Health Psychology Final Exam Flashcards
1
Q
Definition Pain
A
- 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
2
Q
Reasons we need pain
A
- survival - feedback to protect muscles, skin, organs
- Acute pain - goes to motor part of brain to tell us to withdraw
- Good way to learn what not to do - from the “pain experience”
3
Q
Why we study pain
A
- Most prevalent reason to seek health care (80%)
- Most common disability
- Economic effect on society - work absence, lost productivity
- Low QOL - contributes to suicide rate (chronic pain)
4
Q
Acute / Chronic Pain Def.
A
- 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)
5
Q
3 types Chronic Pain
A
- Chronic-intractable-benign: relatively unresponsive to treatment, not malignant, deadly or progressive (e.g. organ damage, low back pain)
- Chronic progressive: increases in severity, can be deadly or degenerative (rheum. arthr., cancer)
- Chronic-recurrent: intermittent (migraines, tmj, trigeminal neuralgia - suicide disease)
6
Q
4 Aspects Chronic Pain
A
- Pain control not too effective - need individualized / multidimensional approach(often undermedicated)
- Widespread effects: interferes with daily life, world becomes very small
- Interplay: physio, psycho, social and behav
- Psych profile: high anxiety, hopelessness
7
Q
Pattern of chronic pain
A
- develop the pain
- wait it out
- try somethings you think might work
- go on short term medication (NB: still motivated)
- if not working start to avoid anything think will cause the pain…world gets very small
- financial implications if leave job - depression (less motivated, helplessness)
8
Q
Neurotic Triad
A
- high hypochondria
- depression
- hysteria (if interpreting body signals wrongly)
9
Q
Video: Artist (Biopsychsoc)
A
- 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
10
Q
Nociceptors and Pain
A
- 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
11
Q
Gate Control Theory of Pain
A
- 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
12
Q
Cognitive thoughts & Gate Control
A
- Expectations: how you think about the pain
- Catasrophizing: rumination, magnification - will open gate and make the pain worse
- Interpretation: meaning given to the pain - determines how it is experienced (soldiers)
- Distraction: works but not long term
- Context: inward vs outward focus - sports
- Treatment: e.g. dentist hides stuff to lower expectation of pain plus headphones to distract
- Anxiety: link to all - i.e. if expect pain and interpret pain as worse will increase anxiety so gate open)
13
Q
Video - Jonathan and Arm
A
- 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
14
Q
Pain Behaviors
A
- Facial / audible expressions
- Distorted movement / posture (limp, hold stomach)
- Negative affect: mood, irritation, anxiety, depression
- 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)
15
Q
Endogenous Opioids and Pain
A
- 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)
16
Q
Assessing Pain - Self Report
A
- 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
17
Q
Assessing Pain - Behaviors
A
- 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
18
Q
Biodmedical Approach Pain Management
A
- 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
19
Q
Overprescription for Pain
A
- 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
20
Q
Video: Seattle Burn Victims
A
EXAM
- 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
21
Q
Pain Management - Cognition
A
- 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)
22
Q
Pain Management - Behavioral
A
- 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
23
Q
Stimulation Therapies
A
- 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
24
Q
Pain Management Programs
A
- 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
25
Q
Chronic Health Condition: Definition
A
- 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)
26
Q
Functional Somatic Syndromes
A
- 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
27
Q
Video: Chronic Fatigue
A
- 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
28
Q
Denial and Chronic Health Issue
A
- defense mechanism - avoid implication of illness
- can work in short term - protective - slow you down while come to terms
- later: can interfere
29
Q
Anxiety and Chronic Health Issue
A
- 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
30
Q
Depression - Chronic Health Issue
A
- 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
31
Q
Crisis Theory
A
- Illness-related factors:
- disabling, disfiguring, painful, life-threatening
- annoying or embarrassing bodily changes
- side effects of treatment - e.g. erectile dysfunt.
- Background & personal factors: personality (resilience), age (young - inconvenient, teen - impact social life and acceptance), gender (men- not good re support grp or disability /self image)
- Physical and Social Environmental Factors
- physical setting (hospital or home) - stairs? need hospice? long term hospital care?
