Function & Neurobiology of Pain

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  • Created on: 05-01-16 11:19
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  • The Function and Neurobiology of Pain
    • Learning Outcomes
      • Describe the function of pain
      • Differentiate between pain and nociception
      • Discuss how the experience of pain can be modulated by cognitive and emotional factors
      • Discuss the influence of cognitive distraction on pain
    • What is pain?
      • 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 the Study of Pain, 2011
      • Pain exists when and where the client says it exists (McCaffery & Beebe, 1989)
      • Purpose of pain: protect organism and increase chances of survival
        • Pain as a warning: occurs before serious injury and promotes immediate withdrawal from stimulus
        • Pain to facilitate healing: damaged joints, diseases or serious injuries causing pain sets limits on activities and enforces rest - essential for body's recuperative mechanisms
        • Pain as education: can help to aid learning by avoiding injurious objects/ situations. In humans, this also involves language and symbols
        • Pain can serve NO APPARENT PURPOSE
      • Types of pain - duration
        • Transient pain
          • - Pain of brief duration and little consequence (Melzack and Wall, 1988).  - Ubiquitous in everyday life, yet rarely a reason for seeking health care
        • Acute pain
          • - Pain of recent onset and probably limited duration. Usually identified by its temporal and causal relationship to injury and disease.        - The local injury doesn't overwhelm the body's reparative mechanisms: healing can occur without medical attention although many look for medical care
        • Chronic pain
          • - Pain lasting a long period of time.         - Commonly accepted arbitrary cut off between acute and chronic pain: 3-6 months.   - Injury may exceed body's capability for healing.         - Therapies providing transient pain relief don't resolve underlying pathological process
    • Why are Psychologists interested in pain?
      • 1. Pain is highly prevalent
        • 19% of Europeans suffer from some form of chronic pain. Back pain most common, then headache (Breivik et al., 2006).
        • Estimated that 14m people suffer in England alone. 2011 - 31% M & 37% F reported chronic pain (BPS, 2015)
        • Internet-based survey of US - chronic pain prevalence 30.7%. Higher for F (34.3%) then M (26.7%) & increased with age (Johannes et al., 2010)
      • 2. Pain can have profound effects on QoL
        • Evidence for probably anxiety in 38.2% of cases & probable depression in 30.1% (Pallant & Bailey, 2005)
        • High fear of movement in 79.6% of patients with chronic lower back pain (Thomas et al., 2010)
        • Associated with disturbances in family functioning, inc. emotional & physical intimacy, alcoholism & depression (Schwartz et al., 2001; Smith, 2003; Ferrari et al., 2007)
      • 3. Pain can have profound effects on society
        • Chronic pain & its burden places big costs on society
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        • UK - back pain costs NHS £1 billion per annum (Maniadakis & Gray, 2000)
        • 4.6 million appointments worth £69 million (Belsey, 2003)
        • Australia - total absent workdays @ 9.9 million annually, reduced effectiveness workdays @ 36.5 million annually (Van Leeuwen et al., 2006)
    • Nociception
      • Functions of the nervous system
        • Three main functions: sensory input, integration of data, & motor output
        • NS provides info about threat or injury. Sensation of pain, by its inherent aversive nature, contributes to this function
        • 2 major components to the somatosensory NS: subsystem for detection of mechanical stimuli (light, touch, vibration, pressure & cutaneous tension) & a subsystem for detection of noxious stimuli & temperature
      • The neural process of encoding & processing noxious stimuli. Not a perception of pain - a response to a stimulus
        • Noxious stimulus: an actually/ potentially tissue damaging event
        • Nociceptors: "pain receptors", though not accurate as nociception doesn't always result in pain
      • Nociceptors
        • Respond to multiple energy forms that produce energy (thermal, mechanical & chemical stimuli) & provide info to the CNS regarding location & intensity
        • Skin densely innervated by nociceptors. Also present in other body tissues (bone, muscle, joint capsules, viscera & blood vessels)
        • Not found in brain or spinal cord
        • A? & C-fibers major nociceptive nerve fibres
          • A? (delta)-fibers associated with fast or first pain: discretely localised sharp, prickling pain. Responsible for sensation of quick, shallow pain specific in 1 area, & respond to a weaker intensity of stimulus than C fibers
          • C-fibers associated with slow or second phase pain: less discretely localised burning, gnawing sensation quantitatively distinct to first pain. As stimulus strength increases, C fibers are recruited & an intense, burning pain is experienced which continues after cessation of the noxious stimulus
    • Cognitive modulation of pain/ GATE CONTROL THEORY
      • Modulation of pain
        • Brain doesn't passively receive pain info from the body, & instead actively regulates sensory transmission
        • Experience of pain can be modulated by cognitive & emotional factors - Distraction a common tool (Johnson, 2005) - Manipulations inducing positive mood associated with reduction in pain perception & vice versa for NA
      • Gate control theory of pain
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    • The role of distraction in pain
    • Congenital insensitivity to pain


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