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Lecture 6

PSY333H1 Lecture 6

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University of Toronto St. George
Lisa Lipschitz

PSY333H1F L6 Oct 17, 2013 o Fixable problem (short-term treatment will help, more optimistic, feel less pain) Ch. 10: Pain & its Management  vs. debilitating condition (report more pain)  Midterm next wk: o Beecher’s example of soldiers (25% asked for morphine o 60-70 MC Qs less often due to life experiences, grateful that they are alive)  From lecture & textbook  Don’t need to know about sleep, eating  vs civilians (80%) disorders (on the next midterm, we will o Sports injuries have a lecture on this) from Ch 4  Pain is secondary o 4-5 Short answers (~1 paragraph, can use pt form) o People who blame themselves experience more pain  From lecture o People who perceive a benefit resulting from the  Can use diagrams if you want to help explain experience of pain perceive the pain less intensely your point Pain has a substantial cultural component What is the Significance of Pain?  No ethnic or racial differences in the ability to discriminate  Congenital Insensitivity To Pain (Analgesia) painful stimuli o Rare genetic disorder (from birth) from gene mutations  Different norms about what types of experiences are painful & o Inhibits the ability to perceive pain or lack appropriate how much pain is appropriate to express response (ex. No motor response)  Members of some cultures report pain sooner & react more  Experience serious injuries w/o any awareness intensely to it o Broken bones, bitten tongues, cuts, burns, eye damage, o Ex. Certain cultures view pregnancy more (+)vely feel less pain & feel it later than compared to cultures that infections o Ex. Very stiff since don’t adjust oneself in a chair think of it as painful  Die at a relatively young age due to health problems that could  Ex. Bates et al. (1993) have been treated if they were able to heed the warning signs that pain provides o 372 patients w chronic pain (physical) o So pain is useful for us o Hispanics, Italians, Polish, & those whose families lived  Causes: increased production of endorphins in the United States for generations  Mutations of genes o Hispanics & Italians:  reported experiencing the most pain, worry, anger, and tension  Sharp pain, dull ache  The International Association for the Study of Pain  perceived their pain as interfering more defines pain as: o American and Polish patients: o “an unpleasant sensory & emotional experience  felt they should suppress their experiences of pain associated w actual or potential tissue damage, or described in terms of such damage”  less expressive and emotional about their pain  Often experience minor pain, which provides us w feedback Learning about bodily fn’ing  Acquire attitudes & bhvrs by watching those around them  Pain is a significant aspect of illness because it is the symptom Rickard (1988) found that teachers rated the children of chronic pain patients as displaying more illness-related bhvrs of chief concern to patients & leads them to seek medical attention (complaining, whining) & visiting the nurse more often than o Pain is often considered of secondary importance to other chidren  Gaining attention, missing school practitioners  the link between pain & the underlying problem o Operant conditioning: (+)ve reinforcement; more can be weak attention from parents  Change report depending on who one is talking to  Pain is psychologically significant: o Patients fear pain in illness & treatment most o Study: If females thought they were talking to their   avoid treatments out of fear of pain husbands on the other side of the wall, and thought their husbands are sympathetic  more expressive of o Depression & anxiety increase the experience of pain their pain  $4 billion is spent annually in Canada on over-the-counter  Speak to unsympathetic husbands  report less pain medications pain o Main ppl experience it & are trying to find relief  Block et al. (1980): found that ppl who receive financial o Almost everyone has the experience of pain benefits for experiencing pain report having more pain & find pain treatments less effective o Since the benefit is getting money for sick leave Why is Pain Difficult to Study?  A variety of factors can contribute to how pain is interpreted o Less motivated to make the treatment work (less  Individual differences resilience) o Depends of personality, motivation – depends if you  Pain is heavily influenced by the context in which it is experienced want to get off sick leave  Heavy psychological component (cognitions) to the  Ppl learn to avoid certain activities based on their fear that engaging in a particular bhvr will lead to pain interpretation of pain o May or may not be good depending on the situation  Somatoform Disorders Gender differences o Presence of physical symptoms that suggest a general  Stereotype: women more sensitive medical condition & are not fully explained by a general o Adoption of male & female gender roles medical condition  There are difs between men & women regarding the o Ex. one might experience chronic back pain but can’t emotional processing of pain find any medical cause  Women experience a variety of recurrent pain  Somatotization Disorder o Polysymptomatic disorder that begins before age 30 yrs, extends over