Psyc 412 1st Edition Lecture 13Outline of Last Lecture I. Significance of PainII. Elusive Nature of PainIII. Pain management IV. Pain perceptionOutline of Current Lecture I. Clinical issues in Pain managementII. Pain Control TechniquesIII. Management of Chronic PainIV. Placebo as a HealerCurrent Lecture- Clinical Issues in Pain Managemento Acute and chronic pain: acute pain usually results from injury chronic pain usually begins as an acute episode but does not decrease with the passage of timeo Types of chronic pain: chronic benign pain: isn’t associated with advancing disease- pain is present but nothing seems injured recurrent acute pain: pain comes and goes- migraines chronic progressive pain: pain that is getting worse due to advancing disease- cancero Acute vs. chronic pain: acute and chronic pain present different psychological profiles chronic pain patients develop maladaptive coping strategies pain techniques work with acute but not chronic pain chronic pain involves the interaction of physiological, psychological, social and behavioral componentso Many chronic pain patients have cognitive distortions about their pain cognitive distortion: we think about things in a way that make us more unhappy than we need to be- someone cuts us off while driving: they have it out for meo See more depression/anger: don’t know when pain is going to end, don’t have controlo Who becomes a chronic pain patient? acute pain patients patients for whom pain interferes with life activitieso Lifestyle of chronic pain: disruption of a person’s life  some receive compensation for their paino The toll of pain on relationships: affects marriage and other family relationships social relationships can be threatened many patients are clinically depressed and contemplate suicideo Chronic pain behaviors: avoiding loud noises and bright lights reducing physical activity avoiding social contactso Pain and personality: pain-prone personality:- a constellation of personality traits that predispose a person to experience chronic paino Pain profiles: the “neurotic triad”: - anxiety disorders, substance use disorders and other psychiatric problemso Pain and stereotyped responses to stress: stress may exacerbate certain pain responses  distinctive patterns of cephalic blood flow occur in response to stress- Pain Control Techniqueso Pharmacological control of pain: drugs:- Morphine- local anesthetics- spinal blocking agents- antidepressantso Surgical control of pain: cutting or creating lesions in the so-called pain fibers at various points in the bodyo Sensory control of pain: counter-irritation: - inhibiting pain in one part of the body by stimulating or mildly irritating another area Dorsal column stimulation exerciseo Biofeedback: a method of achieving control over bodily processes  used to treat chronic disorders, temporomandibular joint pain, hypertension anda broad array of painso Success of biofeedback: only modest for its efficacy in reducing pain o Relaxation techniques: enable patients to cope with stress, anxiety, reducing paino What is relaxation? shifting the body into a state of low arousal controlled breathing meditationo Success of relaxation: modestly successful with some acute pains and when used in conjunction with other methods for chronic paino Hypnosis: one of the oldest techniques for paino How does hypnosis work? relaxation and suggestiono Hypnotherapy has successfully controlled: irritable bowel syndrome, acute pain due to surgery, childbirth, dental procedures, burns, headaches and medical procedureso Acupuncture: developed in China over 2,000 years ago long, thin needles are inserted into designated areas of the body o How does acupuncture work? not really known, although may be due to:- counter-irritation- induction of a state of relaxation- preparation reduces fear and increases tolerance of pain- release of endorphinso Distraction: focusing attention on an irrelevant and attention-getting stimulus in order to reduce pain strategies:- focus on another activity- focus directly on the events but reinterpret the experience Does distraction work?- most effective with low-level paino Coping techniques: increasingly used to help chronic pain patients manage paino Guided imagery: patient is instructed to conjure up a picture that brings him/her happiness during the painful experience induced relaxation can control slow-rising pains some patients rouse themselves by imagining a combative, action-filled sceneo Additional cognitive techniques to control pain: cognitive behavioral therapy:- seven objectives:o re-conceptualize the problemo expect that this training will be successfulo re-conceptualize patient’s own roleo monitor thoughts, feeling and behaviorso teach adaptive responseso attribute success to patient’s own effortso prevent relapse- Management of Chronic Pain: Pain Management Programso Initial evaluation: perform a qualitative and quantitative assessment of pain  explore how the patient has coped with the pain in the past evaluate patient for emotional and mental functioningo Individualized treatment: components of chronic pain management programs :- education, training and group therapy- involvement of family- relapse prevention- evaluation of pain management program- Placebo as a Healero Historical perspective: many years ago, patients were treated with a variety of bizarre, largely ineffective therapieso What is a placebo? “any medical procedure that produces an effect in a patient because of its therapeutic intent and not its specific nature, whether chemical or physical” ranges from drugs to surgery to psychotherapyo Provider behavior and placebo effects: how the provider interacts with the patient determines the effectiveness of a placeboo Patient characteristics and placebo effects: there is no “placebo-prone” personality, but certain types of patients show stronger placebo effectso Patient-provider communication and placebo effects: good communication is essential the symbolic value the placebo has may enhance the placebo effecto Situational determinants of placebo effects: setting where placebo is administered has an effect the shape, size, color, taste and quantity of the placebo also influences its effectivenesso Social norms and placebo effects: