“…the brain is not a passive recipient of information entering from the periphery or the dorsal horn but actively processes and selects information, seeks additional information, and interprets that information. Psychological interventions for pain may have grown in prominence and continue to demonstrate efficacy in large part because these treatments target the organ that is responsible for the experience of pain and how a patient copes with and adapts to that pain…”
(Mark P. J and Dennis C. T)
What is Pain?
o Pain is highly unpleasant physical sensation caused by illness or injury, mental suffering or distress…
o Essentially, pain is the way brain interprets information about a particular sensation that the body is experiencing. Information (or "signals") about this painful sensation are sent via nerve pathways to brain. The way in which brain interprets these signals as "pain" can be affected by many outside factors, some of which can be controlled by special techniques.
o There are things that you can do to reduce the effects of pain on your life, such as appropriate exercise, pacing your activity (not doing too much when you feel better) and relaxation.
o Pain signals are initially processed in the spinal cord and then in the brain, where there are connections with centres associated with anxiety,
oemotions, sleep, appetite and memory.
o The brain sends signals back to the spinal cord, which can, in turn, either reduce or increase the pain further. Cells at the nerve endings, in the spinal cord and in the brain can become over-sensitised as a result of constant pain input. This is called ‘wind-up’ and is one of the reasons why persistent pain does not go away easily, even if the cause of the pain is discovered and treated.
o … there is much to suggest that pain is often a sign of psychological disturbance. This is particularly true if headache is included in the discussion.
o … emotional factors could abate the severity of pain or abolish it altogether, despite the presence of extensive wounds.
o … that anxiety gives rise to local muscle contraction which, if persistent, causes pain.
o … the most striking illustration of pain as a symptom solving unconscious conflicts and serving to symbolize unconscious attitudes is the couvade syndrome. This word, derived from the Basque, couver, meaning to sit on eggs, describes the behaviour of fathers who may act as if suffering from labour pains or lie in bed after their wives' childbirth while the women continue with their normal occupations. Such behaviour occurs in many cultures…
o …It has been indicated that certain attitudes, frequently unconscious, have been attributed to patients with pain of psychological origin. These attitudes include hostility, resentment and guilt…
o … a history of appendicectomy has been reported as occurring frequently in patients with abdominal pain in association with neurotic illness..
o … pain arises when a threat to the body is perceived, either for objective reasons or for emotional ones…
o … pain is used as a communication which requests help. This function is always involved in any complaint of pain…
Mark P. Jensen and Dennis C. Turk
o ..pain behaviours … are no different than any other behaviour with respect to their sensitivity to environmental influences. Pain behaviours followed by reinforcing events, such as affection or sanctioned time out from social responsibilities, will increase in frequency. However, if pain behaviours are systematically ignored, and behaviours incompatible with them—so-called “well behaviours” such as exercise and maintaining an active lifestyle, including employment—are encouraged or positively reinforced, then over time these well behaviours will increase and pain behaviours will decrease. (- Fordyce)
o … once healing has occurred, pain behaviours often become maladaptive—they can contribute to disability (e.g., ongoing resting and guarding behaviours cause muscle atrophy) and maintain pain. (- Fordyce)
o …Motivational interviewing targets “change talk” that is hypothesized to increase the probability of the use of coping responses thought to be adaptive and to decrease the probability of the use of coping responses thought to be maladaptive…
o …overall objective of helping patients change their view of themselves from one in which they are helpless, passive, and dependent to one in which they are active agents who are resourceful and capable of self-managing their symptoms and their lives… (Flor & Turk)
o …any treatments that alter pain-related thoughts—which include virtually all psychological pain interventions— could be beneficial at least in part because they alter activity and processes in the prefrontal cortex. Because the prefrontal cortex is actively involved in the processing of nociceptive information that might subsequently be interpreted as pain, changes in activity in this area could potentially increase or decrease the experience of and response to pain…
o …Recent studies using fMRI have been able to document unique physiological responses in the brain that are associated with prolonged pain, emotional responses accompanying pain…
o … primary psychological factors: specifically, (a) what patients think (cognitive content), (b) how patients think (cognitive processes or cognitive coping), and (c) what patients do (behavioural coping)… (-Jensen)
Acute Pain (ANZCA)
o The ability of the somatosensory system to detect noxious and potentially tissue-damaging stimuli is an important protective mechanism that involves multiple interacting peripheral and central mechanisms. The neural processes underlying the encoding and processing of noxious stimuli are defined as ‘nociception’. In addition to these sensory effects, the perception and subjective experience of ’pain’ is multifactorial and will be influenced by psychological and environmental factors in every individual. (Loeser & Treede)
o Empirical evidence supports a role for fear of pain contributing to the development of avoidance responses following pain and injury, which ultimately lead to disability in many people with persisting pain. (Leeuw et al)
o After limb amputation, reorganisation or remapping of the somatosensory cortex and other cortical structures may be a contributory mechanism in the development of phantom limb pain (Flor et al; Grusser et al).
