Pain Assist. Prof. Merve Topcu PSY 411 Health Psychology

Pain Assist. Prof. Merve Topcu PSY 411 Health Psychology
Department of Psychology Çankaya University , Fall

Pain in general Pain plays a necessary and basic role in survival
Congenital insensitivity to pain Individuals are not able to feel pain Pain may exist for no clear reason Phantom limb pain People experience pain in parts of the body that do not exist Beliefs about pain changes the repsonse

Pain & the Nervous System
Pain originates as stimulation to the skin and muscles Peripheral nervous system (PNS) is responsible

Organization of NS CNS Peripheral NS Autonomic NS Somatic NS
Brain Spinal cord Peripheral NS Autonomic NS Sympathetic NS Parasympathetic NS Somatic NS Sensory & Motor nerves (Skin & muscles) Cranial nerves (Head & neck)

The Somatosensory System
conveys sensory information from the body to the brain consists of several senses, including touch, light and deep pressure, cold, warmth, tickling, movement, and body position 3 types of neurons Afferent (sensory) neurons relay information from the sense organs toward the brain. Efferent (motor) neurons result in the movement of muscles or the stimulation of organs or glands Interneurons connect sensory to motor neurons The sense organs contain afferent neurons, called primary afferents receptors that convert physical energy into neural impulses

The Somatosensory System
Nociception The process of perceiving pain Nociceptors receptors in the skin and organs responding to various types of stimulation that may cause tissue damage, such as heat, cold, crushing, cutting, and burning Myelin A fatty substance that acts as insulation Myelinated afferent neurons, called A fibers, conduct neural impulses faster than unmyelinated C fibers do. The larger A-beta fibers and the smaller A-delta fibers are essential A-beta fibers conduct impulses more than 100 times faster than small, unmyelinated C fibers Stimulation of A-delta fibers produces “fast” pain that is sharp or pricking, whereas stimulation of C fibers often results in a slower developing sensation of burning or dull aching

The Spinal Cord The most important role of the spinal cord is to provide a pathway for ascending sensory information and descending motor messages Produces the spinal reflexes The afferent fibers group together after leaving the skin and this grouping forms a nerve

The Spinal Cord

The Spinal Cord The dorsal horns contain several layers, or laminae.
allow for elaborate interactions between sensory input from the body and the central processing of neural information in the brain.

The Brain The thalamus receives information from afferent neurons in the spinal cord Somatosensory cortex in the cerebral cortex receives information from the thalamus that allows the entire surface of the skin to be mapped onto the somatosensory cortex Areas that are particularly rich in receptors occupy more of the somatosensory cortex

The Brain A person’s ability to localize pain on the skin’s surface is more precise than it is for internal organs. Referred pain, when pain is experienced in a part of the body other than the site where the pain stimulus originates. Heart attack & pain in the arm Positron emission tomography (PET) & Functional magnetic resonance imaging (fMRI) brain activity occurs when nociceptors are activated the human brain reacts in similar ways to emotional and physical pain.

Neurotransmitters and Pain
Neurochemicals have properties similar to those of the opiate drugs They affect the brain to alter pain perception by occupying and activating receptors Opiate-like neurochemicals, including the endorphins the enkephalins, and dynorphin Stress, suggestion, and electrical stimulation of the brain can all trigger the release of these endorphins Glutamate and substance P act in the spinal cord to increase neural firings related to pain. Bradykinin and prostaglandins are substances released by tissue damage; they prolong the experience of pain by continuing to stimulate the nociceptors. Cytokines by the immune system may intensify chronic pain

The Modulation of Pain The periaqueductal gray is involved in modulating pain in midbrain When it is stimulated, neural activity spreads downward to the spinal cord, and pain relief occurs Endorphins in the periaqueductal gray initiate activity Decides whether ignore the pain or feel the pain

The Meaning of Pain Pain was due to two factors:
the sensation and the person’s reaction to that sensation. the multidimensional nature of pain the International Association for the Study of Pain (IASP) Subcommittee on Taxonomy (1979, p. 250) defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

