By,
Ashwini Dinkar
Psychologist & Asst.Professor
Pain is defined as an unpleasant sensory and emotional
experience associated with actual or potential tissue damage,
or described in terms of such damage.
Nature-
Pain is a subjective experience influenced by physical,
psychological and environmental factors.
Pain is a sensation of the body, and is always an unpleasant
emotional experience
Pain can be acute, sub-acute, recurrent, or chronic.
Left untreated or under-treated, acute pain can become chronic
An early theory, called the Intensity Theory, stated that pain was
triggered as an emotional response to stimuli that was more
intense than normal. It claimed the more intense the stimuli, the
more intense the pain response.
In the late 1800s, another theory developed that advocated that
the body had receptors for pain.
Similar to the receptors in the eyes and ears that allow us to see
and hear, this theory went on to say that there was a specific area
of the brain that pain receptors connected to.
As scientific advancements were made, pain theories
expanded.
It wasn’t until the mid-1900s, after World War II, that
medical science had enough information about the nervous
system to put together a theory about how pain was
processed along the central nervous system
According to The Gate Control Theory Of Pain, when
body tissues are injured, such as when you get cut or
scraped, nerve endings in the damaged area transmit
impulses to a particular part of the spinal cord.
Once these nerve impulses reach the spinal cord, one of
two things may happen
i) When the pain is not sufficiently intense, a gatekeeper in
the spinal cord remains shut, so the pain sensations don’t
travel to the brain.
ii) If the sensations are sufficiently intense, the gate is opened,
and the nerve impulses are sent all the way up to the brain,
where they are experienced as pain.
The more signals that reach the brain, the more pain the
person experiences.
These gates are controlled by chemicals—neurotransmitters
Combination of both psychological and social factors.
Psychological factors-
Emotional factors that may increase pain perception are anxiety,
depression and anger.
Positive emotions usually decrease perceived pain.
The cognitive factors attention, expectancy and appraisal,
LOC etc can either increase or decrease pain experiences
depending on their specific focus and content.
Motivational aspect and Coping skills.
Social factors-
Social support, loneliness, marital status, care giver burden,
financial status, home and work environment, social
integration.
Subjective Perception –
It can be subjective because it cannot be directly observed
by those who are not experiencing it.
The pain may be of a stabbing, cutting, stinging, burning,
splitting, crushing, gnawing, nagging, gripping, shooting, or
throbbing character.
Objective Perception-
The patient's behavioral component as observed by the
others in addition to the patient's subjective perception of
pain.
Cognitive Perspective-
The brain’s ability to acquire, process, store, and retrieve
information. (Refer cognitive theories)
Evaluation of pain strongly depends on cognition as it
requires learning and recall of previous experiences
Detailed history taking and mental status examination.
Psychometric assessments (if needed)
Psychoeducation
Psychotherapy – CBT, BT, ACT, MET etc
Skill training and Coping mechanisms
Family intervention.
1. Pharmacological- The focus of pharmacologic pain
management is on alleviating your pain symptoms by
administering prescription.
2. Surgical - A procedure to remove or repair a part of the body
or to find out whether disease is present.
3. Sensory- Suggestive techniques to manipulate the intensity of
pain. Auto-suggestion/Hypnosis, Biofeedback, Guided
imagery, Relaxation techniques, Meditation, Mindfulness
practices etc.
1. Biofeedback- Biofeedback is a type of mind-body technique you
use to control some of your body's functions, such as your heart
rate, breathing patterns and muscle responses.
During biofeedback, you're connected to electrical pads that
help you get information about your body.
2. Relaxation technique- It's a process that decreases the stress
effects on your mind and body.
Relaxation techniques can help you cope with everyday stress.
And these techniques can help with long-term stress or stress
related to various health problems, such as heart disease and
pain
3. Hypnosis- is a changed state of awareness and increased
relaxation that allows for improved focus and concentration.
4. Acupuncture- is the practice of penetrating the skin with thin,
solid, metallic needles which are then activated through gentle
and specific movements of the practitioner's hands or with
electrical stimulation.
Acupuncture is part of the ancient practice of Traditional Chinese
medicine.
