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Health Psych 2G03 Post Midterm 2 Notes.pdf

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Jennifer Heisz

HEALTH PSYCH POST MIDTERM 2 POST MIDTERM 2▯ ▯ Which would be more painful: touch of a feather vs heat from a blow torch?▯ - chronic pain is very different from acute pain▯ - for someone with chronic pain, the feather is AS PAINFUL as a blowtorch▯ unlike acute pain which causes us to attend to it, chronic pain has no advantage, it in itself is - the disease▯ ❖ with acute pain (stubbed toe) your in pain, you pay attention to it, you don’t use it▯ ❖ chronic pain lingers even after the wound is healed▯ EX: an aspiring dancer twisted her wrist▯ - turned into chronic pain▯ - her hand and arm became really sore▯ - if you brushed a feather on her arm she would be in pain▯ - it is not understood how to best treat chronic pain▯ ▯ 1. What is chronic pain?▯ 2. What causes it?▯ 3. how can it be treated?▯ ▯ 1. What is Chronic pain?▯ - pain that persists after healing has occurred▯ - neuropathic pain can be stimulus evoked or spontaneous▯ - nociceptive pain (stubbing toe)▯ - neuropathic pain (neural degenerative)▯ ❖ neurons are not functioning properly▯ ❖ damaged nerve▯ ❖ could occur spontaneously▯ 2. What Causes Chronic Pain?▯ - chronic pain can result in dysfunctional activity at different levels of the pain pathway▯ ❖ periphery▯ ❖ spinal cord▯ ❖ cortex▯ ✦ PERIPHERY▯ STUDY▯ - thermal injury sensitizes nociceptors even after the flare disappeared▯ they applied flare to the hand▯ - - then they tested pain sensitivity around the injured areas▯ - after they were “burned” there was inflammation, however it encompassed spots around the site of injury which also became sensitive▯ - an area “C” off to the side was also affected▯ - after the burn the pain thresholds were significantly lowered▯ ❖ their pain sensitivity is higher▯ - you would expect to see higher scores on a VAS scale▯ - the cause for this hypersensitivity:▯ 1st pathway: hyperalgesia: activates nociceptors at lower level because of sodium channel mutation▯ ❖ the nociceptors at the skin are in a state of hyperactivity▯ ❖ mutation in SCN9A sodium channel gene causes hyperactivity in nociceptors▯ HEALTH PSYCH POST MIDTERM 2 ❖ if the sodium channels opening more often -> many more action potentials than you would normally be able to have. more signals can be sent with pain at lower intensity▯ ❖ you don’t need as strong of a stimulus to activate the AP because they are “primed”▯ ❖ nociceptors became more similar to threshold as mechanoreceptors▯ ❖ less intensity can now initiate the pain response - increased sensitivity to ONLY PAIN STIMULI (ie don’t include the feather example, this is only for naturally painful stimuli)▯ **in congenital analgesia the sodium channel never opens▯ ▯ - nociceptors with lower threshold causes hyperalgesia to noxious stimuli▯ the threshold decreases so that if a stimulus is lower in intensity it can activate the cells▯ - ▯ 2.▯ 2nd pathway: dysfunction at the dorsal horn - mechanoreceptors take over▯ - Allodynia: a noxious response to an innocuous stimulus (like a feather)▯ ❖ something that would normally just activate mechanoreceptors, would cause pain▯ - a feather brushing your arm becomes painful in a state of allodynia▯ - a control would get zero on the VAS pain scale▯ • normally, fibres for pain and touch project to different layers in the dorsal horn▯ ❖ pain fibers synapse at levels 1 and 2 (a delta, C fibers)▯ ❖ mechanoreceptors synapse at 3,4,5,6 etc (A beta fibers)▯ - how can a feather cause a pain stimulus?▯ - neuroplasticity at the dorsal horn allow mechanoreceptors to innervate superficial layers▯ - in a state of chronic pain with neuropathic pain, mechanoreceptors start putting input in superficial layers that are normally only for pain▯ restructuring of the lamina so the neurons go into where the body is expecting pain input▯ - … this feather gets recognized by the body as a pain signal, and gets sent up to the thalamus on the spinothalmic tract :(▯ - regular organization in the dorsal horn helps the body differentiate mechanoreceptors and nocioceptors, in chronic pain the mechanoreceptors take over this spot▯ - dysfuntion at the dorsal horn▯ ▯ - different from hyperalgesia because it is involving the mechanoreceptors, instead of sending touch signals, its sending pain signals▯ ▯ 3. insula activity is associated with the duration of chronic pain causing hyperalgesia▯ - you could have chronic pain for 40 years▯ - people have heightened activity the more years that they have it▯ - higher rates of depression and anxiety in individuals with chronic pain▯ - their emotional health is very poor▯ it is unclear if this is the result or cause of chronic pain▯ - ❖ the insula is part of the neuromatrix of pain, so it could be contributing to the unpleasantness of the pain they are experiencing▯ *** recall that heightened insula is associated with anxiety that increases pain intensity▯ ❖ higher anxiety gives us a higher intensity rating even if the stimulus is the same▯ ❖ this means its possible that with chronic pain the heightened insula activity causes hypersensitivity▯ - chronic pain decreases grey matter density in the prefrontal cortex▯ ▯ HEALTH PSYCH POST MIDTERM 2 CBP: Chronic Back Pain▯ - grey matter loss is localized to frontal region related to cognition▯ ▯ Iowa Gambling Task: evaluates decision making ability▯ - you have a choice of 4 decks of cards, you can choose which deck to pick from▯ - controls are learning which decks will give them bigger payoff with less risk▯ - ppl with chronic back pain don’t follow the smart decisions, and they don’t consider the risks▯ ❖ this is bc of the hypo activity of frontal cortex▯ ▯ Why does pain linger?▯ what causes chronic pain?▯ - dysfuntional neuronal signally in the periphery▯ - culminating in neural degeneration that impairs behavior.