The Meaning of Pain Three stages Acute Chronic Prechronic
Its duration is normally brief & ordinarily adaptive İncludes pains from cuts, burns, childbirth, surgery, dental work, and other injuries. it signals the person to avoid further injury Chronic endures over months or even years type of pain may be due to a chronic condition such as rheumatoid arthritis, or be the result of an injury that persists beyond the time of healing frequently exists in the absence of any identifiable tissue damage. not adaptive but, rather, can be debilitating and demoralizing and often leads to feelings of helplessness and hopelessness chronic recurrent pain pain marked by alternating episodes of intense pain and no pain (e.g., Headache) Prechronic comes between the acute and the chronic stages Deal or fail

The Experience of Pain The experience of pain is individual and subjective Situational and cultural factors influence experience of pain E.g., Battle injuries Beecher (1956) “the intensity of suffering is largely determined by what the pain means to the patient” “the extent of wound bears only a slight relationship, if any (often none at all), to the pain experienced” two-dimensional experience consisting of both a sensory stimulus and an emotional component

The Experience of Pain Individual Differences
Classically conditioned responses to the associated stimuli E.g., dentist fear Role of operant conditioning in pain by providing a means for acute pain to develop into chronic pain Being rewarded for pain behaviors E.g., headache patients report more pain behaviors and greater pain intensity when their spouses or significant others respond to pain complaints with seemingly helpful responses, such as taking over chores, turning on the television, or encouraging the patient to rest People who are anxious, worried, and have a negative outlook tend to experience heightened sensitivity to pain Patients suffering from chronic pain are more likely to be depressed, to abuse alcohol and other drugs, and to suffer from personality disorders

The Experience of Pain Cultural Variations Gender Differences
Cultural background and social context affect the experience Social desirability in expression of pain behaviors among different cultures may reflect behavioral differences in learning and modeling Gender Differences Common stereotype about pain perception is that women are more sensitive to pain than men W reports more than m W experience disabilities and pain-related conditions more often than men Gender roles and socialization For m, be strong & deny pain For w, pain is related to vulnerability Hormonal differences

Theories of Pain Specificity Theory
Hypothesizing that specific pain fibers and pain pathways exist The assumption that pain was the transmission of one type of sensory information Researchers tried to determine which type of receptor conveyed what type of sensory information

Theories of Pain The Gate Control Theory
Pain has sensory component, motivational and emotional components. Modulations begin in the spinal cord. The spinal cord act as a gate for the sensory input that the brain interprets as pain either increase (open the gate) or decrease (close the gate) the flow of neural impulses Central control trigger consisting of nerve impulses that descend from the brain and influence the gating mechanism. Cognitive processes can influence gate control E.g., Anxiety, worry, depression, and focusing on an injury can increase pain E.g., Distraction, relaxation, and positive emotions can cause decreasing pain

Theories of Pain The Gate Control Theory
Presynaptic inhibition of pain If sensory input enters into a heavily activated nervous system, then the stimulation may not be perceived as pain Explains how injuries can go virtually unnoticed

Theories of Pain Neuromatrix theory
An extension to the gate control theory The neuromatrix, a network of brain neurons acts even in the absence of sensory input, producing phantom limb sensations Pain perception is part of a complex process affected not only by sensory input but also by activity of the nervous system, by experience and expectation.

The Measurement of Pain
Pain is a subjective experience Accurate measurement is an issue Self-report ratings Behavioral assessments Physiological measures

Self-report ratings Rating Scales Rate the intensity of their pain on a scale from 0 to 10 (or 0 to 100) w/ 10 being the most excruciating pain possible and 0 being the complete absence of pain. The Visual Analog Scale Pain Questionnaires McGill Pain Questionnaire Multidimensional Pain Inventory Standardized Psychological Tests MMPI-2 for pain assessment is its ability to detect patients who are being dishonest about their experience of pain Beck Depression Inventory Symptom Checklist–90

Behavioral assessments observation of patients’ behavior groan, grimace, rub, sigh, limp, miss work, remain in bed suffering from pain lowered levels of activity use of pain medication body posture facial expressions Especially useful in assessing the pain of people who have difficulty furnishing self-reports—children, the cognitively impaired, and some elderly patients.

