PAIN

Health Psychology
GROUP MEMBERS

Usama-Bin-Fiaz

Muhammad Hafeez
Sohail Ali
 DEFINATION OF PAIN

Pain is an unpleasant sensory and emotional experience associated

with the actual and potential tissue damage.

(Fishman, Ballantyne and Rathmell. 2011)

 TYPES OF PAIN

There are several types of pain. Main types are listed below.

1) Acute pain

2) Chronic pain

3) Referred pain

4) Phantom pain
 ACUTE PAIN

Acute pain is characterized by injury of body tissues and activation

of nociceptive transducer at the site of local tissue damage. Acute
pain is severe as compare to the chronic pain.
 CHRONIC PAIN

Chronic pain is characterized by injury or disease that is caused by

remote factors. The chronic pain extend for long period of time. It's
represented level of pain is low as compared to acute pain.
 REFERRED PAIN

Referred pain is defined as the perceived pain at a site nearby or

event at a distance from the pains origin.
 PHANTOM PAIN

Phantom pain sensation refers to the perception of a variety of

physical feelings in a part of the body that has been removed.
Although this is generally associated with limb amputation.
 THEORY OF PAIN

Specificity Theory
 SPECIFICITY THEORY
Earliest theory of pain proposed by Rene Descartes on 17th century.
There is a direct relationship between nerve endings and pain spots on our body.
Pain travels to the brain is only one pathway, which is the same path used by other sensations.

The Specificity Theory stated that pain is “a specific sensation, with its own sensory apparatus independent of
touch and other senses”.
Severity of injury is directly proportional to the level of experienced pain.

CRITICISM:
• All nerve fibers in our body are not pain receptors, but there are some specialized pain receptors in our body.

E.g. : severely wounded soldiers in battle complain of less pain contrary to extreme pain in minor injuries.
• A single stimulus type (e.g. a blow, electric current) can produce different sensations depending on the type of
nerve stimulated.
FA C T O R S A F F E C T I N G PA I N A N D
ITS PERCEPTION
BIOPSYCHOSOCIAL MODEL

Biological
Nociception
Tissue Damage
Disease Process

Psychological Social
Pain beliefs Cultural influences
Locus of control Learning mechanisms
Lack of self-efficacy Social learning
Limited coping Reward/Punishment
Emotions Classical conditioning
PSYCHOLOGICAL FACTORS

1. LOCUS OF CONTROL:
• Rotter (1996) stated that there were “internal” and “external” Locus of control.

• The “internals” (believe that their own actions significantly influence their health).
• The “externals”(believe that they don't have much control over their health).

• People with a strong internal LOC believed to have good control over their pain and are able to
adapt by effective coping strategies and manage pain better than those with an external LOC.
• Persons who believe that the prognosis for their pain is influenced mainly by luck or fate
(external) are engage in maladaptive coping strategies such as wishful thinking or
catastrophizing.
2. CATASTROPHIZING COGNITIONS:
• Pain catastrophizing is characterized by the tendency to
magnify the threat value of pain stimulus and to feel
helpless in the context of pain, and by a relative inability to
inhibit pain-related thoughts in anticipation of, during or
following a painful encounter.
• A “Neurophysiological Model” of catastrophizing
proposes that:
• Catastrophizing cognitions are associated with higher
levels of brain activity in the areas of anticipation and
attention to pain, emotional aspects of pain and motor
control and are linked to higher levels of pain intensity,
greater disability, poorer psychosocial adjustment.
 CONTINUES…
• In a research study pain catastrophizing was assessed
pre-surgery.
• The results showed significant variance in postsurgical
pain ratings, narcotic usage, depression, pain-related
activity interference and disability levels.
• Another study by Edwards, suggested that pain
catastrophizing was related to increased suicidal ideation
in a large sample of chronic pain patients.
3. SELF-EFFICACY AND EFFECTIVE COPING:
• In a Research study low levels of self-efficacy was found to
be associated with a lower levels of pain tolerance and
higher levels of pain intensity in samples of people with
chronic pain.
• People who believe that they can alleviate pain are likely to
mobilize whatever skills they have learned to preserve
themselves.
• The higher the perceived self-efficacy the longer pain can
be tolerated and less medications are required.
 CONTINUES…

