The psychology of pain

Question 1

What are some features of pain?

Answer 1

Is a perception
Is aversive and unpleasant
Is a signal for action, informs the brain of tissue damage or potential tissue damage

Question 2

What are the different components of pain?

Answer 2

Sensory - we feel it, a stimuli detected by receptors
Affective - changes our moods, feeling and attitudes
Cognitive - changes our ability to think logically and clearly
Motivational - causes us to do something, e.g move hand away from the fire

Question 3

Why do we have pain?

Answer 3

Feedback to adjust the positioning of the body
Warning sign resulting in protective behaviour
Triggers help seeking behaviour
Psychologically can generate fear and anxiety

Question 4

What are the differences in how and psychologist or a doctor might perceive pain?

Answer 4

Psychologist - pain is a sensory phenomenon varies on perception, behaviour during pain is learnt or conditioned
Doctor - pain is a warning sign that something is wrong in the body, a biological error.

Question 5

What is the prevalence of pain?

Answer 5

Chronic pain affects 13-50% of adults in the UK
10-15% of those with chronic pain have moderate to severe disability as a result of their pain
15-22% of all GP appointments are for pain, 10% of all prescription are for pain

Question 6

What are the three different types of pain?

Answer 6

Acute pain - time sensitive, identifiable injury, reduced with healing, associated with increased action from the SNS
Pre-chronic pain - develops at the critical time period when a person should be recovering and pain decreasing, but they still have the potential to not heal and may become chronic pain. Begin to loose hope of getting better
Chronic pain - time for normal healing has elasped but pain continues, often no identifiable tissue damage, no SNS activity, dull with not specific time and location. Often develop anxiety and depression

Question 7

What is the pain pathway?

Answer 7

The route of parallel neurones that carry pain from the receptor in the periphery to the dorsal horn in the spinal cord to the brainstem then the CNS.
Consists of transduction, transmission, modulation and perception.

Question 8

What is meant by pain transduction?

Answer 8

When a painful signal is started from a receptor detecting a stimuli and generating an action potential.
Three types of primary afferents:
1) A-beta = touch
2) A-delta = pain and temperature
3) C-fibres = pain, temperature and itch

Question 9

What are nociceptors?

Answer 9

Receptors in the skin and organs that sense heat, mechanical and chemical tissue damage
Associated with detecting pain

Question 10

What is nociception?

Answer 10

The process of percieving pain

Question 11

What is mean by pain transmission?

Answer 11

When secondary afferent fibres carry pain signals to the dorsal horn in the spinal column
1. A delta fibres - fast, sharp and well localised pain - often acute pain
2. C-fibres - duller, slower onset and poorly localised pain - often chronic pain

Question 12

What is the modulation of pain?

Answer 12

Part of the descending pain signal - inhibits, dampens or amplifies pain related neural signals
Related to the pain gate in the dorsal horn, to stop nociceptive signals

Question 13

What is the gate control theory?

Answer 13

Proposed by Melzack and Wall (1965)
The idea that a neural ‘gate’ in the spinal cord regulates the perception of pain
Therefore pain is not the result of a straight through sensory channel
The pain gate can be controlled by physiological and psychological causes.

Question 14

What is meant by descending central influences in the pain gate theory?

Answer 14

The brain sends information to the dorsal horn pain gate related to emotions, behaviour and past experiences to alter our perception of pain.
Can cause the brain gate to open - more pain, or the pain gate to close - less pain.

Question 15

What is the biomedical frameworks early theory of pain?

Answer 15

Pain is an automatic response to an external factor
Tissue damage causes pain
Pain has a single cause
Psychological factors have no influence over pain

Question 16

What are the two types of pain in the biomedical framework?

Answer 16

Organic pain = ‘real pain’, clear injury causing pain
Psychogenic pain = ‘in the patients mind’, no biological source of pain can be found

Question 17

What understanding meant psychology started to be involved in pain theories?

