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Pain
Behavioral sciences
• What is pain ?
1
• 1- Pain provides constant feedback about the body
enabling us to make adjustments to how we sit or
sleep
• 2-. Pain is often a warning sign that something is wrong
and results in protective behavior such as avoiding
moving in a particular way or lifting heavy objects
• 3- . Pain also triggers help seeking behavior and is a
common reason for patients visiting their doctor.
• 4- Pain also has psychological consequences and can
generate fear and anxiety.
2
• From an evolutionary perspective Its function
to generate change either in the form of
seeking help or avoiding activity.
3
• However, pain is not that simple. Some pain
seems to have no underlying cause and
functions to hinder rather than to help a
person carry on with their lives. Such pain has
a strong psychological component.
4
• Acute pain is defined as pain which lasts for
six months or less. It usually has a definable
cause and is mostly treated with pain killers. A
broken leg or a surgical wound is an example
of acute pain
5
• chronic pain lasts for longer than six months
and can be either benign in that it varies in
severity or progressive in that it gets gradually
worse. Chronic low back pain is often
described as chronic benign pain whereas
illnesses such as rheumatoid arthritis result in
chronic progressive pain. Most of the
researchers concerned with chronic pain
which shows an important role for
psychological factors.
EARLY PAIN THEORIES – PAIN AS A SENSATION
• 1-Early models of pain described pain within a
biomedical framework as an automatic
response to external factors
• 2-It suggested that there were specific sensory
receptors which transmit touch, warmth and
pain, and that each receptor was sensitive to
specific stimulation.
• 3-suggested that nerve impulse patterns
determined the degree of pain and that
messages from the damaged area were sent
directly to the brain via these nerve impulses.
• These models of pain describe pain in the
following ways:
• 1- Tissue damage causes the sensation of pain
 2-Psychology is involved in these models of
pain only as a consequence of pain (e.g.
anxiety, fear, depression). Psychology has no
causal influence.
 3-Pain is an automatic response to external stimuli.
There is no place for interpretation or moderation
• 4-The pain sensation has a single cause
 5- Pain was categorized into being either psychogenic
pain or organic pain. Psychogenic pain was considered
to be ‘all in the patient’s mind’ and was a label given to
pain when no organic basis could be found. Organic
pain was regarded as being ‘real pain’ and was the
label given to pain when some clear injury could be
seen.
INCLUDING PSYCHOLOGY IN THEORIES OF PAIN
• First, it was observed that medical treatments for
pain (e.g. drugs, surgery) were, in the main, only
useful for treating acute pain (i.e. pain with a
short duration). Such treatments were fairly
ineffective for treating chronic pain (i.e. pain
which lasts for a long time). This suggested that
there must be something else involved in the
pain sensation which was not included in the
simple stimulus response models.
2
• It was also observed that individuals with
the same degree of tissue damage differed
in their reports of the painful sensation
and/or painful responses
• The third observation was phantom limb pain. The
majority of amputees tend to feel pain in an absent
limb. This pain can actually get worse after the
amputation, and continues even after complete
healing, Phantom limb pain has no peripheral physical
basis because the limb is obviously missing. In addition,
not everybody feels phantom limb pain and those who
do, do not experience it to the same extent. Further,
even individuals who are born with missing limbs
sometimes report phantom limb pain.
• Four under deep hypnosis major surgical
procedures may be done without pain
THE GATE CONTROL THEORY OF PAIN
• Melzack and Wall (1965) developed the gate control
theory of pain (GCT), which represented an attempt to
introduce psychology into the understanding of pain
• It suggested that although pain could still be understood
in terms of a stimulus–response pathway, this pathway
was complex and mediated by a network of interacting
processes. Therefore, the GCT integrated psychology into
the traditional biomedical model of pain and described not
only a role for physiological causes and interventions, but
also allowed for psychological causes and interventions.
• 1- Peripheral nerve fibers ( small) fibers . The
site of injury sends information about pain,
pressure or heat to the gate
• 2-C-fibers ( in anterior ganglion ) of spinal cord
• 3- psychological state of the individual ( mood,
behavior )
• 4- deep psychological memories about pain
expectations, experiences
• Output from the gate
• The gate integrates all of the information from
these different sources and produces an
output. This output from the gate sends
information to an action system, which results
in the perception of pain.
• What opens the gate?
• 1- Physical factors, such as injury or activation
of the large fibers
• 2-Emotional factors, such as anxiety, worry,
tension and depression
• 3- Behavioral factors, such as focusing on the
pain or boredom
• What closes the gate?
• 1- Physical factors, such as medication,
stimulation of the small fibers
• 2-Emotional factors, such as happiness,
optimism or relaxation
• 3- Behavioral factors, such as concentration,
distraction or involvement in other activities
THE ROLE OF PSYCHOSOCIAL FACTORS IN
PAIN PERCEPTION
Classical conditioning
• An individual may associate a particular
environment with the experience of pain. For
example, if an individual associates the
dentist with pain due to past experience,
the pain perception may be enhanced when
attending the dentist due to this expectation ,
In addition, because of the association
between these two factors, the individual may
experience increased anxiety when attending
the dentist, which may also increase pain
Operant conditioning
• Research suggests that there is also a role for
operant conditioning in pain perception.