o Mindfulness meditation is a way of focusing awareness on the pain and observing it with precision, while at the same time opening up to it and dropping resistance. As we develop this skill, the pain causes less suffering, and may even “break up” into a flow of pure energy.
o Most people equate suffering with pain, but suffering is a function of two variables, not just one. Suffering is a function of pain and the degree to which the pain is being resisted. (S = P x R).
o “Opening to the pain” is the practice of dropping the conscious resistance by letting go of the judging thoughts and continually relaxing whole body as much as possible.
o Although the suffering diminishes as resistance drops, the pain may stay, preserving the proper function of pain as a warning, motivation, etc. In other words, it is sometimes necessary to feel pain, but it is never necessary to suffer.
o Now, if you have pain, and the speaker has had part of it, like every human being, do you allow it to end? Or you want to end it with some medicine? You are following my question? Say you sit in the dentist's chair, the speaker has done quite a bit of it, you sit in the dentist's chair, he drills. Do you associate the pain and identify yourself with the pain? Of course if the pain is too intense he gives you some kind of novocaine or whatever he gives you. But if it is not too unbearable, do you observe the pain without identifying yourself and say, 'My god' - you follow what I am saying? Which do you do? Is it immediate identification with the pain? Or disassociation, and observing. When you have pain, you instinctively hold, if you are sitting on that chair. But if you don't identify with the pain, you can put your hands out quietly and bear it without too much... Which means is it possible to disassociate oneself from the actual movement of pain? Enquire into it. Don't say, 'It is', 'It is not'. You find out for yourself how much, how far, how deeply one can not identify, 'Ah, I am in great pain' - you follow?
o … if you have had a pain yesterday, physical pain, to finish with that pain yesterday, not carry it over to today and into tomorrow…
Let me not pray to be sheltered from dangers
but to be fearless in facing them.
Let me not beg for the stilling of my pain
but for the heart to conquer it.
Let me not look for allies in life's battlefield
but to my own strength.
Let me not crave in anxious fear to be saved
but hope for the patience to win my freedom.
Grant me that I may not be a coward,
feeling your mercy in my success alone;
but let me find the grasp of your hand in my failure.
God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
Living one day at a time;
Enjoying one moment at a time;
Accepting hardships as the pathway to peace;
Taking, as He did, this sinful world
as it is, not as I would have it;
Trusting that He will make all things right
if I surrender to His Will;
That I may be reasonably happy in this life
and supremely happy with Him
Forever in the next.
4. Psychological aspects of pain - H. Mersky
6. Contributions of Psychology to the Understanding and Treatment of People With Chronic Pain - Mark P. Jensen and Dennis C. Turk
7. An fMRI-Based Neurologic Signature of Physical Pain – T. D. Wager, L.Y. Atlas, et all
8. Physiology and Psychology of Acute Pain – ANZCA
9. Pain and Suffering as Viewed by the Hindu Religion - Sarah M. Whitman, MD
12. The Writings of Rabindranath Tagore By Rabindranath Tagore
14. (Synopsis of) Break Through Pain Shinzen Young