Answer 17

Medical treatments for pain were mainly only useful for acute pain
Same degree of tissue damage can cause different experiences of pain in different people
Phantom limb pain in 65-85% of amputees

Question 18

What is meant by pain perception?

Answer 18

The conscious awareness of pain
Controlled by small myelinated A-delta fibres and non-myelinated C fibres
Chemicals released from injury directly stimulate or sensitize nerve endings
How we perceive pain is a combination of transudction, transmission, modification and psychological and personal factors.

Question 19

How does the Gate Control Theory of pain differ from earlier models mainly the biomedical model of pain?

Answer 19

According to the GCT pain is a perception not a sensation
The individual is active in interpreting and appraising pain, is not passive in the magnitude
Variations in pain between individuals is due to the closing and opening of the pain gate
Many factors, not a singular cause, influence the magnitude of pain

Question 20

How does the Gate control theory of pain undermine the mind body dualism biomedical theory?

Answer 20

GCT suggests pain is an interaction of the physical injury to the body and the psychological appraisal and modification in the mind
Hence the mind and body are not separate as both influence our feeling of pain.

Question 21

What can cause the pain gate to open?

Answer 21

Physical factors - injury, activation of fibres C/ A sigma
Emotional factors - anxiety and worry
Behavioural factors - boredom or focusing on the pain

Question 22

What can cause the pain gate to close?

Answer 22

Physical factors - medication, other stimuli, ABeta fbres
Emotional factors - excited, happy, meditation
Behavioural factors - distraction, engrossed in something else, extroverted

Question 23

How does personality relate to pain?

Answer 23

Chronic pain sufferers test higher for hysteria and hyperchondriasis.
Often suffer from more anxiety and depression

Question 24

How does conditioning affect the perception of pain?

Answer 24

Reinforces or changes the belief that something is painful.
Classical conditioning - involuntary response with a stimuli, dentist and pain last time you went
Operant conditioning - children stickers at the end of the dentist, less painful as associates a voluntary trip to the dentist with a reward.

Question 25

How does cognition affect pain?

Answer 25

Catastrophise pain by ruminating and feeling helpless
Meaning - gives pain meaning, I’m going to die etc
Attention - Distraction reduces pain

Question 26

What is the fear avoidance model of pain?

Answer 26

That when we experience pain if we go ahead with no fear around it we will confront the cause and recover
However if we have fear of pain, hence avoid activity such as physiotherapy, chronic pain is more likely to develop, due to disuse and depression

Question 27

What role does emotion have with pain?

Answer 27

Commonly feel anxiety, fear and depression, These are generated by pain and also make pain worse.
Anti-depressants can decrease pain.
May also feel aggressive, guilt or pleasure.

Question 28

What is meant by secondary pain gain?

Answer 28

When patients alter their behavioural response to pain so they appear to be in more pain or to not recover.
As a result they get something they wanted e.g sympathy, money or time off work.

Question 29

Give some examples of how behaviour can negatively or positively affect pain?

Answer 29

Negative - avoidant coping stratergy, does not go to doctors, injury does not heal correctly acute pain develops into chronic pain
Positive - patient complies with physiotherapy injury heals faster and easier, acute pain resolves

Question 30

What is meant by the viscious psychological circle of pain?

Answer 30

Patient in pain
Patient is fearful and anxious of pain
Influences behaviour (sleepless) and pain perception
Pain does not resolve.
Loses faith in the doctor, treatment and self.
Appraisal of pain increases the perception of pain more likely to become chronic.

Question 31

What are some examples of psychosocial factors influencing pain?

Answer 31

Age
Gender
Beliefs around medication (cultural)

Question 32

How does age influence pain?

Answer 32

Older people tend to experience more pain, have less tolerance to pain.
May be biological, may be loss of coping strategies or societal views meaning pain in elderly is not taken as seriously so less effective treatment is given.