Individuals may respond to pain by showing
pain behavior (e.g. resting, grimacing, limping,
staying off work). Such pain behavior may be
positively reinforced (e.g. sympathy, attention,
time off work-as reinforcement factor), which
may itself increase pain perception
Anxiety and fear
• Patients worry about their pain increases the pain
• the successful treatment for the pain then
decreases the pain which subsequently decreases
the anxiety (acute pain)
• the relationship between anxiety and chronic
pain , there is a cycle of pain increase( the
cycle pain -anxiety – more pain in chronic pain
may be interrupted by psychotropic drugs or
psychotherapy
The role of cognition
• A- Catastrophizing
• Patients with pain, particularly chronic pain, in line
with many other patients often show catastrophizing
, catastrophizing as involving three components
• 1-Rumination: a focus on threatening information
both internal and external
• 2-Magnification: overestimating the extent of the
threat
• 3-Helplessness: underestimating personal and broader
resources which might mitigate the danger and
disastrous consequences
• B-Meaning:
• Although at first glance any pain would
seem to be only negative in its meaning,
but that pain can have a range of
meanings to different people ,
• C- Self-efficacy :
• The role of self-efficacy in pain perception and
reduction suggest that increased pain self-
efficacy may be an important factor in
determining the degree of pain perception. In
addition, the concept of pain locus of
control has been developed to emphasize
the role of individual cognitions in pain
perception
• C- Attention
• Much work shows that attention to the pain can
exacerbate pain whereas distraction can reduce
the pain experience; pain causes a shift in
attention towards the pain as a way to encourage
escape and action. The result of this shift in
attention towards the pain is a reduced ability to
focus on other tasks resulting in intentional
interference and disruption
Behavioral processes
• The way in which an individual responds to
the pain can itself increase or decrease the
pain perception ( from the school of cognitive
behavior psychotherapy , we know the way
we behave determine our feeling and
understanding ) .
THE ROLE OF PSYCHOLOGY IN PAIN
TREATMENT
• Acute pain is mostly treated with pharmacological
interventions. However, chronic pain has proved to be
more resistant to such approaches and recently,
multidisciplinary pain clinics have been set up that adopt a
multidisciplinary approach to pain treatment. The goals
set by such clinics include:
• Increasing social support and family life: this aims to
increase optimism and distraction and decrease boredom,
anxiety, sick role behavior and secondary gains.
• Using psychotherapy (cognitive behavior psychotherapy
and hypnosis, psychotropic drugs anxiolytics and
antidepressants )

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Pain

  • 2. • What is pain ?
  • 3. 1 • 1- Pain provides constant feedback about the body enabling us to make adjustments to how we sit or sleep • 2-. Pain is often a warning sign that something is wrong and results in protective behavior such as avoiding moving in a particular way or lifting heavy objects • 3- . Pain also triggers help seeking behavior and is a common reason for patients visiting their doctor. • 4- Pain also has psychological consequences and can generate fear and anxiety.
  • 4. 2 • From an evolutionary perspective Its function to generate change either in the form of seeking help or avoiding activity.
  • 5. 3 • However, pain is not that simple. Some pain seems to have no underlying cause and functions to hinder rather than to help a person carry on with their lives. Such pain has a strong psychological component.
  • 6. 4 • Acute pain is defined as pain which lasts for six months or less. It usually has a definable cause and is mostly treated with pain killers. A broken leg or a surgical wound is an example of acute pain
  • 7. 5 • chronic pain lasts for longer than six months and can be either benign in that it varies in severity or progressive in that it gets gradually worse. Chronic low back pain is often described as chronic benign pain whereas illnesses such as rheumatoid arthritis result in chronic progressive pain. Most of the researchers concerned with chronic pain which shows an important role for psychological factors.
  • 8. EARLY PAIN THEORIES – PAIN AS A SENSATION • 1-Early models of pain described pain within a biomedical framework as an automatic response to external factors • 2-It suggested that there were specific sensory receptors which transmit touch, warmth and pain, and that each receptor was sensitive to specific stimulation. • 3-suggested that nerve impulse patterns determined the degree of pain and that messages from the damaged area were sent directly to the brain via these nerve impulses.
  • 9. • These models of pain describe pain in the following ways: • 1- Tissue damage causes the sensation of pain  2-Psychology is involved in these models of pain only as a consequence of pain (e.g. anxiety, fear, depression). Psychology has no causal influence.
  • 10.  3-Pain is an automatic response to external stimuli. There is no place for interpretation or moderation • 4-The pain sensation has a single cause  5- Pain was categorized into being either psychogenic pain or organic pain. Psychogenic pain was considered to be ‘all in the patient’s mind’ and was a label given to pain when no organic basis could be found. Organic pain was regarded as being ‘real pain’ and was the label given to pain when some clear injury could be seen.
