{"id":296,"date":"2021-03-22T16:54:52","date_gmt":"2021-03-22T16:54:52","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&p=296"},"modified":"2021-03-22T16:54:52","modified_gmt":"2021-03-22T16:54:52","slug":"psychological-basis-of-pain","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/psychological-basis-of-pain\/","title":{"raw":"Psychological Basis of Pain","rendered":"Psychological Basis of Pain"},"content":{"raw":"

Introduction<\/span><\/h2>\r\n
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\"Pain<\/a>The International Association for the Study of Pain\u00a0<\/span>(IASP)<\/b>\u00a0definition of pain highlights the multidimensional components of pain. The interaction of these dimensions (<\/span>sensory-discriminative:<\/b>\u00a0intensity, location, quality and <\/span>behavior\u00a0of pain;\u00a0<\/span><\/span>cognitive-evaluative:<\/b>\u00a0thoughts of the pain as influenced by previous experiences and knowledge; and\u00a0<\/span>motivational-affective<\/b>: emotional responses like anger, anxiety and fear that motivate the response to pain)<\/span>[1]<\/a><\/sup>\u00a0all contribute to the complexity of the painful experience. An individual\u2019s belief systems, pain understanding, thoughts and emotions: anxiety; depression; catastrophizing (or their psychology) influence how the brain interprets a noxious stimulus in relation to the meaning and level of threat the stimulus pose to one's well-being, and thereby influence the resulting output from the brain<\/span>[2]<\/a><\/sup>. Such resulting changes in <\/span>behavior\u00a0(i.e. avoidance)<\/span><\/span>[3]<\/a><\/sup>[4]<\/a><\/sup>\u00a0such as fear avoidance, catastrophizing, pain-related anxiety, stress and learned helplessness can impact upon a pain experience and a patient's coping strategies. While this is unlikely to be an exclusive list of influential psychosocial factors, the following components are well researched and evidenced. This page will review each of these in turn.<\/span><\/div>\r\n<\/div>\r\n

Fear Avoidance<\/span><\/h2>\r\nPain and Fear<\/b><\/a>: Fear is a typical emotional response to an experience that is perceived to be threatening, such as one that leads to a pain sensation[5]<\/a><\/sup>[6]<\/a><\/sup>.\u00a0Future avoidance of the painful activity is often the resulting behaviour\u00a0adopted to protect oneself from a repeat of the fearful emotion and painful experience. This pattern can lead to fear and avoidance of work-related activities, movement, and re-injury[7]<\/a><\/sup>.\u00a0Kinesophobia<\/b><\/i>\u00a0is a term used interchangeably with fear avoidance in health and pain literature. It is defined as \u201can excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or reinjury[8]<\/a><\/sup>.\u201d\r\n

Impact of Fear Avoidance on the Pain Experience<\/b><\/span><\/h3>\r\n
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\"Fear-avoidance-picture.jpg\"<\/a>\r\n
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<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nIn response to acute tissue damage\/injury, feelings of fear are heightened as part of a normal consequence of pain[4]<\/a><\/sup>. The individual will rest and protect the painful area as an adaptive behaviour to allow tissue healing to occur[4]<\/a><\/sup>. As the acute phase and initial tissue healing resolves, it has been suggested that some individuals can confront their fearful emotions and are able to resume normal activities, which ultimately helps extinguish their fears as they experience positive increase in mobility\/movement unassociated with further increases in pain[5]<\/a><\/sup>. For others, they may be unable to\u00a0overcome the fearful emotion<\/b>\u00a0and the resulting\u00a0avoidance behaviour persists<\/b>[7]<\/a><\/sup>. A cycle of continued activity avoidance and fearful emotions may ensue, resulting in chronic pain that may have an adverse effect on the musculoskeletal and cardiovascular system (disuse syndrome)[9]<\/a><\/sup>, which fundamentally increases disability[4]<\/a><\/sup>[7]<\/a><\/sup>[10]<\/a><\/sup>.\r\n\r\nSeveral models have been proposed to explain the persistence of 'fear-avoidance'<\/b>\u00a0and its impact on pain and behaviour<\/b>.\r\n\r\nIn the\u00a0fear-avoidance model of pain<\/a><\/b>, individuals who are likely to demonstrate ongoing fear-avoidance behaviours will be inclined to\u00a0catastrophize<\/b>[6]<\/a><\/sup>[7]<\/a><\/sup>:\r\n
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\"Pain<\/a>\r\n
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<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nVlaeyen and Linton[7]<\/a><\/sup>\u00a0have described the interconnections contributing to fear avoidance as follows: with negative appraisals of a painful experience, fear avoidance behaviours are elicited. Due to hypervigilance, the avoidance behaviour begins to occur in anticipation rather than in response to pain. As there are fewer and fewer opportunities to correct the wrongful association of pain with the avoided activity, the behaviour perpetuates and fear avoidance persists.\r\n\r\nWhile research has consistently shown an association between fear avoidance behavior and pain-related fears[11]<\/a><\/sup>[12]<\/a><\/sup>[13]<\/a><\/sup>[14]<\/a><\/sup>[15]<\/a><\/sup>\u00a0even when pain intensity and other variables were controlled in patients with chronic pain, there are conflicting studies about\u00a0this association in patients with acute pain.\u00a0Studies have shown that high levels of fear avoidance<\/b>\u00a0can be\u00a0a predictor for future episodes of pain<\/b>[16]<\/a><\/sup>[17]<\/a><\/sup>[18]<\/a><\/sup>[19]<\/a><\/sup>[20]<\/a><\/sup>. But on the contrary, studies[21]<\/a><\/sup>\u00a0showed more support for the link between\u00a0depression<\/a>\u00a0with poor function and disability at this early stage[22]<\/a><\/sup>[23]<\/a><\/sup>\u00a0In the\u00a0learning pathway model,<\/b>\u00a0fear avoidance becomes a conditioned response through association of pain with movement[7]<\/a><\/sup>[5]<\/a><\/sup>[22]<\/a><\/sup>. The behavior of avoiding expected pain-provoking movement or activities to prevent new episodes of pain is learned through experience[24]<\/a><\/sup>. The individual may anticipate similar experiences and associate non-painful or non-harmful experiences with pain, resulting in persistent fear-avoidance behavior[7]<\/a><\/sup>[22]<\/a><\/sup>.\r\n\r\nThe following\u00a0factors<\/b>\u00a0can affect\u00a0the strength of association of pain with movement and the fear-avoidance behaviour<\/b>\u00a0that patients may exhibit:[25]<\/a><\/sup>\r\n