Pain Management Pain (causes and effects)

1. Department of Applied Psychology
Government College University, Faisalabad

2. Health Psychology
Course code Psy-558 Credit hrs. 3(3-0)
Lecture 8
Pain
Types
Theories
Pathways
Course Instructors
Ms. Nazia Yaqoob
Ms. Rabiya Amer
Ms. Maryam Shahzadi

4. Pain is "an unpleasant sensory and emotional
experience associated with actual or potential tissue
damage, or described in terms of such damage".
(International Association for study of pain).
Pain is a signal in your nervous system that something
may be wrong. It is an unpleasant feeling, such as a prick,
tingle, sting, burn, or ache.

5.  Pain is the most common health problem that leads people
to seek medical help.
 Pain is viewed as merely a ‘‘signal’’ that something is wrong
somewhere in the body, until it reaches the emotional brain,
where this signal becomes what we feel as pain.
 Thus it is medically significant as it encourages people to
take medications or precautions.

6.  It also provides feedback about the functioning of our
bodily systems and help us to make adjustment in our
postures.
 It has psychological consequences and can generate fear
and anxiety.

7. Elusive nature of pain
 Pain is considered as a psychological experience
 As it may be sharp or dull.
 It can be consistent, can start and stop.

8. Elusive nature of pain
 The degree to which it is felt and how incapacitating it is
depend in large part on how it is interpreted some persons
have high tolerance for pain while others have low tolerance.
 As the Livingstone (1943) defined “pain as a subjective &
individual experience modified by degrees of attention,
emotional state and the conditioning of past experiences.”

9. Elusive nature of pain
 Thus the intensity of pain is not proportional to
the degree of suffering, but on the
interpretation of the experience.

10. Elusive nature of pain
 The context in which pain is experienced also have
an effect on its reaction like athletes in field show
more tolerance
 Culture and gender also have an impact on the
experience of pain

11. Review what we have discussed so
far….

12. Classification of pain
Pain is mostly classified in two types
 Acute pain is the pain which is confined to a restricted area
of tissue damage and is short timed.
 Mostly the duration is 6 months, once the damaged tissue is
repaired the pain subsides.

13. Acute pain
 It is characteritized by injury of body tissues and activation of
nociceptive receptors at the site of tissue damage. (picone,
2012)
 Painkillers are effective for
treating acute pain.

14.  Chronic pain is the pain which lasts longer than 6
months and has mild to severe recurrent episodes.
 This pain does not resolve with treatment and does not
have a identifiable cause e.g. arthritis, back pain.

15. Chronic pain
 Chronic pain is associated with other symptoms like
fatigue, insomnia, irritability, frustration
 It may not be caused by any injury

17.  Other types of pain
 Chronic Benign pain
 It is a non cancer pain
 That is mostly unresponsive to treatment

18.  Chronic cancer pain
 It is caused by tumor progression,
 malignancies
 or degenerative disorders like arthritis

19.  Chronic episodic pain

This type of pain involves recurrent
episodes of varying intensity

The pain episode can last for days and
even weeks e.g. migraine.

20.  Referred Pain
 It is a type of pain which is perceived at distance from the
actual origin of pain.
 Brain misinterprets signals as coming from the somatic
regions

21.  Nociceptive pain
 It is the result of
activation of
nociceptors

22.  Visceral Pain

It is caused by stimulation of receptors in
internal organs i.e. abdomen, skeleton,
heart.

23.  Somatogenic pain
 It is caused by the real physical origin e.g. fracture,
injury in bones, joints.

24.  Neuropathic Pain
 It results from the direct injury or
aletrnations to nerves in the peripheral
nervous system (diabetic neuropathy,
alcoholism etc.)

25.  Psychogenic pain

It is like an imaginary pain with no
physical cause.

27.  The Pain pathways

Transduction noxious (painful) stimulus is
detected by afferent nerve endings and is
translated into nociceptive impulses.
 Three types of afferent nerves are present

A-beta information related to touch,
 A-delta information related to pain and
temperature and
 C-fibers information related to pain,
temperature and itching.

28.  Transmission

The impulses are sent to the dorsal horn of
the spinal cord and then to the brain.

A-delta & C-fibers transmit the impulses

29.  Modulation

It is the process in which the pain related
signal is either reduced or enhanced.

Periaqueductal gray in midbrain is involved
in pain modulation.

31.  Take a short break

Get yourself relax

& Think what type of pain you mostly
experience?

Classify your experience of pain
according to the types we have
discussed

32. Theories of pain
 Biomedical theory
 The theory stated that pain is the consequence of tissue damage,
 It is an automatic response to an external factor.
 Mental or psychological processes have no role in pain causation.

33.  Specificity Theory
 It is proposed by Rene Descartes in 17th century.
 According to this theory there is a direct
relationship between nerve endings and pain spots
on our body.

34. Specificity theory (contin)
 Pain is travelled through brain by the same
pathways which are used by other sensations.
 It states that pain is a specific sensation, with its
own sensory apparatus independent of touch and
other senses

35.  Intensity theory
 It stated that pain is produced when any sensory
nerve is stimulated beyond a certain level i.e.
high intensity stimulation on sensory nerves
produces pain.

36. Intensity Theory
• However Trigeminal system does not support
this theory. As according to trigeminal system a
person can experience severe pain even by a
gentle touch applied to a trigger zone.
• Thus this theory is not accepted but still its
explanation is considered important that
intensity of stimulation can cause pain.

37.  Gate Control Theory
 Melzack and Wall (1965) proposed the idea of neural gate that
regulates the experience of pain. Thus it states that pain has
physiological as well as psychological causes.
 The brain send information to the gate about the behavior (attention,
focus on the source of pain), emotional state (anxiety, fear) and control
(self-efficacy) of a person.

38.  Gate control (conti)
 Nociceptors in the peripheral nerves first sense injury
and, in response, release chemical messengers, which
are conducted to the spinal cord, where they are passed
directly to the reticular formation and thalamus and
into the cerebral cortex.
 These regions of the brain, in turn, identify the site of
the injury and send messages back down the spinal
cord, which lead to muscle contractions, which can help
block the pain, and changes in other bodily functions,
such as breathing.

39. Gate control (conti)
 Two types of peripheral nerve fibers are involved in this process.
 A-delta fibers are small, myelinated fibers that transmit sharp pain.
They respond especially to mechanical or thermal pain, transmitting
sharp, brief pains rapidly 100 m/s
 C-fibers are unmyelinated nerve fibers, involved in polymodal pain,
that transmit dull, aching pain 0.5-2 m/s

40. Gate control (conti)
 The interplay among these connections determines when
painful stimuli go to the brain.
 When no input comes in, the inhibitory neuron prevents the
projection neuron from sending signals to the brain (gate is
closed).

41. Gate control (conti)
 Normal somatosensory input happens when there is more
large-fiber stimulation (or only large-fiber stimulation).
 Both the inhibitory neuron and the projection neuron are
stimulated, but the inhibitory neuron prevents the projection
neuron from sending signals to the brain (gate is closed).
 Nociception (pain reception) happens when there is more
small-fiber stimulation or only small-fiber stimulation. This
inactivates the inhibitory neuron, and the projection neuron
sends signals to the brain informing it of pain (gate is open).

42. Gate closed
Gate open

43. Which theory in your opinion explain the
pain well???
Explain your answer???

44.  References

Taylor, S. H. (2018). Health Psychology. McGraw-Hill
education: New York.

Ghosh, M. (2015). Health Psychology: Concepts in Health
and Wellbeing. Pearson Education: India.

45. CLASS DISCUSSION