- Social support: stigmas, relationship issues, need others who see it as manageable
32
Q
Tasks
A
- Go to doctor a lot, relationship with healthcare team
- adjust to hospital, procedures and regimen
- Cope with the symptoms or disability
- Control negative feelings - maintain positive outlook
- Prepare for an uncertain future
- Maintain satisfactory self-image & sense of competence & preserve good relationships (i.e. positive psychosocial functioning) - not feel dependent
33
Q
Maintaining Positive Self-Image
A
- Includes body image, achievement, social functioning and the private self
- Attractiveness
- Evaluate self-concept as good / bad (the “I am”)
- Chronic illness can produce drastic changes in how we view the “self”
- e.g.: “I am in a wheel chair” “I am no longer a sexual being”
34
Q
How to Improve Negative Self-Image
A
- Body image can be restored if possible (no burns)
- Body image improved by stressing other aspects of health - re-evaluate how much weight we put on our physical appearance & focus on other aspects of the self to maintain a positive self image
35
Q
The Achieving Self
A
- Achievement through vocational and personal goals
- study of spinal cord injury ppl and their personal projects list (result: those who were depressed never changed their projects but held onto them hoping…those who were doing better modified their goals to “possible” ones or replaced them with something meaningful)
36
Q
The Social Self
A
- Social interactions are critical aspects of self-esteem
- worry that others will not support (especially if want to talk about the illness, not sure what else to say)
- if stigmatized illness (neck cancer) hard to rebuild social identity
- isolate to protect the self-esteem
37
Q
Illness as Positive
A
- some find benefit - e.g. “wake up call”
- become more present in life, value people more and simple things, can be easier on the “self”
- can see the illness as a challenge (leukemia video where the guy said it made him a better husband, person, father - softened him) - small stuff np
38
Q
Coping Strategies CHC
A
- Denying or minimizing - Passive
- Seeking info - Active
- Learning to provide one’s own medical care - Active
- Setting concrete, limited goals (doable projects) - Active
- Recruit instrumental and emotional support - Passive
- consider possible future events (& prepare for them)
- Gain a manageable perspective
39
Q
Control Related Beliefs
A
- Control-related beliefs: (will power, compliance, good health habits and self-treatment) - may cope better in the long run and experience less distress
- BUT: if there really IS low control and try to control it, it could backfire….(e.g. try use diet for Stage 4 cancer) so:
- focus on aspects that are controllable which may facilitate better judgement
40
Q
Realistic View
A
- MUST develop a realistic view of the illness in order to cope effectively
- ALL require some change / alteration of activities
-
If not realistic:
- non-adherence to treatment program
- improperly attuned to signs of disease
- engage in behaviors that pose a health risk instead of those that could make it better
41
Q
Self-Blame as Coping
A
- When is self-blame accurate (possibly):
- Diabetes type II
- Obesity
- Heart Disease
- Lung Cancer - if was smoker
- Can be good if it leads to you making positive changes and not blaming others (or non-adaptive - e.g. “oh well I already had one” re smoker and heart attack so no desire to quit)
42
Q
Quality of Life (QOL)
A
- attributes valued by patients including:
- comfort or sense of well-being
- exent to which they are able to maintain reasonale physical, emotional, social and intellectual cognitive functioning
43
Q
QOL Assessments
A
- change in symptoms is not necessarily linked to improved quality of life
- assess: physical, psychological and social function/ disease or treatment related symptomology
- how much the disease and treatment interferes with daily living activities
- advanced disease: functional : (bathing, dressing, toileting, mobility, eating etc.)
44
Q
Why Study QOL?
A
- CHC impacts psychological health (depression, anxiety, panic)
- Psychological distress increases risk of mortality
- Aim to reduce stress levels & manage stressors that can’t be eliminated
- can help to design interventions
- can pinpoint which problems are likely to emerge for each CHC population
- help to measure impact of treatments/interventions
- compare quality of treatments
45
Q
Comorbidity and QOL
A
- Additive impact on QOL (if more than one CHC)
- more complex management of the condition
46
Q
Diabetes Mellitus
A
- Chronic endocrine disorder in which the body is not able to manufacture or properly use insulin
- Insulin (pancreas) binds to receptors on cells to let the glucose in the cell (for energy) & otherwise the glucose accumulates in the blood (hyperglycemia)
- cells think starving, alert body to eat more, then sugar rises even more
- 6.8% Canadian population
- higher for men, increase with age highest FN reserve
47
Q
Type 1 Diabetes
A
- Type I - insulin dependent diabetes mellitus
- normally develops in childhood
- cells on pancreas destroyed
- need insulin injections
- vulnerable to hyperglycemia and ketoacidosis (high fatty acids in blood - no glucose so cell burns fat as energy - kidney malfunction cuz can’t rid all waste/fat so accumulates in body and poisons it - can be fatal )
48
Q
Type II Diabetes
A
- Non-insulin dependent diabetes
- Pacreas produces some insulin but body resists the action of the insulin
- managed usually through diet and meds
- usually develops after 40
49
Q
Causes Type II Diabetes
A
- Insulin resistence - cell receptors no longer respond
- producing so much insulin (eat too much sugar) so receptors bombarded and get desensitized THEN pancreas thinks needs more insulin to use up extra glucose so balance off & insulin producing cells stop
- Usually diets high in fats and sugars, stress OR
- overprod. of protein that impairs metabolism of sugars and carbohydrates
- Risk: obesity, sedentary, male, low SES, older, smoking
