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Chapter 10, 13, 14

PSYC 332 Chapter Notes - Chapter 10, 13, 14: Nociception, Mecha, Pain Management


Department
Psychology
Course Code
PSYC 332
Professor
Dean A Tripp
Chapter
10, 13, 14

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CH 10: Pain and its Management
STATS ect.
Chronic = long term (6 months or more), painful, and difficult to treat.
One of the most common causes of disability in Canada, affecting 1/10 CAD (1.5
million)
More common in elderly (65+) and women.
Cost 10 billion Annually
Pain is difficult to study b/c it is a subjective experience.
Soldiers requesting morphine ¼ compared to 80% of civilians.
Chinese students lower pain tolerance, due to differences in cultural norms
regarding expression and coping.
Measures
The Pain Catastraphizing Scale: to address the psychosocial components of
pain.
The McGill Pain Questionnaire
Pain behaviours observable beh that arise as manifestations of chronic pain.
Four basic types:
1. Facial and audible
2. Distortions in posture
3. Negative affect
4. Avoidance of activity
How children express pain? This data depends on behavioural and self-reports. Having
more verbally expressed pain meant higher rates of facial reactions and a higher pain
rating.
Pain verbalization associated with age and how parents respond (pain
promoting> control>pain reducing to child’s pain experiences.
Physiology of Pain
Pain is a protective mech. to bring into consciousness awareness of tissue
damage.
Pain is accompanied by motivational and beh. responses; withdrawal and
intense emotional reactions. eg. Crying or fear
Pain Perception
1. Mechanical Nociception (general pain perception)mech damage to
the tissues.
2. Thermal damage
3. Polymodal nociception pain that triggers chemical reactions from
tissue damage
Activation of peripheral nerve fibres:
1. A-delta & C- fibres: mechanical or thermal /pressure and vibration pain.
2. A-beta fibres: have a suppressing effect on the aching pain transmitted by the C-
fibres.
Theories of Pain
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Traditional models suggested the transmission of pain signals from the site of injury
to brain ie. Pain perceived was a directly proportional to tissue damage.
Gate Control Theory (Melzack & Wall):
Psychological factors play a sig. role in the pain experience.
Modulation of the pain gate occurs at the spinal column level by the dorsal
horn.
A-delta and C-fibres = open
A-beta = close
Signals descending from the brain can also modulate pain central control
trigger (large diameter, rapidly conducting fibres that activate cognitive
processes)
Why pain is subjective based on personal physical, emotional and cognitive
experiences.
The Periductal gray activation linked to pain relief.
Cerebral cortex involved in cog. Judgements about pain.
Secondary affect feelings of unpleasant and negative emotions associated with
future concerns of pain.
Limitations: it cannot some chronic pain eg. Phantom limb pain experienced
among amputees.
An extension to gate control theory=
Neuromatrix theory
- There are networks of neurons that extends throughout areas of the brain to create
the felt sensation of a whole, unified self body self neuromatrix. This generates
nerve impulses that are characterized into characteristic repetitive patterns called
neuro-signatures.
*** Both state that pain is a result of multiple determinants and not sensory factors
alone
Neurochemical Bases of Pain and It’s Inhibition
The brain can inhibit pain by sending descending messages.
Study on rats/discovery of Stimulation produced analgesia: electrically
stimulating a proportion of brain could produce high levels of analgesia there not
feel pain of abdominal injury.
Endogenous Opioid peptides neurochemically based internal pain regulators
clearly involved in the response of stress.
1. Beta-endorphins: limbic system and brain stem
2. Pronekephalin: neuronal, endocrine an central nervous system
distributions
The phantom limb is perceived as an integral part of oneself. Mirror box to
reflect movements from the intact limb to create an illusion of the amputated
limb has shown some success in reducing phantom limb pain.
- Treatment involves gaining control over the phantom limb and developing a
coherent body image accepting it’s absence.
- Immersive virtual reality (IVR) - can result in a positive change in sleep
patterns.
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3. Prodynorphins: found in gut, the posterior pituitary and brain
- Physical activity can produce opioids enhance immune function and explains
somewhat why we don’t feel in pain during sports.
Stress-induced analgesia (SIA) acute stress reduces sensitivity to pain
Clinical Issues in Pain Management
Traditionally management = pharmacological, surgical ands sensory tech.
Psychological components to management = Biofeedback, relaxation, hypnosis,
acupuncture, distraction, guided imagery.
Patient self-management has assumed centrality.
Acute pain specific injury that produces tissue damage therefore self-limiting and
typically disappears once damage is repaired. Short term less than 6 months usually.
Types of chronic pain
Unfolding physiological, psychological, and behavioural experience that evolves over
time into a syndrome.
1. Chronic pain: diff from acute pain in that it does not decrease w/ treatment and
the passage of time.
2. Chronic benign pain: longer than six months, intractable to treatment, origins
from multiple locations.
3. Recurrent acute pain: series of intermittent episodes of acute pain, however
last longer than 6 months
4. Chronic progressive pain: longer than six months and increases in severity.
Associated with malignant/degenerative disorders eg. Cancer or rheumatoid
arthritis
Acute and chronic pain present different psychological profiles.
Pain is present in 2/3 of patients who seek care fore depression. Pain and
depression are heavily intertwined. Hard to detangle their effects.
Most pain control tech work well to control acute pain, but are less successful w/
chronic pain.
Chronis pain involves more complex interactions of physiological, psych, social
and beh. components.
Families are greatly effected by chronic pain.
Secondary gains: attention received for having chronic illness.
Chronic pain patients often are in a depressed mood and have beliefs that pain is
permanent.
Chronic pain in seniors: 27% of seniors living in private homes experience chronic
pain, higher in long term care facilities at 38%. This could be greatly
underestimated, as many do not report their pain.
More likely with those who have arthritis, hear disease and diabetes as well as
already have two or more chronic conditions
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