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What is pain?

The body's response to harmful stimuli - those that are intense enough to cause tissue damage or threatened to do so
Warning signal that our well bring is being threatened


What is the Traditional Biomedical view of pain?

The extent of pain severity is directly proportional to the amount of tissue damage
Everyone with the same injury should then experience the same amount of pain
Objective definition- should be able to measure severity of injury based on


What sort of reaction of pain?

Pain is a Subjective (unique to an individual) reaction to an objective stimulus (e.g.tissue damage)
Two people with same tissue damage may experience different pain
-The way you perceive pain may say a lot more about your psychological state than about the intensity of the pain stimulus
-past experiences, state of mind, mood


What are the Theories of pain?

Gate control Theory
Classical Conditioning Model
Operant Conditioning Model
Cognitive Behavioural Model


What is the Gate control Theory?

A Biopsychosocial view
A HYPOTHETICAL mechanism called the "gate" exists at the spinal cord level which can block some pain signals while allowing others through to the brain.
The gate receives input from two directions


What are the two directions of the Gate Control Theory?

1. Ascending messages (biological in nature) - approach
2. Descending messages (psychological in nature) - managing pain


What is the Ascending Messages input in the Gate control Theory?

Biological in nature
Receptors in the skin
Are sent via peripheral nerve fibres following injury. These fibres synapse at the gate and carry pain messages to the brain


What is the Descending Messages input in the Gate control Theory?

Psychological in Natures
Related to Thoughts and Feelings
Can open or close the gate. These can include: context, interpretation, attention, past experience.


How is the patient feeling when the spinal nerve gate is "open"?

More suffering


How is the patient feeling when the spinal nerve gate is "closed"?

Less suffering


What is the Operant Conditioning?

A response to painful stimuli is withdrawal because an individual attempts to escape the noxious stimuli (e.g. moving away, not repeating the movement, removing the pain by taking painkillers) (NB- this is Adaptive with acute pain)
The result of the withdrawal behaviour is diminishment/avoidance of pain (i.e. removal of unpleasant stimulus) This serves as Negative reinforcement.
Reinforcement such as attention/sympathy from others may maintain chronic pain behaviours


What is "Withdrawal" an example of, in Operant Conditioning?

Negative Reinforcement (removal of an unpleasant stimuli) because it removes the pain. The withdrawal behaviour that led to the removal of pain is reinforced (and thus will more likely occur again)


What is the two Manners of Operant Conditioning Learning?



What does the Reinforcement aspect of Operant Conditioning Learning include?

An environmental stimulus that occurs after behaviour and INCREASES the likelihood that the behaviour will occur in the future


What are the two aspects of the Reinforcement aspect of Operant Conditioning Learning?

Positive Reinforcement - Presentation of a pleasant stimulus
Negative Reinforcement - Removal of an unpleasant stimulus


What does the Punishment aspect of Operant Conditioning Learning include?

An environmental stimulus that occurs after behaviour and DECREASES the likelihood that the behaviours will occur in the future


What are the two aspects of the Punishment Reinforcement aspect of Operant Conditioning Learning?

Positive Punishment - Presentation of un unpleasant stimulus
Negative Punishment - Removal of a pleasant stimuli


According to the Operant conditioning Model. what may maintain Chronic pain behaviours?

Reinforcement such as attention/sympathy from others may maintain chronic pain behaviours


What is a Behavioural aspect pertaining to treating chronic pain?

Didn't do anything (no active at home)
Limping, bending, leaning on her side (these are pain behaviours)
Increased exercising in the hospital
Walking test under time , repeat at end again (shows improvement + an objective way of showing her improvement (to herself))


What is a Cognitive aspect pertaining to treating chronic pain?

Explain what is going on
Realigning her thoughts
-"wasn't necessarily that the pain was greater, was more that you suffering was greater" - saw a positive change after this acknowledgement


What is the difference between Perception and sensation?

Sensation is more biological
Perception = Cognition or organisation of thoughts


What is Perception?

The process that organise information in the sensory image and interpret it as having been produced by properties of objects or event sin the external, three-dimensional worldn


What is Sensation?