a period years Coping Styles  Pain catastrophizing (making it much bigger, making o Characterized by combo of pain, gastrointestinal, outcomes bigger, ruminating) sexual, & pseudoneurological symptoms in different areas of the body o vs resilience (focus on overcoming, feel less pain)  Higher levels of anxiety or have (-)ve thoughts experience or o Ex. headaches, chronic back pain, impotence, nausea, report more pain diarrhea, bowel irritation o More Diagnostic Criteria: Results in medical treatment  Self-efficacy, Perceived ability to cope  more likely to experience less pain or causes significant impairment Personality Somatoform Disorders  People who experience chronic pain are more likely to have an  Pain Disorder anxiety or depressive disorder o Pain is the predominant focus & causes significant  Those w IBS score higher on measures of neuroticism & have distress o Psychological factors play a role higher rates of major depression, pain disorder, and agoraphobia o No general medical condition behind it  Extraverted people are more tolerant of pain & have higher  Ex. have back pain but there is no medical reason for it (after having been tested) pain thresholds than introverts  People w strong internal locus of control believe they have o Decreases quality of life, increases rate of stress control over their pain & cope more effectively  Hypochondriasis o Excessive preoccupation w fears of having a serious Stress illness based on a misinterpretation of 1 or more bodily  Those who report low job satisfaction, poor relationships w signs or symptoms o No matter how minor the symptom may be, they are coworkers, and stress at work are more likely to have chronic pain convinced that they have or are about to be diagnosed  Conflicts w others are associated w the development of ulcers w a serious illness o (-)ve stigma talking about this (painful condition) o Physical tests to rule out illness  cognitive-bhvr’al  Those experiencing high stress are more likely to report having frequent headaches therapy, acceptance therapy  Increase in IBS symptoms (irritable bowel syndrome) Measuring Pain  Tensing muscles all the time (w/o noticing) o  jaw problems, grinding teeth  One barrier to the treatment – difficulty ppl have describing it objectively  Stop taking care of self (ie. eating properly, exercise)  Pain threshold: the pt at which the intensity of a stimulus is Emotional Pain perceived as painful  Pain tolerance: duration of time or intensity at which a person  Social rejection can be painful (similar to physical pain) is willing to endure a stimulus beyond the pt where it began to  The human brain reacts in similar ways to emotional & physical pain (anterior cingulate cortex & right ventral hurt  Most ways to measure pain are Verbal reports prefrontal cortex) o Possible solutions to this problem are to draw on the  Social exclusion affects brain activity in a similar way that physical pains does large, informal vocabulary that ppl use for describing pain (throbbing vs shooting) or by using a pain o Ex. playing video game w 2 made-up ppl  reject you questionnaire (ex, McGill Pain Questionnaire, Ronald from the game  DeWall et al. (2010) Melzack,1971):  Helps ppl to describe the pain, show where it is, o Randomly assigned young adults to take Tylenol or a and the intensity of the pain placebo twice daily for 3 wks o Rate daily diary, report feelings of rejection & The McGill Pain Questionnaire emotional pain o Results:  those who took Tylenol reported less social pain (such as feeling hurt by being teased) compared to those who took the placebo o use similar words for emotional pain as physical pain  ex. “broken heart” DSM-IV TR: How do you know when someone is in pain?  Pain bhvrs: are observable bhvrs that occur in response to chronic pain  The signal goes to the spinal cord  immediately passes to a  4 basic types: motor nerve (1) connected to a muscle (ex. arm) 1. (-)ve affect (bad mood, anxiety, depression) o  a reflex action that does not involve the brain 2. Facial & Audible expression of distress o Want this to happen very quickly 3. Distortions in posture or gait  But the signal also goes up the spinal cord to the thalamus (2) 4. Avoidance of activity (due to pain) where the pain is perceived Pain Bhvrs Physiology of Pain  Analysis of these bhvrs provides a basis for assessing how  Somatosensory System: conveys sensory info from the body to pain disrupts the lives of patients dealing w dif illnesses the brain  Pain is currently assessed as a complex biopsychosocial  Sensory info begins w the sense receptors on or near the event involving psychological, bhvr’al, and physiological surface of the body components o  Receptors change physical energy (heat, pressure) o Ex. Coping methods, cognitions, changing bhvrs, into neural impulses changing relationships o  Neural impulses that originate in the skin & muscles are part of the peripheral NS The Experience of Pain o  Impulses travel toward the spinal cord & brain  Nociception: process of perceiving pain  Skin is the largest of the sense organs  Nociceptors: receptors in the skin and organs that respond to various types of stimulation (cutting, burning, cold)  There are 3 major kinds of pain perception: 1. Mechanical nociception: damage to body tissue o crushing, tearing o ex. A cut
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