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Chapter 10

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PSYC 3170
Gerry Goldberg

Chapter 10: Pain and its management. - Most middle aged people or older people experience chronic pain on a daily basis. No introduction to pain would be complete without consideration of its prevalence and cost. Many people who suffer from chronic feel have more than one chronic health conditions and use over the counter pain killers, tranquilizers and sleeping pills at rates 2 to 4 times higher than those without chronic pain. Chronic pain also interferes with peoples normal activity, which cannot carry out in response to pain. It also leads to anxiety and depression. -Significance of Pain: Pain hurts so it overwhelms other needs, but its significance goes beyond this disruption. Pain is significant for managing daily activities. Pain is critical to provide us feedback so we can do something about and see treatment, if there was no pain we would know there was something wrong and wont go to seek treatment for it. Minor pains happen to us all the time which we fix unconsciously such as rolling over sleep, shifting our posture etc. However, the relationship between pain and illness is weak, in example of a cancerous lump which causes no pain until in its last stages. Pain is what patients fear most in a treatment and it is the reason for requests for euthanasia. -Why is pain difficult to study? : Pain is a personal, subjective behavior, influenced by cultural learning, the meaning of situation and the attention paid to the situation and other psychological variables. Pain is a mysterious part of treatment as the degree to which its felt and how incapacitating it is depend largely on how it interpreted. Example during world war 2, comparison between wounded soldiers and wounded civilians, soldiers asked for less morphine than civilians as for soldiers pain meant that he was alive and will be sent back home where as for a civilian pain meant unwellness and interruption of valued activities. Cases reported in sports games where when athletes are hurt remain oblivious to pain b/c of sympathetic arousal to diminish pain sensitivity during sports. Pain has a cultural componenet as well, some people have a different of reacting to pain and expression of pain as other cultures. -Measuring Pain: Difficulty in treatment of pain is that people have to describe it as it cant be seen compared to a lump of cancer or broken bone which can be seen in X-ray. One solution to measuring pain is the verbal vocabulary that people use to describe pain, such as throbbing pain, shooting pain or dull ache. Some researchers developed pain questionnaires like McGill Pain Questionnaire, Pain catastrophizing scale etc. Pain Behaviours are another measure of pain, four types of pain behaviors identified 1) facial and audible expression of distress 2) distortions in posture or gait 3) negative affect 4) avoidance of activity. Pain behaviours can asses how disrupted ones life is beacuase of the pain. -Physiology o Pain: Pain is a protective mechanism that brings into ones awareness of tissue damage. Pain responses lie crying and fear and important in its diagnosis and treatment. 3 types of pain perceptions: 1) nociception results from mechanical damage to the tissue of the body 2) thermal damage: experience of pain due to temperature 3) polymodal nociception: pain that triggers chemical reactions from tissue damage. Nociceptors (peripheral nervers) first sense pain and release chemical messengers which are conducted down spinal cord to the thalamas, reticular formation and into celebral cortex which identify site of injury and sed messages back down to spinal column which help block pain. -Two peripheral nerve fibres: A-delta fibres are small and myelinated that transmit sharp pain and determine sensory aspects of pain where as C fibres are non myelinated and transmit dull aching pain and influence motivational and affective elements of pain. Peripheral fibres enter the spinal column at the dorsal horn. Both fibres project into different brain areas. - Therioes of Pain: Previously it was believed that amount of pain experienced was directly proportional to amount of tissue damage but GATE CONTORL THEORY challenged this by proposing that psychological factors play an important role in experiencing pain. Acc. To gate control theory, there is neural pain gate which modulates the pain signals to the brain and which can occur at the spinal column dorsal horn by A-delta fibres which are involved in closing the gate. Signals descending from the brain can modulate pain thru a central trigger system, of large diameter conducting fibres that activate cognitive processes which in turn then alter the pain gate thru descending fibres. Brain could now be seen as selecting, filtering and modulating signals rather than simply receiving them and dorsal horns as stations that either amplify or inhibit pain. Pain sensitivity, intensity and duration all interact to influence pain and unpleasantness and related emotions through a central network of pathway in the limbic structures and thalamus directs inputs cortex and also carries background input with pain which give the strong emotions associated with pain! The whole point of this theory is that pain is different under different circumstance and can be modulated by the brain and that its also a psychological process! - Gate control theory misses out Phantom limb pain where a person with an amputated limb experiences pain in the limb, how does that limb send signals to the brain to experience pain? This is explained by the neuromatrix theory! - The neuromatrix theory: Acc to this theory, there is a network of neurons that extend throughout the areas of the brain to create the felt representation of a unified physical self, called body-self neuromatrix. Neuromatrix is genetically determined but also by sensory inputs or experience. Each pain a person experiences, neuromatrix generates nerve impulses which are continuously and cyclically processed into a characteristic pattern called its neurosignature! Each pain has its own neurosignature with a number of sensory, cognitive and emotional factors that are unique to it and thus in a phantom limb pain, it is this neurosignature and NOT the sensory inputs that create the pain.- Neurochemical Bases of Pain and Its Inhibition: The brain can control the amount of pain a person experiences by send messages to block the transmission of pain. Study when stimulating a part of a rats brain, it produced so much analgesia that the rat experienced no pain during abdominal surgery. - Opioids like heroine and morphine are drugs that help control pain, they can be manufactured in specific parts of the brain, glands and project on sites with which have receptors for them. - 3 types of endogenous opioid peptides: - 1) beta-endorphins, produce peptides that project on to limbic system and brain stem - 2) Proenkephalin, peptides that have widespread neuronal, endocrine and CNS. - 3) Prodynorphins: found in the gut, the posterior pituitary and brain. - Each of these have different receptors, potencies and pharmacological profile. - These endogenous opioid peptides are pain suppressors of the body and can be effective in response to stress, and reduce pain called stress-induced analgesia. - Since they are present in the pituitary gland, hypothalamus further indicates their role in stress. Also known to have a role in immune function. - What a
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