  • 11. INCLUDING PSYCHOLOGY IN THEORIES OF PAIN • First, it was observed that medical treatments for pain (e.g. drugs, surgery) were, in the main, only useful for treating acute pain (i.e. pain with a short duration). Such treatments were fairly ineffective for treating chronic pain (i.e. pain which lasts for a long time). This suggested that there must be something else involved in the pain sensation which was not included in the simple stimulus response models.
  • 12. 2 • It was also observed that individuals with the same degree of tissue damage differed in their reports of the painful sensation and/or painful responses
  • 13. • The third observation was phantom limb pain. The majority of amputees tend to feel pain in an absent limb. This pain can actually get worse after the amputation, and continues even after complete healing, Phantom limb pain has no peripheral physical basis because the limb is obviously missing. In addition, not everybody feels phantom limb pain and those who do, do not experience it to the same extent. Further, even individuals who are born with missing limbs sometimes report phantom limb pain.
  • 14. • Four under deep hypnosis major surgical procedures may be done without pain
  • 15. THE GATE CONTROL THEORY OF PAIN • Melzack and Wall (1965) developed the gate control theory of pain (GCT), which represented an attempt to introduce psychology into the understanding of pain • It suggested that although pain could still be understood in terms of a stimulus–response pathway, this pathway was complex and mediated by a network of interacting processes. Therefore, the GCT integrated psychology into the traditional biomedical model of pain and described not only a role for physiological causes and interventions, but also allowed for psychological causes and interventions.
  • 16. • 1- Peripheral nerve fibers ( small) fibers . The site of injury sends information about pain, pressure or heat to the gate • 2-C-fibers ( in anterior ganglion ) of spinal cord • 3- psychological state of the individual ( mood, behavior ) • 4- deep psychological memories about pain expectations, experiences
  • 17.
  • 18. • Output from the gate • The gate integrates all of the information from these different sources and produces an output. This output from the gate sends information to an action system, which results in the perception of pain.
  • 19. • What opens the gate? • 1- Physical factors, such as injury or activation of the large fibers • 2-Emotional factors, such as anxiety, worry, tension and depression • 3- Behavioral factors, such as focusing on the pain or boredom
  • 20. • What closes the gate? • 1- Physical factors, such as medication, stimulation of the small fibers • 2-Emotional factors, such as happiness, optimism or relaxation • 3- Behavioral factors, such as concentration, distraction or involvement in other activities
  • 21. THE ROLE OF PSYCHOSOCIAL FACTORS IN PAIN PERCEPTION
  • 22. Classical conditioning • An individual may associate a particular environment with the experience of pain. For example, if an individual associates the dentist with pain due to past experience, the pain perception may be enhanced when attending the dentist due to this expectation , In addition, because of the association between these two factors, the individual may experience increased anxiety when attending the dentist, which may also increase pain
  • 23. Operant conditioning • Research suggests that there is also a role for operant conditioning in pain perception. Individuals may respond to pain by showing pain behavior (e.g. resting, grimacing, limping, staying off work). Such pain behavior may be positively reinforced (e.g. sympathy, attention, time off work-as reinforcement factor), which may itself increase pain perception
  • 24. Anxiety and fear • Patients worry about their pain increases the pain • the successful treatment for the pain then decreases the pain which subsequently decreases the anxiety (acute pain) • the relationship between anxiety and chronic pain , there is a cycle of pain increase( the cycle pain -anxiety – more pain in chronic pain may be interrupted by psychotropic drugs or psychotherapy
  • 25. The role of cognition • A- Catastrophizing • Patients with pain, particularly chronic pain, in line with many other patients often show catastrophizing , catastrophizing as involving three components • 1-Rumination: a focus on threatening information both internal and external • 2-Magnification: overestimating the extent of the threat • 3-Helplessness: underestimating personal and broader resources which might mitigate the danger and disastrous consequences
  • 26. • B-Meaning: • Although at first glance any pain would seem to be only negative in its meaning, but that pain can have a range of meanings to different people ,
  • 27. • C- Self-efficacy : • The role of self-efficacy in pain perception and reduction suggest that increased pain self- efficacy may be an important factor in determining the degree of pain perception. In addition, the concept of pain locus of control has been developed to emphasize the role of individual cognitions in pain perception
  • 28. • C- Attention • Much work shows that attention to the pain can exacerbate pain whereas distraction can reduce the pain experience; pain causes a shift in attention towards the pain as a way to encourage escape and action. The result of this shift in attention towards the pain is a reduced ability to focus on other tasks resulting in intentional interference and disruption
  • 29. Behavioral processes • The way in which an individual responds to the pain can itself increase or decrease the pain perception ( from the school of cognitive behavior psychotherapy , we know the way we behave determine our feeling and understanding ) .
  • 30. THE ROLE OF PSYCHOLOGY IN PAIN TREATMENT • Acute pain is mostly treated with pharmacological interventions. However, chronic pain has proved to be more resistant to such approaches and recently, multidisciplinary pain clinics have been set up that adopt a multidisciplinary approach to pain treatment. The goals set by such clinics include: • Increasing social support and family life: this aims to increase optimism and distraction and decrease boredom, anxiety, sick role behavior and secondary gains. • Using psychotherapy (cognitive behavior psychotherapy and hypnosis, psychotropic drugs anxiolytics and antidepressants )