PSYC 3170 Chapter Notes - Chapter 10: Ronald Melzack, Chronic Pain, Phantom Limb

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24 Apr 2012
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Chapter 10 Notes
Pain is significant fro managing daily activities
Symptom to most likely have individuals seek treatment
It if fundamentally a psychological experience and the degree to which it is felt and how
incapacitating it is depends in large part how it is interpreted
Pain is a substantial cultural component
o Members to some cultures report pain sooner and react more intensely than
other individuals in other cultures
Measuring pain:
Verbal reports: darw on a large, informal vocabulary that people use for describing pain
o McGill pain Questionnarie –whetehr pain is throb shoot etc
o Pain Catastrophizing Scale full pic of dimension of the pain
Pain behaviours: are observable behaviours that arise as manifestations of chronic pain
4 basic types of pain behaviours-measurable-psych,phys,behavioral components
o facial and audible expressions of distress
o distortions in posture or gait
o negative affect
o avoidance of activity
physiology of pain:
the experience of pain is protective mechanism to bring the consciousness the
awareness of tissue damage
nociception (pain perception): that results from mechanical damage to the tissue of the
bofy
thermal damage: or the experience of pain due to temperature exposure
polymodula nociception: a general category referring to pain that triggers chemical
reactions from tissue damage
o nociceptors in the peripheral nerves first sense injury and in response release
chemical messengers to spinal cord where they pass the reticular formation and
thalamus into cerebral cortex
o 2 major types of peripheral nerbve fibers:
A-delta fibers: small myelienated fibers, transmit sharp pain
C-fibers: unmylienated nerve fibers that involve polyumodual pain (dull
or aching pain)
o Motivational and affective elements of pain appear to be influenced more
strongly in C fibres thalamic, hypothalamic and cortical areas
Theories of pain:
Gate control theory: (Ronald Melzack and Partick Wall 1965) suggested that pain
resulted from the transmission of the pain signals from the site of injury to the brain and
that the amount of pain experienced was directly proportional to the amount of tissue
damage
o Psych factors play role in pain
o There is a neutral pain gate that can open and close to modulate pain signals to
the brain
o Trhough activity of a-delta and C-fibers
o View pain as a role of the brain and other central nervous system regions in the
pain experience
Type of factor
Factors that open the
Factors that close the
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gate
gate
Physical
Extent of injury
Inappropriate activity level
Medications
Counter stimulants
(massage heat)
Emotional
Anxiety or worry
Tension
Depression
Positive emotions (joy and
interest)
Relaxation
Cognitive
Focusing on pain
Boredom
Distraction or intense
concentration on other
things
Involvement and interest
in life activities
o Gate theory has its limitations
o Cannot explain phantom limb theory: a phenomenon that takes place
commonly among amputee, generate nerve impulses
o Neuromatrix theory: there is a network of neurons that extend throughout
areas of the brain to create the felt of representation of a unified physical
self called the body self neuromatrix
o pain is a mulidimentional experience that results from multiple
determinants and not sensory factors alone
Neurochemical bases of pain and it inhibition
endogeneous opidiod petides: fall into three general families:
o Beta-endorphins: produce peptides that project to the limbic system and brain
stem, among places
o Pronekephalin: ehich peptides that have widespread neuroal, endocrine and
central nervous system diatribion
o Prodynorphins: found in the gut the posterior pituitary and the brain
Chronic and Acute Pain:
Acute pain: typically results from a specific injury that produces tissue damage, such as
wound or broken limbs
o Produces substantial anxiety and prompts its sufferer to engage in an urgent
search for relief
Chronic pain: typically begins with an acute episode, but unlike acute pain, it does not
decreased with treatment and passage of time
Chronic begin pain: typically persists for six months or longer and its relatively
intractable to treatment (ex: chronic back pain)
Recurrent acute pain: involves a series of intermittent episodes of pain that are acute
in character but chronic in inashmuch as the condition persists for more than six
months (migraine headaches)
Chronic progressive pain: persists longer than six months and increases in severity over
time (cancer)
Acute verses Chronic pain:
Acute and chronic pain present differnet psychological profiles because chronic pain
often carries overlay of psychological distress, which complicated diagnosis and
treatment
o Maladaptive coping strategies (catastrophizing illness) while engaging in social
withdrawl
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