Response to Pain

Carl GrahamClinical Psychologist

The Pain Stew

Central SensitisationRepeated learning principleThe more you use it, the easier it fires

off

Even as the damage heals, it doesn’t take much to maintain an active pathway

Distress & RelaxationIn constant nocioception but not all

signals are perceived as pain. Threat → Stress → Distress → Load

Change pain by changing response... Though relaxation doesn’t change

nocioception

AttentionSensation of waistband on tummyWas that sensation there all the time?Sensations can fade into background

“noise”If pain is going up and down periodically,

your attention will always be drawn to itAim to make the pain more constant and

less threatening so it feels like any other sensation Pacing

MoodDepression is not a disease!

Being faced with more punishers than rewards results in endocrine system activation

Dopamine and noradrenaline

Cold pressor experiment

The Problem of LanguageBrain scans environment for threat

Physical reality vs. imagined stimulus

Child and dog outside at night example:Bad experience is over, but humans keep

replaying it and scan the environment so it doesn’t happen again

Inflammation & Sickness ResponseWhat happens when you get a cold/flu?PainTired/fatigueMood drops Temperature changes (fevers and chills)General malaise

Muscle stiffnessGut symptomsConcentration & memory problems

What is the function?

ControllabilityTattoo Parlour:

Who wants the first scenario?Who wants the second scenario?

What is the difference?

Expectancy & SupportFear avoidance:Expecting a task to promote pain and, as

a result, avoiding it

Family support is great, but only to the point that it improves your function

The Point of RelaxationThe pain you choose is easier to have:

Notice sensations and your response Notice pain sensations and your response Learn how to fail to feed the pain via distress Lay down a new learning history:

avoid vs. approach

Every time the tiger walks into the room, relax first, then slowly approach

“Behavioural Neuromodulation”

Goal setting – (valued activity)Activity pacingMovementIncorporate “rest” breaksDistress management (pain vs. fear of pain)Fail to avoid and learn to approachGet back into valued and pleasurable

activities