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Flashcards in Health Psychology Final Exam Deck (123)
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1

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 

2

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"

3

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)

4

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)

5

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)

6

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

7

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 pain...world gets very small
  6. financial implications if leave job - depression (less motivated, helplessness)

8

Neurotic Triad

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

9

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

10

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

11

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

12

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)

13

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

14

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)

15

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)

16

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

17

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

18

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

19

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

20

Video: Seattle Burn Victims

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

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)

22

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

23

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

24

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

25

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)

26

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

27

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

28

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

29

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

30

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