Psychology of Pain

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The experience of pain is a noxious and unpleasant sensation that usually accompanies potentially harmful stimuli to the body. The psychology of pain is the study of the pain experience, and the intricate interplay between the experience and an individual’s higher cognitive functions. It has been previously shown that while the body physiologically responds to painful stimuli, there are also higher brain areas that respond to pain to produce behavioural responses to minimize and avoid damage to the body [1]. Pain can affect the higher cognitive processing in the bottom-up manner, disrupting attention in the short term and possibly causing depression or hyper-vigilance in the long term2. On the other hand, the higher cognitive abilities can in turn affect the experience of pain by modulating the intensity. This can be from expectation, like the well-known placebo and nocebo effects3, as well as from emotions that the individual is feeling. The importance of a patient’s mental state with respects to pain is stressed by the fact that some authors argue that the fear of pain can be more debilitating than the pain itself2. Consequently, the study of the pain psychology yield valuable information in planning pain management in clinical settings.

Pain response models

Two-Part Model for Pain behavior

There seems to be two fundamentally different categories of pain responses present in humans. One is a basic response system involving physiological and bodily reactions including change in facial colour or irregularities in breathing such as holding one’s breath or gasping, processed by the anterior-posterior insula4,5. The other category is the advanced response system involving processing of pain signaling in higher brain centers initiating at anterior cingulate cortex (ACC)4,5 resulting in vocal, emotional, facial or protective reactions6. Vocal responses included moaning, crying and screaming (3 intensity levels); emotional responses included agitation, non-cooperation and irritability; facial responses included furrowing of eyebrows, squinting, and frowning; and finally, protective reactions included guarding the painful area, and moving it away7. This model was developed using metrics from the Non-communicating Adult’s Pain Checklist (NCAPC) for individuals with intellectual and developmental disabilities (IDDs) and thus the metrics used to measure pain were by no means exhaustive, and some of the most complex or non-immediate behavioural responses may be missing from the list of responses in model.

Analgesic Problem Solving Model

As pain is a noxious stimuli, it is reasonable that individuals feeling pain will try to avoid further pain and will seek analgesia whether that by means of pharmaceutical analgesics or other treatments such as the immobilization of a sprained ankle. This response begins with the interruption of the individual’s attention to cause worry which in turn promotes successful problem solving behavior8. The problem solving behavior involves characterizing the pain, trying to deduce the cause of the pain usually in biomedical terms then trying to seek ways to reduce or eliminate the pain. If the chosen solution fails, then the pain is redefined to find another solution and this loop continues until analgesia is found1,9.
As the problem continues not to be solved as is the case for patients with chronic pain, the worry does not extinguish as expected since pain exists to promote successful problem solving. Instead, the failed attempts only serve to increase worry which may further develop into affective disorders10, hyper-vigilance11 and overall decreased quality of life. This model is consistent with the plethora of data that stresses the importance of patients accepting that pain relief is unachievable in clinical treatment of chronic pain12,13.

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Lorem ipsum dolor sit amet, consectetur adipiscing elit. Sed pellentesque ullamcorper ante quis vehicula. Aenean massa odio, placerat eget vehicula id, porta eget mauris. In hac habitasse platea dictumst. Aenean suscipit pellentesque ante. Etiam vel nunc a justo laoreet congue. Phasellus at ullamcorper quam. In mattis sem blandit lectus pharetra ac feugiat nibh ornare. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Suspendisse a risus a lacus feugiat tempor. Morbi sed risus turpis, quis viverra arcu. Fusce vel erat libero. Nam nunc ante, laoreet at tincidunt quis, tempor vel lorem. Integer dapibus pulvinar est, sit amet ultricies orci posuere et. Mauris euismod sagittis sapien quis vulputate. Maecenas mollis massa ac nibh ultricies egestas. Etiam tincidunt, lorem sed bibendum ultricies, orci metus feugiat lacus, sit amet gravida ante mi sit amet metus.

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Lorem ipsum dolor sit amet, consectetur adipiscing elit. Sed pellentesque ullamcorper ante quis vehicula. Aenean massa odio, placerat eget vehicula id, porta eget mauris. In hac habitasse platea dictumst. Aenean suscipit pellentesque ante. Etiam vel nunc a justo laoreet congue. Phasellus at ullamcorper quam. In mattis sem blandit lectus pharetra ac feugiat nibh ornare. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Suspendisse a risus a lacus feugiat tempor. Morbi sed risus turpis, quis viverra arcu. Fusce vel erat libero. Nam nunc ante, laoreet at tincidunt quis, tempor vel lorem. Integer dapibus pulvinar est, sit amet ultricies orci posuere et. Mauris euismod sagittis sapien quis vulputate. Maecenas mollis massa ac nibh ultricies egestas. Etiam tincidunt, lorem sed bibendum ultricies, orci metus feugiat lacus, sit amet gravida ante mi sit amet metus.

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Lorem ipsum dolor sit amet, consectetur adipiscing elit. Sed pellentesque ullamcorper ante quis vehicula. Aenean massa odio, placerat eget vehicula id, porta eget mauris. In hac habitasse platea dictumst. Aenean suscipit pellentesque ante. Etiam vel nunc a justo laoreet congue. Phasellus at ullamcorper quam. In mattis sem blandit lectus pharetra ac feugiat nibh ornare. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Suspendisse a risus a lacus feugiat tempor. Morbi sed risus turpis, quis viverra arcu. Fusce vel erat libero. Nam nunc ante, laoreet at tincidunt quis, tempor vel lorem. Integer dapibus pulvinar est, sit amet ultricies orci posuere et. Mauris euismod sagittis sapien quis vulputate. Maecenas mollis massa ac nibh ultricies egestas. Etiam tincidunt, lorem sed bibendum ultricies, orci metus feugiat lacus, sit amet gravida ante mi sit amet metus.

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