The process by which stimulation of a sensory receptor gives rise to neural impulses that result in an experience or awareness of conditions inside or outside the body


What are the four reasons why we experience pain?

WARNING that our well being is threatened
PREVENTS tissue damage/avoids and or PROTECTS FURTHER damage to damaged tissue
Promotes immobilisation for HEALING (tendency to keep it still if it hurts e.g. sprained ankle)
INFORMS the individual of damage
- Contrast: Congenital Analgesia (Individual is unable to feel pain)


What does the Gate Control Theory assert?

That non-painful input closes the "gates" to painful input, which prevents pain sensation from travelling to the CNS. Therefore, stimulation by the non-noxious physical or psychological) input can suppress pain


What role did the expectations/cognitions, as well as social aspects of performance, play in managing pain for the dancer?

Expectations/Cognitions: Dancer doesn't pay attention to the pain (gate is "closed"). Mind over matter situation. Accepts that pain is normal for a dancer (inevitable)
Social: she is a Performer, her JOB is to show ballet as Enjoyable, Peaceful, Easy & Pretty, showing her pain will counteract this. Masks what she actually feels in order to be good at her job.


What is Classical Conditioning?

When one thing becomes associated with another
-e.g. Whenever the dancer hears Swan Lake music she gets the pain in her leg


What is an example of the Operant Conditioning Model of Pain?

Lower back Injury -->
Bending over Hurts -->
Avoidance of certain activities (i cant load the dishwasher) -->
You ask for more help (e.g. for household tasks, visiting GPs so taking time off work) -->
You don't experience as much pain but ... you worry that other activities may trigger the pain so you could end up living in "ever decreasing circles"


What is the Cognitive Behavioural Model?

The role of patient's appraisals and coping with strategies are of primary importance
The perception of pain is in your brain, so you can affect physical pain by addressing thoughts and behaviours that fuel it
(Think - Do - Feel)


What are the three point on the Cognitive Behavioural Model Triad?

Thoughts Feelings or emotions Behaviours of actions
(Think - Do - Feel)


What does the Cognitive Behavioural Model Triad represent?

How we think affects how we feel and how we act
Our appraisal (i.e. cognition) and coping strategies are especially important when dealing with chronic pain


When are our appraisal/cognition and coping strategies important?

Especially important when dealing with chronic pain


What is Phantom Limb pain?

Continuing to feel the presence of a limb that has been lost. The phantom Limb experience involves pain.


Is Phantom Pain uncommon?

No, it Is common. Not just war Veterans who needed amputees.
Occurs due to Birth defects, Injuries etc.


What are the Negative expectations about the controllability of pain in relation to the Cognitive Behavioural Model?

the patient sees themself as helpless


What are the Coping Strategies described in the Cognitive Behavioural Model?

Passive Coping strategy - Inactivity, and over-reaction to painful stimuli (e.g. resigns to pain meds)
Active Coping strategy- Encourages a problem solving attitude (e.g. does Mirror Therapy)


What are some Biological influences of Phantom limb?

Nerves are disrupted/ cut off due to the amputation
Our brain is biologically altered due to this amputation
Is affected by Temperature
Affect on Blood Flow


What are some Psychological influences of Phantom limb?

Sensations from patient's past experience with pain in this area Continues (get same feeling) after the amputation (even through the limb is removed)
Able to Retrain the brain to have new experiences / new feelings about the Limb which is now gone
Attitudes, Emotions, Mood and Perceptions of pain can impact your Phantom Limb experience (for +ve or -ve)


What are some Social Influences on Phantom Limb?

Feel helpless
Sympathy/Attention is Good for a little while, but then becomes negative (constant reminder + more depression)
Impacts Sexual Health - impact on relationships
Environmental Cues + Memory (+psychological) Instigates pain
Looks from other received when using Wheelchair, Crutches, Prosthetic Limb
Impacts ability to keep working (builder with no arm) --> and therefore Financial Strain
Causes Lifestyle Change
Makes the pain Last Longer due to everything else alongside it