• Individuals who experience pain may develops two types of

coping.
• Adaptive coping: active coping strategies are considered to be
adaptive in which patient is an active participant and assumes self
management responsibilities.
• Maladaptive coping: these are passive coping strategies in which
patient withdraw from activities and shows dependency on others
for pain relief. (Placebo)
• Studies have found that active coping strategies decreases the pain
intensity and increases pain tolerance.
• However, passive coping is associated with greater pain and
related depression.
4. PAIN AND EMOTIONS:
• The typical emotional reaction to pain includes anxiety, fear,
anger, guilt, frustration, and depression.
• According to FAM (Fear-avoidance model) “Fear of pain” is
the most important emotional factor in perception of pain.
• A fear response to pain leaves an individual with two
options:
 Confrontation (Menstrual pain)
 Avoidance (Fracture pain and hygiene care)
• The “Confronter” is more likely to view pain as temporary ,
is motivated to return to normal work, social and leisure
activities, and is prepare to confront their personal pain
barriers.
 Continues…
• The pain “Avoider” is motivated by fear and avoid both pain
experience (cognitive component) and painful activities
(behavioural component).
• Thus, this avoidance leads to more pain and is harmful to the
recovery process.
• Certain other negative emotions such as anger, hostility and
depressed mood can also influence pain perception.
• Negative emotional states registers in the brain in a manner
that strikes brain pathways which are responsible for
enhancing pain.
• The expression of anger and hostility are often used as
defensiveness and can seriously compromise the therapeutic
relationship between nurse-patient, which further deteriorates
patient’s condition.
 P E R S O N A L I T Y A N D PA I N
(PSYCHOSOCIAL COMPONENT)
NEUROTICISM
(Eysenk’s personality theory): High neuroticism is the result
of cortical arousal which increases sensitivity and contributes
to emotional instability. Such individuals are more likely to
worry about physical symptoms like (pain).
 These individuals generally do not cope well with stress
and perceive painful stimulus as threatening and distressful.
 certain dimension of neuroticism negatively correlates with
pain (experiment): 1.Negative mood decreases pain
tolerance time. 2.Emotional vulnerability increases pain
intensity and unpleasantness.
 Neuroticism is significantly high in patients with lower
back pain, joint pain and cancer pain etc.
(Eysenk’s personality theory): Extraversions have low cortical
arousal, requiring more frequent and stronger stimulation to
acquire satisfactory levels of arousal. As a result, extravert exhibit
diminished pain sensitivity and higher pain threshold.
Extraversion is also associated with use of active and strong
coping strategies that lead to better adaption to painful stimulus.
(For example, being optimistic).
Extroversion is positively associated with general health
perception. Individual both healthy and with self-reported medical
problems feel good about themselves and try to mobilize all their
resources to maintain this state of health.
Extraversions are more likely to complain about their pain and
express their sufferings than individuals high in neuroticism.
 PAIN CONTROL TECHNIQUES

1. PHARMACOLOGICAL CONTROL OF PAIN:

o It is the traditional and most common method of controlling pain.

o Narcotics are well known in controlling pain. Amongst narcotics,

morphine (the Greek GOD of sleep) has been the most popular
pain killer for decades.
o However, pharmacological control of pain is the potential for
addiction.
2. SURGICAL CONTROL OF PAIN:
o Some techniques attempts to disrupt the conduct of pain from
the periphery to the spinal cord, whereas others are designed to
interrupt the flow of pain sensations from the spinal cord
upward to the brain.
o Moreover, there is some indication that surgery can ultimately
worsen the problem because it damages the nervous system,
and this damage can itself be a chief cause of chronic pain.
3. SENSORY CONTROL OF PAIN:
o One of the oldest known techniques of pain control is
COUNTERIRRITATION, a sensory method.
o Counter-irritation involves inhibiting pain in one part of
the body by stimulating or mildly irritating another area.
o Overall, sensory control techniques have had some
success in reducing the experience of pain. However,
their effects are often only short-lived, and they may
therefore be appropriate primarily for temporary relief
from acute pain.
 R E L A X AT I O N T E C H N I Q U E S