Question 33

How does gender influence pain?

Answer 33

Women report more frequent and worse pain
Some anaglesics are more effective in women than men and vice versa
Difference appears in adolescence - stereotypes around gender.

Question 34

What is meant by pain as an interpersonal construct?

Answer 34

The experience of pain depends on how the person in pain is still able to interact with others, both in their family and within their local society.
How society creates ideas around pain and how this influences how a person in pain behaves and thinks about themselves.

Question 35

What is the opiod prescription crisis?

Answer 35

US death rate from durg overdoses using opioids more than tripled between 1999 and 2017.
Higher rates of suicide and overdose associate with opioids meant the US life expectancy started to decline
Pressure to reduce the prescription of opioids to reduce the amount in circulation

Question 36

What is the rubbish life syndrome?

Answer 36

Also known as diogenes syndrome
Often hoarding, poor personal hygiene and isolated lifestyle
Higher reports of chronic pain.

Question 37

What are some psychogenic ways to manage pain?

Answer 37

1) Placebo - release endorphins
2) Hypnosis - alters perception of pain
3)Stress - cortisol, opioids
4) Cognitive - endorphins
These are often limited for severe pain. Endorphin release can be counter acted by opioid antagonists. Hypnosis and stress as not always considered ethical.

Question 38

What are some stimulation methods of controlling pain?

Answer 38

TENs
Acupuncture
Central Gray

Question 39

How does TENs relieve pain?

Answer 39

Electrical stimulation of large fibres blocks or alters pain signals to the brain
Must be applied at the site of pain

Question 40

How does acupuncture relieve pain?

Answer 40

Blocks pain signals to the brain or activates large fibres
Sometimes less effective when on opioid antagonists

Question 41

How does central grey relieve pain?

Answer 41

Electrical stimulation activates endorphin release, can be controlled by opioid antagonists.

Question 42

What are some surgical ways to relieve pain?

Answer 42

Cut periphery nerve cord
Rhizotomy (cut connection to the dorsal horn)
Cord hemisection
These physically break the pain pathway
Frontal lobotomy - removing white matter in the frontal lobe
These can have significant consequences if not performed correctly, can effect other neural functions and behaviour.

Question 43

What is operant based therapy to treat pain?

Answer 43

Aims to stop maladaptive behvioural responses and start adaptive responses
Alters the association between threat of pain and physical behaviour
Uses reinforcement of punishment to change behaviour
Good for: whiplash, complex regional pain and chronic lower back pain

Question 44

What is cognitive based therapy to treat pain?

Answer 44

Involves psychoeducation, relaxation, behavioural pacing and changing cognition.
Aims to change the way you think and behave based on talking therapies, create a more realistic appraisal of pain
Effective in patients with chronic or continuous pain, these patients are more likely to have negative thoughts to change.

Question 45

What conditions is CBT often used to treat pain in?

Answer 45

Cancer
Complex pain syndromes
HIV/AIDs
Fibromyalgia
IBS

Question 46

What are some methods of psychological pain management?

Answer 46

Operant based therapy
Cognitive based therapy
Mindfulness based therapy
Acceptance and commitment therapy

Question 47

What is the relationship between stress and pain?

Answer 47

Psychogenic pain - when physical pain is linked to stress
Those suffering from chronic pain have a disregulate HPA axis, more likely to suffer from chronic stress
Muscle tensing and inflammation can increase pain.

Question 48

What are some stress reduction methods to decrease pain?

Answer 48

Progressive muscle relaxation
Deep breathing
Meditation
Aims to decrease activation of the SNS, reduces the chance of chronic inflammation and autoimmunity

Question 49

What is acceptance and commitment therapy?

Answer 49

Based on developing psychological flexibility
Aims to get people to accept mental events/pain in order to avoid mal-adaptive coping mechanisms.
Often used for musculoskeletal pain and whiplash associated disorders.