▯ ▯ Allodynia is resistant to opiate and NSAID analgesics▯ ❖ things like morphine don’t work▯ ❖ we need to combine biological and psychological approaches▯ ❖ physiotherapy and talk therapy▯ _______________________________▯ ▯ Obvious Health risks for highly visible at risk populations▯ - alcoholics, smokers, obese people▯ ▯ However, there are people at much higher risk that we might not think of…▯ at risk populations: hidden in plain sight▯ Socioeconomic Status▯ - social standing or class of an individual or group▯ - measured as a combination of education, income and occupation▯ - access to resources plus issues related to privilege, power and control▯ - it’s more than money. its the state of mind and potential to influence ppl that is critical▯ 1. Middle Manager▯ - low socioeconomic status is more than a lack of money. it’s a lack of control▯ EX: jill is a middle manager and just got promoted▯ - the problem is that you are stuck in the middle▯ - senior management tells you what to do, and then you have employees who have needs and demands▯ - MM are positioned at the point of greatest dissonance▯ ❖ you can’t please everybody, you don’t really have the power to make a lot of change▯ - monkeys: extremely social and form social heirarchies▯ ❖ study tracked monkey cortisol levels to see which monkeys at what level would have the most stress▯ ❖ results: lower and higher ranking both had lower cortisol than the middle. the middle ones had the highest cortisol levels▯ Social Stress and hurt feelings▯ - if you have a lot of people demanding things of you, you cannot please everyone at the same time▯ - social stress activates the physiological stress response▯ ❖ high activation of the amygdala can activate HPA to release more cortisol causing more of a stress response▯ HEALTH PSYCH POST MIDTERM 2 - low SES is associated with chronic or repeated exposure to adversity▯ ❖ although the stress response is protective, prolonged stress response becomes stressful on the body▯ - low SES is a risk factor for coronary heart disease▯ - the allostatic load on the system causing repeated stress is damaging on the body▯ ❖ why it’s important to love your job▯ ✦ Stress increases pro-inflammatory cytokines to increase risk of CHD▯ ❖ high levels of stress interact with immune system and change cytokine balance, causing more TH2 and less TH1, this imbalance disrupt immune functioning▯ ❖ more susceptible to infection and cancer▯ ❖ inflammation is huge risk factor for CHD▯ - day to day stress activates HPA axis. heightened amygdala activates stress system. when stress system is high, these stress hormones interact with the immune cells to change their function. ▯ - interleukone 6 causes less inflammation in the body▯ chronic stress is similar to the effect of smoking cigarettes a lot▯ poverty in the developed world is more difficult to recognize but still has an effect on health▯ - low SES can cause a lot of stress to a child▯ ▯ STUDY - transcription factors▯ - low early life SES vs high early life SES▯ - pro inflammatory factor:▯ - conveys stress signals to immune cells: changes proportion of TH1/TH2▯ - glucocorticoid receptors:▯ - children born into low SES, as adults have a down regulation of glucocorticoid receptors, which could cause fewer glucocorticoid receptors being made, there is an up regulation of signals b/w stress system and immune system —> greater impact on the immune system, greater inflammation. —> just because of SES▯ ▯ - adults with low SES had higher levels of inflammation markers later in life.▯ _______________________________▯ ▯ WRITE OUT NOTES FROM MARCH 26▯ ▯ _______________________________________▯ ▯ Although Self Control is a limited resource, it can be built up like a muscle▯ - this would make you more resilient▯ - elite athletes are highly regimented and resilient▯ ▯ Can Exercise make you more resilient?▯ STUDY: 40 rats▯ ❖ assigned them to a cage with a running wheel OR a without a running wheel▯ ❖ for 6 weeks▯ - after 6 weeks: they were subjected to uncontrollable shock OR no shock.▯ - they measured freezing behaviour and escape latency▯ - RESULTS - learned helplessness▯ SEDENTARY with shock: rats freeze up (learned helplessness),▯ HEALTH PSYCH POST MIDTERM 2 sedentary without shock: not as much freezing▯ Runners with shock: perform more similarly to ones without shock, not as much learned helplessness▯ runners without shock: similar results as the ones with the shock▯ ***the runners were less likely to learn helplessness▯ RESULTS - escape latency▯ sedentary with shock: much less likely to try to escape, they primarily were just freezing▯ sedentary without shock: would escape right away▯ Runners: perform at the same level as those without stress▯ ** suggests that exercise helps protect the animal from the effects of stress, and they don’t show as much learned helplessness▯ ▯ The stress-bufering effects of exercise are seen at many levels▯ - helps prevent stress induced immune dysfunction▯ - reduces cortisol levels in the blood▯ reduces the severity of stress related depression and anxiety▯ - someone under chronic stress, less affected by it if they are athletic▯ - ▯ - athletes suffer from mental illness but their training may help alleviate symptoms▯ Can we strengthen our resilience?▯ - exercise increases our resilience to stress▯ - this may be why athletes with mental illness can still perform at high levels▯ ▯ Behavior Therapy can modulate resiliency▯ - one way to overcome fear is to unlearn fear association▯ - fear from innocuous cues can be conditioned through experience▯ - classical conditioning of a stress response can distort thinking▯ - CS + US = CR —> over time the CS alone is enough to cause fear▯ ▯ Unlearning a conditioned fear response through extinction▯ learning trials: CS isn’t intense, but its paired with a shoc
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