 Rationale for teaching pain patients relaxation techniques, is that it enables

them to cope more successfully with stress and anxiety, which may also
ameliorate pain.
 Relaxation may also affect pain directly, for e.g. the reduction of muscle
tension or the diversion of blood flow induce by relaxation may reduce
pains that are tied to these physiological processes.
 In relaxation, an individual shifts his or her body into a state of low arousal
by progressively relaxing different parts of the body.
 CONTINUES…

 The common relaxation technique nurses use in their practice is

encouraging patients in deep breathing exercises mainly to
divert their minds from painful procedures for instance IV
annulation and early labor.
 Generally, relaxation is modestly successful with some acute
pains and may be value in treating chronic pain when used in
conjunction with other methods of pain control.
 HYPNOSIS
 In 1829, prior to the discovery of anesthetic drugs, a French surgeon, Dr. Cloquent, performed a remarkable
operation on a 64 year old women who suffered from breast cancer and the tumor was being removed without
anesthesia through hypnosis and the lady felt no pain.

 First, a state of relaxation is encouraged.

 Next, patients are explicitly told that the hypnosis will reduce pain.
 In the hypnotic trance, the patient is usually instructed to think about the pain
differently.
 It has been used successfully to control acute pain due to surgery, child birth,
dental procedures, burns and headache as well.
 In acupuncture treatment, long thin needles are inserted into
specially designated areas of the body that theoretically
influence the areas in which a person is experiencing pain.
(Practiced in china for more than 2,000 years).
 How acupuncture controls pain is not fully known. But it is
possible that acupuncture triggers the release of endorphins,
thus reducing the experience of pain.
 When Naloxone (an opiate antagonist) is administered to
acupuncture patients, the success of acupuncture in reducing
pain is reduced.
 DISTRACTION

• Individual who are involved in intense activities like sports or

military maneuvers can be oblivious to pain full injuries due to
Distraction
• There are two quite different mental strategies for
controlling discomfort.

Focus directly on the

To distract oneself by
events but to reinterpret
focusing on some other
the experience. Focus
activity. To distract oneself
directly on the events but
by focusing on some other
to reinterpret the
activity.
experience.
CONTINOUS…
• Distraction appears to be most effective for coping with low-
level pain. Its practical significance for chronic pain is limited
by the fact that such patients cannot distract themselves
indefinitely.
 GUIDED IMAGERY

 Guided imagery has been used to control some acute pain and discomfort.
 In guided imagery a patient is instructed to conjure up a picture that he or she
holds in mind.
 This process brings on a relaxed state, concentrates attention, and distracts the
patient from the pain or discomfort.
 Apart from calm and pleasant guided imagery, some patients take more personally
aggressive stance towards pain, these patients use it to rouse themselves into a
confronted stance by imagining a combat and action filled scene.
CONTINOUS…
 These two virtually opposite forms of imagery may actually
achieve some beneficial effects in controlling pain through
the same means i.e. inducing positive mood state and both
focus attention and provide a distraction from the pain.
C O G N I T I V E B E H AV I O R A L T H E R A P Y
F O R PA I N

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 C O G N I T I V E B E H AV I O R A L T H E R A P Y
F O R PA I N

1. ACCEPTANCE AND COMMITMENT THERAPY:

 Aim for ACT is to reduce the feelings of failure (drug dependency) of strategies to control
pain.
 The therapist creates a collaborative environment in which Patients with pain can review
their actual problem and find out their previous way of struggling to solve this problem.
This gives a clear understanding of the time duration of persisting problem and range of
strategies tried by patient to improve situation.
 It helps identifying the actual problem which is not the pain itself, rather the behaviour of
disregarding oneself for the repeated failures to achieve an effective pain control.
2. AWA R N E S S A N D P E R S P E C T I V E
3. MINDFULLNESS
4. C O G N I T I V E D E - F U S I O N

 Marry had a………….

 London bridge is……..
 Humpty dumpty sat on a………
 Ring-a-ring o' roses, A pocket full of posies, A-
tishoo! A-tishoo! We all………
 But, what if, I can’t…..
5. WILLINGNESS