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Week 6 Lecture 3

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by: Brittany Notetaker

Week 6 Lecture 3 Psych 150

Brittany Notetaker

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Pain Chapter 10 Learning objectives: You should be able to… 1) Compare and contrast the one-to-one model of pain with biopsychosocial models of pain. 2) Illustrate how biopsychosocial models of ...
Introduction to Health Psychology
Ted Robles
Class Notes
Psychology 150 Week 6 Lecture 6
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"Same time next week teach? Can't wait for next weeks notes!"
Henderson Schneider

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This 4 page Class Notes was uploaded by Brittany Notetaker on Friday February 19, 2016. The Class Notes belongs to Psych 150 at University of California - Los Angeles taught by Ted Robles in Winter 2016. Since its upload, it has received 28 views. For similar materials see Introduction to Health Psychology in Psychlogy at University of California - Los Angeles.

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Date Created: 02/19/16
Pain 1 Learning objectives: You should be able to… 1) Compare and contrast the one-to-one model of pain with biopsychosocial models of pain. 2) Illustrate how biopsychosocial models of pain can be applied to treating patients with chronic pain SCREENCAST: What is pain? Sensory and emotional experience of discomfort, usually associated with actual or threatened tissue damage or irritation Different types of pain Acute: short-lived, usually due to injury, tissue damage Chronic: Prolonged, persistent; at least 3 months duration Recurrent acute: Brief bouts, but chronic Chronic benign: Does not respond to treatment Chronic progressive: Increases in severity Hyperalgesia: Increased pain sensitivity What is the societal impact of chronic pain? What kinds of suffering occur with chronic pain? Are there objective measures of pain? Self-report measures Pain behaviors “Physical” measures Biological bases of pain perception (nociception) Nociceptors  Mechanical damage  Thermal damage  Polymodal – thermal, mechanical, chemical Nerve fiber transmission Fast nerve fibers Slow nerve fibers Key neurotransmitters involved in pain perception  Substance P  Myelinated  Unmyelinated  Sharp, localized  Polymodal pain  Glutamate pain  Endogenous opioid peptides  Dull, aching pain o Beta-endorphins  Serve skin, mucous  All body tissues membranes except the brain Pain 2 o Enkephalins Models of pain One­to­one model Brain Early model – one-to-one relationships between:  Tissue injury and pain o The level of pain should be proportional to your injury. E.g. cutting off one or your arms should hurt less compared to cutting both From pain fibers arms. *Injury and pain should have a one- Transmission cells to- one relationship, more injury more pain.  Analgesia dose (pain medication dose) and pain relief Spinal cord o If you take greater dose of pain medication, that should reduce your pain more. What were Henry Beecher’s observations about pain in soldiers vs. civilian patients? He noticed that soldiers with really serious wounds had fewer pain complaints compared to when they returned home from war civilians who were being hospitalized b/c of injury. Phenomena that cannot be reconciled with one-to-one models of pain: 1. The variable relationship between injury and pain 2. Non-noxious stimuli can sometimes produce pain (ex: allodynia) 3. Location of pain and tissue damage is sometimes different (extreme example: phantom limb pain) 4. Pain can persist long after tissue healing 5. Nature of pain and location can change over time 6. Pain is multi-dimensional 7. Biomedical pain treatment doesn’t often work Biopsychosocial models: Gate-control theory Gate control theory  Sensations that signal pain are modified  Neural “gate” regulates pain experience Signals coming from you rain receptors get modified before they get sent to your brain. In particular the pain receptor gets modified by some sort of neural gate that regulates the flow of pain transmission to your brain. From pain fibers Gate Transmission cells Gate open= more pain signals sent to your brain. Gate closed= less pain signals sent to your brain. From other peripheral fibers “Gate open” “Gate less open” From pain fibers From pain fibers Gate Transmission cells Gate Transmission cells From other peripheral fibers From other peripheral fibers Pain 3 Open (more pain) Close (less pain) Extent of injury Medication Physical Inappropriate activity level Counterstimulation factors Appropriate activity level Rest Negative emotions Relaxation Emotio Positive emotions ns Focusing on pain Life involvement, interest Boredom Concentration/distraction Though Maladaptive attitudes and Adaptive attitudes and ts expectations thoughts FOCUS ON THE THOUGHTS PART ABOVE Thoughts: Appraisals, maladaptive beliefs Appraisals Beliefs Harm Catastrophizing Threat Fear avoidance Perceived control Self-efficacy *It turns out that having these negative appraisals about pain such as viewing pain as a sign of damage or that you should stop engaging in activity or that pain will lead to disability, is related to more pain. One of the ways to help or manage chronic pain is that you can help work with them to reduce their negative appraisals about pain. Catastrophizing: when individuals experience pain they think the worst is going to happen such that they will be totally disabled to do anything. Those individuals report and experience more pain. If you help them reduce this, you can actually help them manage their pain and report less pain. Treatments for pain Medications: Surgery Chiropractic manipulations Analgesics Antianxiety meds Nerve blocks Opioids – target CNS Acupuncture Nonopioids – target Muscle relaxants Trigger point injections peripheral nervous Biofeedback system Anticonvulsants Counterirritation (e.g., TENS, spinal cord Antidepressants Topical agents stimulators) Does cognitive behavioral therapy for chronic pain work?  Effective treatment across 20+ studies (median effect size = 0.5; Morley, Eccleston, Williams, 1999)  Equal effective as spinal fusion for low back pain (Brox et al., 2003, 2006)  Improvements in pain, quality of life, and cost-effectiveness after 5 years (Linton & Nordin, 2006) Interdisciplinary pain rehabilitation programs (Physicians, physical therapists, occupational therapists, psychologists)  3-4 week programs, ~8 hr/day, in groups Pain 4  Similar pain outcomes as conventional treatment  Effective in reducing health care consumption MYTHS about pain (Turk & Winter, 2006) 1. Pain is ALWAYS a reliable signal of physical damage and injury 2. When no clear physical damage is found, pain must be imaginary 3. Chronic pain that does not respond to standard treatment should not be taken seriously


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