Health Psychology

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Health Psychology

• Lecture 5
• Pain

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Lecture 5 - Outline

• Part 1
• Anna Nagy (Stress)
• Part 2
• Duane (Pain)
• Part 3
• Term Test 1 Preparation

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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)

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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

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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

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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)

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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

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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

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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

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Assessing or Measuring Pain

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

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Assessing or Measuring Pain

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

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McGill Pain Questionnaire

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

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Pain Management

• Physical/Medical Treatment
• Chemical Analgesia (pain relief)
• Narcotics (e.g., morphine)
• Peripherally acting analgesics (e.g., asprin)

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Pain Management

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

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Pain Management

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

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Pain Management

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

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Pain Management

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

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Pain Management

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

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Pain Management

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

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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

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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

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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)

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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

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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?

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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

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The Stress Response and the Development of
Allostatic Load
Stress Response and Development of Allostatic
Load. (McEwen, 1998)
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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)

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HPA