheral fibres activated (ABeta - pinch somewhere else) might not open
    • Message from brain: might not open
  • Signals that descend from brain (cognition) can also modulate pain


Cognitive thoughts & Gate Control

  1. Expectations: how you think about the pain
  2. Catasrophizing: rumination, magnification - will open gate and make the pain worse
  3. Interpretation: meaning given to the pain - determines how it is experienced (soldiers)
  4. Distraction: works but not long term
  5. Context: inward vs outward focus - sports
  6. Treatment: e.g. dentist hides stuff to lower expectation of pain plus headphones to distract
  7. Anxiety: link to all - i.e. if expect pain and interpret pain as worse will increase anxiety so gate open)


Video - Jonathan and Arm

  • His cognitive decision-making part of his brain (needed to get out -did not want to die there) closed his pain gate and he then was flooded with natural painkillers (endogenous opioids)
  • takes all areas to generate a "pain experience" - emotion, sensory, motivational and decision-making, attentional networks
  • John: used "interpretation" - meaning was about survival and how his death would impact his loved ones - led to less anxiety and lower pain


Pain Behaviors

  1. Facial / audible expressions
  2. Distorted movement / posture (limp, hold stomach)
  3. Negative affect: mood, irritation, anxiety, depression
  4. Avoidance of activity: (that could cause pain)

Note: if these are reinforced they may bring on more pain, more disability. Why reinforce? secondary gains, disability cheques, spouse or other creating dependency - operant conditioning (often person not even aware doing it)


Endogenous Opioids and Pain

  • SPA - stimulation produced analgesia: stimulate periaqueductal grey - substance P blocked by inhibitory interneurons
  • interneurons: cause release of the endogenous opioids
  • chronic pain patients can have an impaired endogenous opioid system 
  • endogenous opioids good for short term - get away from the acute pain - but not good for long term as need pain to survive (protective)


Assessing Pain -  Self Report

  • Interview method: get sensory experience of pain, how person coping, how feel about it - subjective
  • Scales / Diaries: 
    • Visual analogue: mark a line - good little kids
    • Box scale/numeric rating: choose number 1-10
    • Verbal rating scale: choose word/phrase
    • Questionnaire: McGill Pain Q.
      • affective, sensory and evaluative
      • need good command English - age? immigrent? Could be discriminative


Assessing Pain - Behaviors

  • Clinical: patient performs activities, rate mobility (watching for pain behaviors)
  • Home: family rates patient doing everyday things - time, trigger, pain/no pain, see if any reinforcement of spouse
  • Psychophysiological measures:
    • EMG - tension in muscles (not great tool)
    • Auntonomic: HR - inconsistent
    • EEG - spikes and surges from acute pain

Still need to supplement with self-reports for accuracy


Biodmedical Approach Pain Management

  • Surgical - radical (i.e. disconnect part of PNS or spinal cord), synovectomy (remove inflamed membranes), spinal fusion - all risky and little long term relief
  • Pharmalogical: most common, 1st line defense
    • OTC drugs
    • local freezing
    • central - morphine, opiates 
    • indirect (antidepressants - improve mood)
    • not always effective, can be addictive, side effects


Overprescription for Pain

  • now have guidelines of list of recommendations that are supposed to be followed prior to prescribing opiates (therapy, physical therapy, meditation, anti-depressants etc.)
  • When accepted? Cancer patients


Video: Seattle Burn Victims


  • people got anxious during burn bandage changes  - the tools created high anxiety, amplified the pain
  • gave patients a "place" to escape from the pain (to grab their attention and distract)
  • Sent them into a "virtual snow world" - played a game, lots action so focused on that and then oblivious to activity in hospital room 
  • 50% reduction in pain acivity


Pain Management - Cognition

  • cognitive restructuring: create more helpful and positive cognitions - increase effective and active coping efforts
  • Active coping: 
    • Distraction & Attention - dentist example- focus on non-pain stimulus - divert attention from pain (better for moderate pain)
    • Non-pain imagery - more senses put into it the more attention grabbing & imagery should be incompatible with the pain (g: moderate pain)
    • Pain redefintion: substitute realistic thought - "you can handle this" "there are benefits to this", increase self-efficacy
    • Mindfulness: can be used any time - so focus only on the pain and nothing else to be with it and not judge it (remove emotion and cognit)


Pain Management - Behavioral

  • Operant conditioning: reduced pain reports, can revert if (e.g.) getting disability cheques
  • Fear reduction: desensitization - good to decrease catastrophizing, fears & increase activity
  • Relaxation/Biofeedback: good for migraines, reduced by 40-50%, best results combined with relaxation


Stimulation Therapies

  • Counter-irritation - reduce one pain by creating another
  • TENS - used A Beta fibres to decrease pain
  • Accupuncture: needles- distract or direct attention from pain, maybe peripheral fibres close gate


Pain Management Programs

  • GOAL: decrease drug use & use of medical services, lead meaningful life (even with pain) and enhance social support
  • proven effective
  • Educates:
    • about the pain
    • how to reduce pain
    • improve sleep, decrease depression
    • relapse prevention
    • family involvement


Chronic Health Condition: Definition

  • Long term health condition that is managed but not treated or cured (Tertiary Prevention) and that impacts daily physical, emotional and social functioning - QOL
  • 3 out of 5 Canadians have one
  • 1/3 adults 18-44 have at least one
  • most of us will get and die from one (2/3 deaths)


Functional Somatic Syndromes

  • NO tissue abnormality but suffering and disability
  • overlap in symptoms (fatigue, pain, sick-role behavior, negative affect - mood, depression, muscle soreness..)
  • Uncertain etiology: diagnosis of exclusion


Video: Chronic Fatigue

  • Emotional impact: felt in cage, jealous friends, lonely
  • Social impact: no pubs, bars, no school, can't initiate social interactions, can't be with friends
  • Biopsychosocial: family impact (table for 3 not 4), impact on marriage, like a bereavement)
  • Cognitive restructuring: better than before and does not focus on the "walls or door" - cage thing


Denial and Chronic Health Issue

  • defense mechanism - avoid implication of illness
  • can work in short term - protective - slow you down while come to terms
  • later: can interfere


Anxiety and Chronic Health Issue

  • lack of info, waiting for procedures and test results, side effects etc.
  • overwhelmed by potential change to life, or death
  • overly vigilant re physical changes
  • can exacerbate symptoms - create stress, pain


Depression - Chronic Health Issue

  • Common, long term reaction
  • mostly if unpredictable and progressive illness
  • some higher risk: functional somatic syndromes
  • medical fallout:
    • more pain and disability
    • exacerbates risk / course of disease
    • reduced treatment adherence
    • assessment not easy cuz symptoms overlap