Al Azhar university Gaza Lama El Banna psychology

1. Pain
Behavioral sciences

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

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 )