Physiological measures Electromyography (EMG) measures the level of muscle tension Pain increases muscle tension Autonomic indices hyperventilation, blood flow in the temporal artery, heart rate, hand surface temperature, finger pulse volume, and skin conductance level

Pain Syndromes Acute pain is both a blessing and a burden
Chronic pain serves no clear purpose categorized according to syndrome Headache and low back pain are the two most frequently treated pain syndromes

Headache Pain Headache pain is the most common of all types of pain
More than 99% of people experiencing headache The headache classification committee of the international headache society (IHS) The three primary pain syndromes are migraine, tension, and cluster headaches

Headache Pain Migraine headaches represent recurrent attacks of pain that vary widely in intensity, frequency, and duration. No clear reason known originating in the blood vessels in the head complex cascade of reactions that include neurons in the brain stem have a genetic component Migraine attacks often occur with loss of appetite, nausea, vomiting, and exaggerated sensitivity to light and sound. Migraine headaches often involve sensory, motor, or mood disturbances

Headache Pain Migraines also exist in two varieties:
those with aura & those without aura with aura, have identifiable sensory disturbances that precede the headache pain; w/out aura, have a sudden onset and an intense throbbing, usually (but not always) restricted to one side of the head. Women are two to three times more likely than men to have migraine headaches Most migraine patients experience their first headache before age 30 However, the period for the greatest frequency of migraines is between ages 30 – 50.

Headache Pain Tension headaches are muscular in origin, accompanied by sustained contractions of the muscles of the neck, shoulders, scalp, and face. Gradual onset Sensations of tightness; constriction or pressure; highly variable intensity, frequency, and duration; and a dull, steady ache on both sides of the head. People with this pain syndrome reported lost workdays and decreased effectiveness at work, home, and school because of their pain

Headache Pain Cluster headache
severe headache that occurs in daily or nearly daily clusters Some symptoms are similar to those of migraine, including severe pain and vomiting but cluster headaches are much briefer, rarely lasting longer than 2 hours The headache occurs on one side of the head often the eye on the other side becomes bloodshot and waters More common in men than in women, by a ratio of 2:1

Low Back Pain As many as 80% of people in the United States experience low back pain at some time Most injuries are not permanent, and most people recover Those who do not recover quickly have a poor prognosis and are likely to develop chronic pain problems Health care expenditures for these people total more than $90 billion a year in the United States The incidence of low back pain shows some variation for countries around the world produces direct expenses, such as medical care, and indirect costs, such as lost workdays disability, affecting people in countries around the world

Low Back Pain The most frequent cause of low back pain is probably injury or stress Pregnancy Aging Arthritis and osteoporosis Infections, degenerative diseases, and malignancies Psychological factors such as fear, anxiety, depression, a history of trauma and abuse, and reinforcement experiences, all of which are more common among chronic pain patients

Arthritis Pain Rheumatoid arthritis is an autoimmune disorder characterized by swelling and inflammation of the joints as well as destruction of cartilage, bone, and tendons. changes alter the joint, producing direct pain changes in joint structure lead to changes in movement, which may result in additional pain It is most prevalent among people 40 to 70 years old. Women are more than twice as likely as men to develop this disease Rheumatoid arthritis interferes with work, family life, recreational activities, and sexuality

Arthritis Pain Osteoarthritis is a progressive inflammation of the joints that produces degeneration of cartilage and bone It affects mostly older people causes a dull ache in the joint area, which worsens with movement; the resulting lack of movement increases joint problems and pain They often experience feelings of helplessness, depression, and anxiety, which exacerbate their pain

Arthritis Pain Fibromyalgia is a chronic pain condition characterized by tender points throughout the body. Accompanying symptoms of fatigue, headache, cognitive difficulties, anxiety, and sleep disturbance Diminishes quality of life

