Pain Psychology

Pai n Pain psychology • Define pain , physiology of pain • Psycho- social factors of pain • Pain management (psychological methods) Pain and Medicine In the early days when pain was approached exclusively from a biomedical model, the importance of the mind was not considered. Medicine is usually the first call to manage pain. Medical approach is useful for treating chronic pain, but effects on pain are modest. When the pain is not responsive to medication, or resistant to treatment, or persists after healing and while healing, the reason for the pain is not found then the alternative treatment or a combined approach can be used. Clinical and health psychology have improved the bio psychosocial structure to make sure to focus on psychosocial issues in treating different organic and psychosomatic disorders and counterbalancing the evidence based approach with the etiquette based one in the clinician-patient relationship and communication (Kahn, 2008; Castelnuovo, 2013). Clinical and health psychology has found solutions; protocols, treatments, evidences, etc. in any medical area: psycho-cardiology, psycho-oncology, psycho-geriatrics, psycho-pneumology, psycho-endocrinology, neuropsychology, and psychology in pain management as well. Psychology of Pain When a person is in pain the brain activity and neural interactions shows there are multiple layers of complex abstract thoughts and feelings. This determines how much pain a person feels and how they deal with pain. Environmental influences, behavioral constructs and the cognitive constructs are all play a role in individuality of a person. These factors should be considered and incorporated into any treatments. Psychological treatment is counseled because pain is a good example of a mind-body connection. When the body feels pain, one's thoughts and emotions are influenced by how much pain is felt. Psychology of Pain When an individual is in pain, They may have feelings of anger, sadness, hopelessness, and despair. Pain can alter an individual’s personality, disrupt their sleep, and interfere with work and relationships. Depression and anxiety make pain worse, yet pain causes depression and anxiety. Stress makes pain worse, yet pain causes stress. Lack of sleep makes pain worse, yet it is very difficult to sleep when you have pain. Psychological treatment can help with managing the effects of pain. Psychology of Pain Psychological therapies are highly indicated both for the treatment of painful conditions and for the treatment of pain related to several neurological diseases. Similar positive results about psychotherapy efficacy were reported in specific pain disorders such as low back pain, fibromyalgia, tension-type headache and migraine, pain associated with rheumatoid arthritis, chronic abdominal pain in adolescents, etc. (Castelnuovo et al) Psychology of Pain Clinical health psychology focuses also on the study of the psychological determinants in pain patients such as the role of depression, anxiety, pain-related disability, catastrophic thinking, psychological inflexibility, coping skills, beliefs, attitudes, expectations, self-efficacy, placebo, etc. Different psychological models of pain and disability (such as Fear-avoidance, Acceptance and commitment, Misdirected problem solving, Self-efficacy and Stress-diathesis models) have tried to highlight the psychological processes behind pain (McCracken and Morley, 2014) Psychotherapeutic treatment options Cognitive behavioral therapy (CBT): talk therapy that helps to change your thoughts and behaviors related to pain and improve coping strategies. Mindfulness-based stress reduction (MBSR): a form of mediation where you learn to nonjudgmentally become aware of your thoughts and feelings and accept pain and other uncomfortable sensations as neither positive nor negative. Biofeedback: a technique where your body functions such as heart rate, muscle tension, and skin temperature are monitored to make you aware of your involuntary responses to stress. During biofeedback sessions you Factors effect psychology of pain • Gender • Personality • Age • Culture Pain “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”(1979) One of the most common health problems that causes people to seek medical attention Pain is actually beneficial to long-term health and survival DEFINITION Pain is a noxious unwanted8 perception in which the patient seeks medical intervention. “pain is subjective, individual and modified by degree of attention, emotional state and the conditioning of past experience(Livingstone 1943). The intensity of the pain is not directly proportional to the degree of suffering. Because it is basically a psychological experience and depends on how it is interpreted or experienced. Types of Pain • Acute pain – shorter duration up to six months • Acute monophonic pain • Recurrent acute non-malignant pain • Chronic pain- longer duration >six months • Chronic malignant pain- progressive • Intractable- benign • Chronic pain associated with non- malignancy disease- identiable pathology • Chronic non malignant pain syndrome • Recurrent acute- migraine • Chronic and acute pain may have different causes- behavioral factors may be involved in acute pain Pain receptors Physiology of Pain Receptors Nerve Fibers Spinal Coed Spinothalamaic Tract Thalamus Central