1. Health Psychology
Pain

2. Requirements Types and theories Measuring Controlling and managing
Use first three studies, last two more for information

3. Types (and Theories of Pain) Background
EPISODIC ANALGESIA
Injury without pain
NEURALGIA
Sudden, sharp pain along nerve pathway after nerve disease has ended
CASUALGIA
Burning pain after deep wound has healed
PHANTOM LIMBS
Sensations in a missing limb
PUPOSE OF PAIN
Warning, learning, limit activity – a necessary evil
NOCICEPTION
Detection of tissue damage by specialised nerves
FEELING PAIN
Nociception, perception, suffering, behaviour

4. Theories of Pain Specificity theory Pattern theory Gate control theory
Special system of nerves carry messages from receptors to pain centre of brain
FOR – specialised receptors heat/touch
AGAINST – injury without pain, neurographs
Pattern theory
No separate system for perceiving pain, but shared with senses like touch
3 types receptor – nociceptor (pain only), Stimuli receptor (strong or weak stimuli), Touch receptor (touch only not pain)
Gate control theory
Biopsychosocial approach
Activity in pain fibres – open gate, activity in sensory nerves – close gate (rubbing, scratching), messages from brain – anxiety/excitement opens/closes – explain distraction working
Neuromatrix
Brain’s image of body on which sensory data is played out - holgram

5. Measuring Pain Background
Karoly – elements;
sensory, neurophysiological, emotional, behavioural, impact, information processing
Interview
Time consuming and interpretation complex
Questionnaire/Rating Scales
Interpretation and language
Generally reliable and valid
Physical measure
Pain threshold and just noticeable differences
Pain tolerance, drug request point, pain sensitivity range

6. Controlling Pain Background
Chemical treatment
Analgesic (aspirin, acetimonphen, opiates)
Placebos
Treatment with no obvious active ingredient
Ethics
Surgery
Trigeminal neuralgia – destroy nerves to facial area (numbness)
Physical therapy
Manual – massage
Heat – microwave diathermy, ultrasound – deep tissue injury. Does the heat close the gate?
Cold – ice pack
Acupuncture
Electrotherapy
Spinal cord stimulation
Deep brain stimulation
TENS/PENS
Psychological treatment
Operant conditioning – social reinforcement, increase exercise and rest, reduce drugs, training to not reinforce pain behaviour
Coping
Reinterpretation of pain, physical relaxation methods, distraction
Cognitive behavioural therapy
Change maladaptive behaviour, change self-statements, change assumptions and beliefs

7. 3 Short Summaries
Pain is a complex experience with a variety of psychological and physiological components. Although we have an understanding of some of the factors that increase or reduce pain we do not yet have a complete picture of it.
As with all attempts to measure behaviour and experience, pain poses a number of problems, including the need to rely on self-reports of people with pain. They, in turn, have to make comparative judgements about their pain without ever knowing what pain is like for other people.
Although we only have sketchy understanding about he causes of pain there are a wide range of treatments to relieve it. These treatments include physiological, physical, cognitive and behavioural treatments which often work best when used in combination.

8. Pain – study 1 Bigatti Who What Results 2002
Pain measures & fibromyalgia
Quasi-experiment, testing instruments for validity, reliability, ease of use
602 informed
What
Pain level measured using 5 common pain scales (pain rating perception, pain index intensity, words chosen intensity, manual tender point weights, visual analogue mark line) + arthritis self-efficacy scale (pain, symptoms, self-efficacy) + fibromyalgia impact (health physical, psychological, social, global) + Pittsburgh sleep quality
Correlated with each other and other measures
Results
Correlation between the first 5 pain scales – concurrent validity. Visual scale most correlated with other scales and the extra 3 scales. Easy to use and patients feel comfortable with it.

9. Pain – study 2 Strujis et al Who What Results 2003
Fake manipulation of tennis elbow
31 all had tennis elbow, informed, excluded if other symptoms
What
2 treatment groups – random. 1 – manipulation 9 sessions, devised for the study. 2 – ultrasound, massage, stretch & strengthen, 9 sessions
Independent practitioner administered. Researcher blind to group
At outset, 3 weeks, 6 weeks – global measurement of improvement (1-6 scale), severity of complaint (pain), pain free grip & maximum grip force
Examined using statistical analysis
Results
No significant differences at outset
3 weeks – 62% manipulation group – successful; 20% normal treatment
6 weeks – manipulation group decrease pain during day
No other differences between groups

10. Pain – study 3 Luffy Who What Results 2003
Paediatric pain measurement 3 tools
Experiment
100 African-American children 3-18y, sickle cell anaemia, 49% female. All speak English, cognitively able (checked) Informed consent and assent
What
Divided into three age groups. Interviewed (parent present) recount 2 painful procedures. Asked which was most painful. Rated on 3 scales and repeated again after a minimum of 15 minutes. Counterbalanced presentation of tests.
Oucher Scale (numerical or pictorial); Wong/Baker (select a picture of a face which matches pain); VAS (line)
If the procedure identified as most painful was rated with the highest pain threshold then a score of 1 given – if not a score of 0. Consistent responses totalled and divided by number of participants – percentage validity for group. With retests - Score 1 if VAS within 5mm, score 1 if same picture chosen for face.
Given all three tests and asked which they preferred – ranked
Results
17/100 children could not use the VAS
Retest reliability – 38% oucher, 37% faces, 29% VAS. If slight variation allowed then 70%, 67% and 45%.
Faces 56% prefer, oucher 26%, VAS 18%

11. Study 4 Melzack & Wall 1965 Gate control theory
Neural gate in dorsal horn of spinal cord. Three factors open and close gate. Amount of activity in small pain fibres, amount of activity in peripheral fibres, messages descending from brain.
Decrease pain by preventing pain reaching the gate or increase large peripheral fibre stimulation and close the gate. Also get brain to think in positive way therefore send message to close gate.

12. Study 5 Melzack & Togerson Who What Results 1971 Language of pain
Doctors, patients, graduates, students
What
Classify adjectives into groups describing pain aspects (doctor and graduate)
Doctor, patient, student rate each group for intensity
Results
Part 1 – 3 groups; sensory (feels like, location, intensity, duration, quality) – affective (emotional feeling) – evaluative (subjective feeling – e.g. unbearable, troublesome). 16 sub-groups
Pain is multi-dimensional, physical sensation, subjective experience, emotional response, has a meaning.

13. General Review Ethics Reliability/validity Reductionism
Strujis – did they experience more pain?
Bigatti – the manual tender point examination
Luffy – avoids using recall
Reliability/validity
Bigatti and Luffy found measures to be valid and reliable – for specific groups
Luffy may have been testing memory with the older participants since they remembered which they chose rather than being reliable
Reductionism
Scales – physical and emotional experience not captured by selecting a number, not a meaningful account of reality
Ecological validity
Relationship between procedure and everyday life
Strujis & Bigatti – real patients in pain used
Luffy – excluded those in pain for ethical reasons but reduced ecological validity as recall and memory being tested

14. Questions
Describe what psychologists have found out about what pain is and how we can measure it.
Disucss the psychological evidence on pain and its measurement.
Suggest one psychological technique that could be used to reduce chronic back pain. Give reasons for your answer.
Describe one theory of pain (6)
Contrast one theory of pain with another theory of pain (10)
Describe one way of measuring pain (6)
Discuss the validity of measures of pain (10)
Describe one method of controlling pain (6)
Discuss the effectiveness of methods of controlling pain (10)