Cancer Pain More than 13 million people in the United States have a cancer diagnosis (Mariotto, Yabroff, Shao, Feuer, & Brown, 2011). Cancer can produce pain in two ways through its growth and progression through the various treatments to control its growth Some cancers are much more likely than others to produce pain. Head, neck, and cervical cancer patients experience more pain than leukemia patients Across countries, almost half of cancer patients’ pain was untreated

Phantom Limb Pain Pain can occur in the absence of injury
Phantom limb pain, the experience of chronic pain in a part of the body that is missing Amputation removes the nerves that produce the impulses leading to the experience of pain, but not the sensations The sensations often start soon after surgery as a tingling and then develop into other sensations that resemble actual feelings in the missing limb, including pain. Women who have undergone breast removal also perceive sensations from the amputated breast People who have had teeth pulled sometimes continue to experience feelings from those teeth

Phantom Limb Pain Amputees sometimes feel that a phantom limb is of abnormal size or in an uncomfortable position Phantom limbs can also produce painful feelings of cramping, shooting, burning, or crushing. Phantom pain remains over time Pain is more likely to occur in the missing limb when the person experienced a great deal of pain before the amputation Some authorities suggest that phantom limb pain has an emotional basis. This neuromatrix pattern continues to operate, even if the neurons in the peripheral nervous system do not furnish input to the brain.

Phantom Limb Pain Brain is capable of reorganization after injury, producing changes in the nervous system. Phantom limb pain may arise from changes that occur in both peripheral and central nervous systems after removal of the limb. Rather than compensate for the loss, the nervous system makes changes that are maladaptive, creating pain.

Medical approaches to managing pain
Drugs Analgesic drugs relieve pain without causing loss of consciousness The opiates and the nonnarcotic analgesics Both types exist naturally as derivatives of plants, and both have many synthetic variations. Contemporary opiate painkillers, suchh as morphine, codeine oxycodone, and hydrocodone the development of both tolerance and dependence. Tolerance is the body’s decreased responsiveness to a drug. When tolerance occurs, larger and larger doses of a drug are required to bring about the same effect. Dependence occurs when the drug’s removal produces withdrawal symptoms. Because opiates produce both tolerance and dependence, they are potentially dangerous and subject to abuse.

Drugs (cont’d) The risk of addiction is less than 1% The number of chronic pain patients who develop an addiction to opiate pain medications is less than 4% of the number who are prescribed them The best predictor of opiate painkiller abuse is personal history of illegal drug and alcohol use People who misuse these substances are more likely to also misuse opiate painkillers No other type of drug produces more complete pain relief Wariness about abuse of these drugs affects both physicians, who are reluctant to prescribe them People with either acute or chronic pain frequently fail to receive sufficient relief.

Drugs (cont’d) Self-paced administration activate a pump attached to their intravenous lines and deliver a dose of medication whenever they wish, within well-defined limits. Wide acceptance because patients tend to use less medication, obtain better pain relief and experience higher satisfaction Patient-controlled transdermal delivery system

Drugs (cont’d) Whereas undermedication may be a problem for cancer pain patients, overmedication is often a problem for patients suffering from low back pain. Low back pain patients who use pain medication have poorer outcomes, more health problems, and higher costs than those who do not. The nonnarcotic analgesics include a variety of nonsteroidal anti-inflammatory drugs (NSAIDs) & Acetaminophen Aspirin, ibuprofen, and naproxen sodium appear to block the synthesis of prostaglandins A class of chemicals released by damaged tissue and involved in inflammation

Drugs (cont’d) The nonnarcotic analgesics act at the site of injury instead of crossing into the brain They change neurochemical activity in the nervous system and affect pain perception Pain that occurs without inflammation is not so readily relieved by NSAIDs NSAIDs can irritate and damage the stomach lining Even producing ulcers Aspirin’s side effects include the alteration of blood clotting time, and aspirin and other NSAIDs are toxic in large doses, causing damage to the liver and kidneys. Acetaminophen Pain-relieving capability similar to that of aspirin Large quantities of acetaminophen can be fatal

Drugs (cont’d) Antidepressant drugs and drugs used to treat seizures also influence pain perception, and these drugs can be used to treat some types of pain. Antidepressants can be useful in treating low back pain Some types of anticonvulsant medication can help people with migraine headaches Even the variety of drugs and strategies for their use are not adequate for many people with chronic pain. Those individuals may consider surgery or other treatments to attain relief.

