Psychodynamic Models: Freud
-popularized by Freud
-Chronic pain: results from unconscious conflicts
-Suppression of negative memories and emotions
Psychodynamic Models: Engel
-Engel was influenced by freud and the field of psychosomatic medicine
-anecdotal/clinical descriptions of pain-prone patients
-personality predispositions to develop chronic pain->psychogenic pain
Behavioural Models” Skinner
-focus on observable behaviours
-core principle: behaviours are influenced by their consequences
Behavioural Models: Fordyce
-pioneered the extension of operant principles to chronic pain
-pain behaviours maintained by positive consequences
Cognitive-Behavioural Model: Turk
-people active processors of information, not passive reactors to environment
-cognitions influence how people feel
-cognitions: key role in the perception of pain, how people adjust to pain
-paitents learn aladptive ways of thinking feeling and behaving
-CB perspective: major influence on psych assessment and treatment
Pain Appraisals
refer to cognitive evaluation or interpretation persons make regarding their pain
Primary Appraisals
-immediate evaluation about whether the pain sensation is threatening or not
-if appraised as threatening: attentional focus directed towards pain
-Emotional states can be experienced
Secondary Appraisals
-belief about the degree of control over pain
-beliefs about ability to cope with pain
-beliefs about ones ability to function despite pain
-expectations about pain and pain treatment
Negative Pain Beliefs
-decreased use of coping strats
-increased clinical pain intensity
-increased pain related disability
Catastrophic Thinking
-assc. w/ increased pain intensity and increased disability and increased pain expression
-rumination, magnification, helplessness
Rumination
-on pain symptoms
-i keep thinking about how much it hurts
Magnification
-of the threat value of pain
-this might be caused by something serious
Helplessness
-when facing pain
-nothing I can do to reduce the intensity of pain
Fear-Avoidance Beliefs
-Pain is harmful and that activity should be avoided
-many patients are passive/sedentary to fear-avoidance beliefs
Fear Avoidance Leads to
-decreased muscle strength
-avoidance of physical activities
-increased pain related disability
Perceived Injustice
-chronic pain can contribute to feelings of injustice
-injustice towards: causes of pain, someone elses negligence
-injustice: due to pain that persists despite various treatments
-injustice towards: employers, insurers, clinicians, healthcare system
-associated with anger and depressive symptoms
-increased pain intensity, increased pain related disability
Dimensions of Injustice
-Blame/Unfairness
-Severity/Irreparability of Loss
Chronic Pain & Mental Disorders
-pain is known to cause mental distress
-inter individual variablity in the intensity/sevreity of psychological distress
-many patients with pain meet diagnostic criteria for 1 or more disorders
-chronic pain sufferers are some of the most common mental disorders among pain paitents
Common Mental Disorders in Chronic Pain Paitents
-depressive disorders
-anxiety disorders
-trauma and stressor related disorders
-personality disorders
-substance use disorders
-prevelance varies across studies due to differences in patient populations and diagnostic methods
Mental Disorder Blocks to Treatment
-higher pain intensity and pain related pain related disability
-decreased treatment efficacy
-can create pain management challenges
Depression & Chronic Pain
-low mood, loss of pleasure (anhedonia)
-hopelessness, guilt, suicidal thoughts
-MDD and persistent depressive disorder
-increased pain intensity and pain related disability
Anxiety & Chronic Pain
-high prevalence of anxiety symptoms
-pain accompained by multiple stressors
-finances/work, access to care, implications of pain and limitations
-generalized anxiety disorder, panic attacks, panic disorder
-increased pain intensity and pain related disability
Trauma/Stress & Chronic Pain
-high prevalence of traumas among persons with chronic pain
-high prevalence of ptsd: veternas with pain, car accidents
-associated with increased pain intensity and pain related disability
Role of Brain in Pain Perception
-advances in neurosciences and brain imaging techniques
-multiple brain regions, networks involved in pain perception
-chronic pain vs healthy persosn: differences in brain structure and function