control mechanisms of pain Theories of pain • • • • • • • • Pain gate theory (melzack & wall) Pattern theory (Sinclair) Chemical theory (Neurotransmitters)Encephalin/B endorphins) Descending control theory (PAG/Raphe nucleus inhibition) Substane ‘P’ levels Serotonin levels Central control mechanisms (by brain) Specific theory (unique theory) Gate control theory - Melzack & Wall (1965) Severity of pain sensation determined by balance between excitatory and inhibitory inputs to T cell in spinal cord Gate control theory - Melzack & Wall (1965) • • • • C & A delta nociceptor afferents give excitatory input to dorsal root ganglion of spinal cord-A delta (myelinated) about 40 mph and C fibers (unmyelinated ) about 3 mph, other sensory information travels at about 180-240mph Substantia gelatinosa, large diameter A beta non – nociceptor afferents give inhibitory input Increased firing of non- nociceptor afferents causes presynaptic inhibition of T cell and the spinal gate from excitatory cells presynaptic inhibition of T cell and the spinal gate from excitatory cell to the brain is closedPhysical agent modalities and physical activities believed to close the gate by activating the non- nociceptor Chemical processes involved in pain - Substance P • • • Chemical mediator thought to be involved with transmission of pain . associated with inflammatory pain it excites pain transmitting neurons when released its mechanism is not fully understood Glutamate- release affects amount of pain experienced Prostaglandins ,bradykininreleased when tissue damaged Chemical processes involved in pain Endorphins • • • • • Pain perception modulated by these opiate like neurotransmitters The endorphins bind to certain sites on the nervous system including peripheral nerves They suppress pain transmission at the spinal cord level by inhibiting the release of the neurotransmitter gamma aminobutyric acid (GABA)in the periaqueductal gray matter(PAGM)and raphe nucleus of the brain High concentrating of opiate receptors in limbic area of brain explains the stress relief and euphoria associated with opiates Limbic system involved with emotional component of pain Pain Cycle Tips for coping with pain • • • • Consider the following steps that can be helpful in changing habits and improving your sleep: Stay active. Pain—or the fear of pain—can lead people to stop doing the things they enjoy. It’s important not to let pain take over your life. Know your limits. Continue to be active in a way that acknowledges your physical limitations. Make a plan about how to manage your pain, and don’t push yourself to do more than you can handle. Exercise. Stay healthy with low-impact exercise such as stretching, yoga, walking and swimming. Tips for coping with pain • • Make social connections. Call a family member, invite a friend to lunch or make a date for coffee with a pal you haven’t seen in a while. Research shows that people with greater social support are more resilient and experience less depression and anxiety. Ask for help when you need it. Distract yourself. When pain flares, find ways to distract your mind from it. Watch a movie, take a walk, engage in a hobby or visit a museum. Pleasant experiences can help you cope with pain. Tips for coping with pain • • Don’t lose hope. With the right kind of psychological treatments, many people learn to manage their pain and think of it in a different way. Follow prescriptions carefully. If medications are part of your treatment plan, be sure to use them as prescribed by your doctor to avoid possible dangerous side effects. In addition to helping you develop better ways to cope with and manage pain, psychologists can help you develop a routine to stay on track with your treatment. Factors affecting pain - Physical factors• • • • • • • • • Pain tolerance Body constitution/genetics Age Sex Temperature Climate(Humidity, cold, winter) Light, darkness Noiselevel Avoidance of physical activity Factors affecting pain - Psychological factors • Personality (introvert/extrovert) • Social context or role (eg:-soldier vs civilian) • Attention • Ecstasy • Attitudes, past experience anxiety/ depression • Learning / memory (education) • Dependency/ conditioning • Avoidance behavior Factors affecting pain - Psychological factors Learning / memory (education) • Modeling • Secondary • Financial • Culture Factors affecting pain - Psychological factors Personality • Anxiety and depressive disorders • Extroversion is associated with higher • Pain thresholds • Internal locus of control is associated with better coping Psychological methods for controlling pain • • • • • Hypnosis Biofeedback Relaxation and distraction Cognitive- behavior therapy Behavioral medicine Psychological methods for controlling pain Behavioral / cognitive approaches • Distraction • Music and pain reduction- andderson et al. (1991) • Relaxation • Progressive technique • Autogenic technique- use of self instructions of warmth and heaviness Behavioral /cognitive approaches • • • • • • • Guided imagery Systematic Desensitization Reframing Meditation Stress management techniques – not as effective as other techniques Thinking about the pain and expectations Progressive Muscle Relaxation Guided Imagery Placebo • Classical conditioning • Patient’s may change behaviors physiological changes which inhibit the experience of pain