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Health Psychology

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Pain is the sensory and emotional experience of discomfort which is usually ... Muscle tension (Electromyograph, EMG) Indices of autonomic activity ... – PowerPoint PPT presentation

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Title: Health Psychology


1
Health Psychology
  • Lecture 5
  • Pain

2
Lecture 5 - Outline
  • Part 1
  • Anna Nagy (Stress)
  • Part 2
  • Duane (Pain)
  • Part 3
  • Term Test 1 Preparation

3
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)

4
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

5
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

6
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)

7
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

8
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9
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

10
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11
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

12
Assessing or Measuring Pain
  • 1. Psychophysiological measures
  • Muscle tension (Electromyograph, EMG)
  • Indices of autonomic activity
  • Heart rate (ECG), skin conductance
  • Evoked potentials (EEG)

13
Assessing or Measuring Pain
  • 2. Measurement of Pain Behaviors
  • Behavior checklist
  • 3. Self-report measures
  • Interview
  • Rating Scales
  • Pain Questionnaires (McGill Pain Questionnaire)

14
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15
McGill Pain Questionnaire
  • Measures 3 dimensions of pain experience
  • Sensory - location, temporal pattern, quality
  • Affective - emotional response (e.g., annoying)
  • Evaluative - perceived intensity

16
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17
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19
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20
Pain Management
  • Physical/Medical Treatment
  • Chemical Analgesia (pain relief)
  • Narcotics (e.g., morphine)
  • Peripherally acting analgesics (e.g., asprin)

21
Pain Management
  • Physical/Medical Treatment
  • Surgical approaches
  • Severing peripheral nerves
  • Spinal tracts

22
Pain Management
  • Physical/Medical Treatment
  • Acupuncture
  • insertion of metal needles under the skin at
    acupuncture points
  • Endorphins and enkephalins

23
Pain Management
  • Physical/Medical Treatment
  • Transcutaneous Electrical Nerve Stimulation
  • Electrodes on area of pain
  • Stimulates non-pain fibers (A-beta)

24
Pain Management
  • Psychological Intervention
  • Hypnosis
  • Altered state of consciousness
  • Produces a high degree of analgesia in a minority
    of individuals

25
Pain Management
  • Psychological Intervention
  • Biofeedback
  • Feedback using EMG (muscle tension)
  • Teaches awareness and control of bodily processes

26
Pain Management
  • Psychological Intervention
  • Relaxation Techniques
  • Meditation, progressive muscle relaxation
  • Relaxation reduces anxiety

27
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

28
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

29
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)

30
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31
Current Topics
  • Effects on Cognition/Learning and Memory
  • Animal researchHow stress affects the brain
  • Hippocampushigh concentration of GC receptors
  • StressIncreased 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

32
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?

33
Allostasis
  • Allostasis ability to achieve stability through
    changecrucial 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

34
The Stress Response and the Development of
Allostatic Load
Stress Response and Development of Allostatic
Load. (McEwen, 1998)
35
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
    systemscompensatory responses in other systems
    (disruption of counter-regulatory mechanisms)

36
HPA
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