NO CLASS ON THURSDAY FEB. 13 Psycho-social Complications of Chronic Pain 1. Counterproductive coping a. Isolation b. Negative beliefs 2. Social Support: a. Hazards of positive support b. Hazards of no support 3. Negative stereotypes 4. Medical complications and risks 5. Double binds (1-4, above) Pain and Depression Wrong model: Pain Depression --- What’s missing? Correct model: Pain ↓ activity ↓ mastery ↓ control Depression Pain Prone Personality Are some personalities more prone to experiencing, reporting pain? MMPI = Minnesota Multiphasic Personality Inventory a. Acute pain pats: Hypochondriasis – overly attend to body Hysteria – extreme emotionality/exaggerate symps. b. Chronic pain pats: Neurotic triad: Hypcondriasis + hysteria + depression Secondary gain: What are social benefits of pain? Attention, special identity “Functional type”: neurotic triad + schizo / psychopathology / paranoia Danger of “Pain Prone Personality” concept? 1. Negative stereotypes 2. Causal direction “MECHANICAL” PAIN REDUCTION TECHNIQUES Drugs Surgery Sensory Control: Counter-irritation “PSYCHOSOCIAL” PAIN REDUCTION TECHNIQUES Biofeedback Relaxation Hypnosis Acupuncture Guided Imagery Cognitive Reframing Distraction Pain Management Programs Pain Relief Through Virtual Reality Severe burns one of most painful conditions to treat: cleaning, re-bandaging excruciating. Pennebaker symptom research suggests that distraction should do what to pain? Reduce it. Why? Competition of cues. SnowWorld: Virtual Reality program designed for pain relief. Patients enter SnowWorld during procedures Shoot snowballs at snowmen, penguins Report pain reductions 30%-50% Note SnowWorld colors. Why? Summary Benefits of Psychosocial Approaches Change meaning of experience Provides skill set, reduces helplessness Gives patients an active role in pain management Success with techniques increases self-efficacy Changes ways of thinking Pain Management Programs 1. Evaluation a. pain b. functional status: life style changes, limitations c. Emotional and mental functioning 2. Treatment plan a. Pre-set time. Not indefinite. b. Specific goals. c. Contract 3. Program a. Education 1. Nature of pain: physio, psychological 2. Pain reduction techniques b. Therapy 1. Psycho therapy 2. Cognitive therapy: c. Family therapy d. Relapse prevention Class 7: Stress I Stress: Health Psych “Bullseye” Integrates mental states, bodily states, environmental conditions Window to core psych processes: * How we make sense of events, and how interpretations affect health. • Emotions, emotions & thinking, emotional control • Social relations in coping and in failed coping Stress is where psych can do most for health. Causes of illness, Treatment of illness, illness prevention What Are Stressful Events? Broken Heart Syndrome “Stress cardiomyopathy” Temporary heart condition due to loss-related stress Chest pain, due to surge of stress hormones. Loss-related stress? Duration: typically 1 week Break-up Death Departure Stress Defined Stress is a negative emotional experience accompanied by predictable biochemical, physiological, cognitive, and behavioral changes that are directed either toward altering the stressful event or accommodating to its effects. Taylor, p 168. Cannon Model of Stress Walter Cannon, 1932 Fight or Flight response SNS + endocrine mobilizes body for fight or flight Stressful events _____You can fight: ..... _____You can flee ... X _____You can neither fight nor flee, "traps" Which are the most stressful? General Adaptation Syndrome (GAS) Hans Selye (1956) All stressors produce same pattern: Per Selye: Prolonged stress --> Enlarged adrenals cardiovascular disease Shrunken thymus arthritis Shrunken lymph hypertension Ulcerated stomach compromised immune system Physiology of Stress 1. SAM: Sympathetic-adrenomedullary Event cortex hypothalamus SNS adrenal medulla catecholamines charged feeling increased BP, HR, etc. SAM Corresponds to Cannon's stress model 2. HPA: Hypothlamic-pituitary-adreocortical Event cortex hypothalamus coritcotrophin releasing factor (CRF) pituitary adrencorticotropic hormone (ACTH) adrenal cortex corticosteriods conserves carbos reduces inflammation HPA corresponds to Selye's stress model SAM and HPTA Stress Patterns Health Implications of Sustained Stress Catecholamine elevation, sustained, inhibits immune system Cardiovascular effects 1. Arteriosclerosis 2. Senility: neurons in hippocampus 3. Depression 4. Fat distribution: Higher waist-to-hip ratio 5. Sudden death syndrome Stress, Opioids, and Illness Susceptibility Opiates are? Pain-reducing drugs, from plants. Morphine, heroin Endogenous opiods (aka endorphines): Like opiate, produced by body. Stress triggers endorphine production Stress opioid release immune suppression ? ↑ illness susceptibility Prolonged Stress Widens “Window of Vulnerability” Chronic stress ↑ recovery phase ↑ cortisol phase ↑ immune suppression ↑ illness risk. Allostatic load = effects of cumulative stress exposure Reactivity and Stress Vulnerability People vary in stress reactions NOT just a matter of being mentally tough / whimpy Physical constitutions differ Autonomic NS Neuroendocrine response Immune response Study of children 3-5 yrs old, reactivity Measure reactivity to stressor -- a. cardio (HR, BP) b. immune Parents track stressor reactions, illness for 12 weeks Result: stress leads to illness among ____ Low Reactive X High Reactive ____ Stress as Function of Person-Environment Fit Low Stress: Moderate Stress: High Stress: Resources Resources Resources >> ≥ < Challenge Challenge Challenge