Surgery aims to repair the source of the pain or alter the nervous system to alleviate the pain Low back surgery is the most common surgical approach to pain Surgery can also alter nerves that transmit pain This procedure may use heat, cold, or radiofrequency stimulation to change neural transmission and control pain. Another tactic for altering pain through changing nerve transmission involves stimulation of nerves through implanted wires that stimulate rather than damage nerves. Activation of the system produces pain relief by activating neurons and by releasing neurotransmitters that block pain

Spinal stimulation is a promising technique for controlling back pain Surgery has at least two limitations as a treatment for pain. It does not always repair damaged tissue It does not provide all patients with sufficient pain relief.

Behavioral techniques for managing pain
Relaxation training Behavioral therapy Cognitive therapy Cognitive behavioral therapy

Relaxation training used successfully to treat pain problems such as tension and migraine, rheumatoid arthritis, and low back pain typically functions as part of a multicomponent program

Behavioral therapy behavior modification based on operant conditioning the goal of behavior modification is to shape behavior, not to alleviate feelings or sensations of pain. positive reinforcers that frequently follow pain behaviors include attention from family, relief from normal responsibilities, compensation from employers, and medications that people receive from physicians create chronic pain works against pain traps identifying the reinforcers training people in the patient’s environment use praise and attention to reinforce more desirable behaviors withhold reinforcement when the patient exhibits less desired pain behaviors

Behavioral therapy (cont’d) Objective outcomes indicate progress the amount of medication taken absences from work time in bed or off one’s feet number of pain complaints physical activity, range of motion, and length of sitting tolerance Behavioral approach can decrease pain intensity, reduce disability, and improve quality of life

Cognitive therapy based on the principle that people’s beliefs, personal standards, and feelings of self-efficacy strongly affect their behavior concentrate on techniques designed to change cognitions, assuming that behavior will change when a person alters his or her cognitions. irrational thoughts, are the root of behavior problems. Pain-related catastrophizing The tendency to catastrophize is associated with the magnification of pain, both acute & chronic pain

Cognitive behavioral therapy assumes that thoughts and feelings are the basis of behavior modifying environmental contingencies and building skills to change observable behavior includes strategies for addressing the harmful cognitions that are common among chronic pain patients, such as fear and catastrophizing.

Cognitive behavioral therapy (cont’d) Pain inoculation program Reconceptualization stage patients learn to accept the importance of psychological factors for at least some of their pain often receive an explanation of the gate control theory of pain Acquisition and rehearsal stage learning relaxation and controlled breathing skills. Follow-through stage instructions to spouses and other family members ignore patients’ pain behaviors reinforce such healthy behaviors E.g., Physical activity, decreased use of medication, fewer visits to the pain clinic, or an increased number of days at work construct a posttreatment plan for coping with future pain apply their coping skills to everyday situations outside the pain clinic

Cognitive behavioral therapy Acceptance and commitment therapy (ACT) acceptance of the pain focusing attention on other goals and activities that individual values especially helpful for chronic pain patients

Fin...

Pain Assist. Prof. Merve Topcu PSY 411 Health Psychology

Similar presentations

Presentation on theme: "Pain Assist. Prof. Merve Topcu PSY 411 Health Psychology"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Pain Assist. Prof. Merve Topcu PSY 411 Health Psychology

Similar presentations

Presentation on theme: "Pain Assist. Prof. Merve Topcu PSY 411 Health Psychology"— Presentation transcript:

Similar presentations

About project

Feedback