health psychology lecture 5 pain. lecture 5 - outline part 1 –anna nagy (stress) part 2 –duane...
TRANSCRIPT
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Health Psychology
Lecture 5
Pain
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Lecture 5 - Outline
• Part 1– Anna Nagy (Stress)
• Part 2– Duane (Pain)
• Part 3– Term Test #1 Preparation
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Question
What is pain?
Pain is the sensory and emotional experience of discomfort which is usually associated with actual or threatened tissue damage or irritation
(Sarafino)
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Types of Pain
Acute vs. Chronic Pain
ie - short-term vs. long-term pain
Psychological impact of chronic pain depends on…• Chronic benign pain• Recurrent acute pain• Chronic progressive pain
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Physiology of Pain Perception
Overview
Specialized nerve fibers transmit perception of pain to the brain
• Noxious stimuli algogenic chemicals
• Algogenic chemicals activate nociceptors
• Nociceptors nerve impulses to brain
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Physiology of Pain Perception
Pain signals travel along 2 types of nerve fibers
• A-delta: sharp, well-localized pain
• C fibers: diffuse, dull, aching or burning pain
Non-pain signals travel along A-beta fibers • Touch, pressure, warmth, mild irritation
(Experience of non-pain sensations relevant to perception of pain)
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Gate-Control Theory
Extent to which gate is open depends on…
• Amount of activity in pain fibers
• Amount of activity in non-pain fibers
• Messages descending from the brain
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Endogenous Opioids
Endorphins and Enkephalins
• Exist in the brain, spinal chord and other organs
• Released in response to stress or trauma
• Messages descending from the brain
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Pain Behaviors
Behaviors specifically associated with pain - usually indicate the presence of pain to the onlooker
• Facial/audible expressions• Statements• Altered gait or posture• Avoidance of tasks
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Assessing or Measuring Pain
1. Psychophysiological measures
• Muscle tension (Electromyograph, EMG)
• Indices of autonomic activity– Heart rate (ECG), skin conductance
• Evoked potentials (EEG)
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Assessing or Measuring Pain
2. Measurement of Pain Behaviors
• Behavior checklist
3. Self-report measures
• Interview
• Rating Scales
• Pain Questionnaires (McGill Pain Questionnaire)
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McGill Pain Questionnaire
Measures 3 dimensions of pain experience
• Sensory - location, temporal pattern, quality
• Affective - emotional response (e.g., annoying)
• Evaluative - perceived intensity
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Pain Management
Physical/Medical Treatment
• Chemical Analgesia (pain relief)
– Narcotics (e.g., morphine)
– Peripherally acting analgesics (e.g., asprin)
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Pain Management
Physical/Medical Treatment
• Surgical approaches
– Severing peripheral nerves
– Spinal tracts
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Pain Management
Physical/Medical Treatment
• Acupuncture
– insertion of metal needles under the skin at acupuncture points
– Endorphins and enkephalins
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Pain Management
Physical/Medical Treatment
• Transcutaneous Electrical Nerve Stimulation
– Electrodes on area of pain
– Stimulates non-pain fibers (A-beta)
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Pain Management
Psychological Intervention
• Hypnosis
– Altered state of consciousness
– Produces a high degree of analgesia in a minority of individuals
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Pain Management
Psychological Intervention
• Biofeedback
– Feedback using EMG (muscle tension)
– Teaches awareness and control of bodily processes
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Pain Management
Psychological Intervention
• Relaxation Techniques
– Meditation, progressive muscle relaxation
– Relaxation reduces anxiety
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Pain Management
Psychological Intervention
• Cognitive Therapy
– Assumption: Cognitive variables impact the…• Interpretation of pain
• Affective features that accompany pain (depression)
– Aim: Challenge and replace pain beliefs• Pain beliefs “promote disability and engender distress”
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Pain Management
Psychological Intervention
• Behavior Therapy
– Assumption: Pain behaviors increase attention to pain, interfere with activities, reduce fitness
– Aim: Eliminate reinforcement of pain behaviors
– Aim: Provide reinforcement for healthy behaviors
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Pain Management
Evaluating Psychological Interventions
• CBT (cognitive-behavior therapy)
– Enhance mood and mobility
– Reduce pain perception and pain behavior
– But … CBT is not a panacea (pain eliminator)
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Current Topics
• Effects on Cognition/Learning and Memory– Animal research—How stress affects the brain
• Hippocampus—high concentration of GC receptors• Stress=Increased cortisol secretion in most cases• Atrophy of dendrites/Effects on neurogenesis
– Sex differences
– Suggestive Evidence in humans• Hippocampal volume loss? (Cushings, Depression, PTSD)• prevent access to contextual info (may lead to enhanced fear based
memory (PTSD))• Caregiver study
• Allostatic Load
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Stress Affects Health
• Acute Stress Enhances Immunity—– Enhances traffic of lymphocytes and macrophages to the area of
need (‘delayed-type hypersensitivity’)
– Dependent on adrenal secretion; last 2-5 days
– Enhances responses for which there is an immunologic memory (beneficial for cancer or tumour cell, but pathologic for autoimmune or allergic responses)
• Can you think of any diseases where this might be a factor?
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Allostasis
• Allostasis: ability to achieve stability through change—crucial to survival
• Accommodation: Body protected by various systems including ANS, HPA, cardiovascular, metabolic and immune systems
• Allostatic Load: long term effects of the physiologic response to stress.– Wear and tear from chronic over-activity or under-
activity of systems
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The Stress Response and the Development of Allostatic Load
Stress Response and Development of Allostatic Load.
(McEwen, 1998)
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Four Situations Associated With Allostatic Load
• Frequent Stress
• No Adaptation to Repeated Stressors in Some Individuals
• Failure to shut off stress response after stressor abates
• Inadequate responses in some allostatic systems=compensatory responses in other systems (disruption of counter-regulatory mechanisms)
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HPA