Health psychology an introduction to behavior and health 8th edition brannon test bank

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CHAPTER 7 Understanding and Managing Pain Lecture Outline I. Pain and the Nervous System All sensory stimulation, including pain, starts with activation of sensory neurons and proceeds with the relay of neural impulses toward the brain.

A. Somatosensory System The somatosensory system conveys sensory information from the body through the spinal cord to the brain.

1. Afferent Neurons Afferent (sensory) neurons convey sensory information from sense organs to the spinal cord and then to the brain. Efferent (motor) neurons result in the movement of muscles. Interneurons connect afferent and efferent neurons.

Primary afferents are those neurons that have receptors in the sense organs and that originate the neuron’s message. The vast number of neurons and their interconnections makes neural transmission complex.

2. Involvement in Pain Nociceptors are neurons capable of sensing pain stimuli. Three different types of neurons are involved with transmitting pain impulses. The large A-beta fibers and smaller A-delta fibers are covered with myelin, which speeds neural transmission. The smaller and more common C fibers require high levels of stimulation to fire. These different fibers with their different thresholds and transmission speeds may relate to different types of pain sensation.

B. The Spinal Cord Primary afferents from the skin enter the spinal cord where they synapse with neurons in the dorsal horns of the spinal cord. The dorsal horns contain several laminae (layers). Laminae 1 and laminae 2 form the substantia gelatinosa, a structure that receives sensory input from the A and C fibers.

Complex interactions of sensory input occur in the laminae of the dorsal horns, and these interactions may affect the perception of sensory input before it gets to the brain.

C. The Brain The thalamus receives sensory input from the different neural tracts in the spinal cord. The skin is mapped in the somatosensory cortex in the parietal lobe of the cerebral cortex, and the proportion of cortex devoted to an area of skin is proportional to that skin’s sensitivity to stimulation (see Figure 7.2). Sensory information from internal organs are not mapped as precisely as the skin, leading people to have the ability to identify stimulation from the skin but less distinct sensory perceptions of their internal organs. This is also the reasoning behind referred pain, when pain is experienced in a part of the body other than the site where the pain stimulus originates.

D. Neurotransmitters and Pain The neurotransmitters that form the basis for neural transmission also play a role in pain perception. The discovery of the endogenous opiates—enkephalin, endorphin, and dynorphin—led to the discovery of neural receptors specialized for

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Chapter 7 these neurotransmitters and the conclusion that opiate drugs produce analgesia because of the brain’s own chemistry. The neurotransmitters glutamate and substance P and the chemicals bradykinin and prostaglandins may exacerbate pain stimulation.

Proinflammatory cytokines produced by the immune system are also involved in pain, possibly creating chronic pain by sensitizing neurons in the spinal cord.

E. Modulation of Pain When the periaqueductal gray, a structure in the midbrain, is stimulated, pain relief occurs. The neurons in the periaqueductal gray synapse with neurons in the nucleus raphé magnus, a structure in the medulla (see Figure 7.3). These neurons descend to the spinal cord and may constitute a descending control system for pain perception.

II.

The Meaning of Pain The traditional view of pain focused on the physical sensations, but about 100 years ago, C. A. Strong proposed that pain consists of not only the sensation but also person’s reaction to that sensation.

A. Definition of Pain Perhaps the most acceptable definition of pain is the one proposed by the International Association Subcommittee for the Study of Pain that defined pain as an unpleasant sensory experience accompanied by an emotional experience and actual or potential tissue damage.

At least three stages of pain have been identified. Acute pain is ordinarily adaptive, lasts a relatively short period of time, and includes pain from cuts, burns, and other physical trauma. Chronic pain endures beyond the time of normal healing, is relatively constant, is often reinforced by other people, and may become selfperpetuating. Prechronic pain is experienced between acute and chronic pain and is critical because during this time, the pain may either go away or evolve into chronic pain. Another type of pain is chronic recurrent pain, or when there are alternating episodes of intense pain and no pain.

B. The Experience of Pain Pain is both personal and subjective, but situational and cultural factors play a role in its experience. Beecher’s observations on wounded soldiers during World War II highlight the variability of pain—seriously wounded soldiers reported little pain.

Individual variations exist in the experience of pain, but as Beecher suggested, situational factors are important. Cultural expectations and stereotypes as well as cultural sanctions against the expression of pain influence pain behaviors. Sanctions against expressing pain may be a large part of the gender difference in pain, but some evidence indicates that women may also be more sensitive to pain. Thus, a variety of individual, cultural, and gender-related factors influence the experience of pain.

C. Theories of Pain How people experience pain is the subject of a number of theories. Of the several models of pain, two capture the divergent ways of conceptualizing pain: the specificity theory and the gate control theory.

1. Specificity Theory The specificity theory can be traced to Descartes, who hypothesized that the body works by mechanistic principles. Applied to pain, this theory holds that pain is the result of transmission of specific signals. Research has failed to find pain

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Understanding and Managing Pain receptors or fibers specifically devoted to pain transmission. This theory also fails to integrate the variability of the pain experience.

2. The Gate Control Theory Melzack and Wall formulated the gate control theory of pain as a way to explain the variability of pain perception (see Figure 7.4). They hypothesized that a gating mechanism exists in the spinal cord and that sensory input is modulated in the substantia gelatinosa of the dorsal horns of the spinal cord. This modulation can change pain perception, as can brain-level alterations from a hypothesized central control trigger. This theory includes explanations of both physiological and psychological modulations of the pain experience. Melzack has proposed an extension to the gate control theory, called neuromatrix theory, which places a stronger emphasis on the brain’s role in pain perception.

III. The Measurement of Pain Tools for measuring pain are important in order to evaluate the various pain therapies. A number of techniques have been used to measure laboratory and clinical pain, and these fall into three main categories: self-reports, behavioral assessments, and physiological measures.

A. Self-Reports Self-reports of pain include simple rating scales, standardized pain inventories, and standardized personality inventories.

1. Rating Scales With self-report rating scales, patients rate the intensity of their pain on a scale; for example, the scale may range from 1 to 100. A similar technique is the Visual Analog in which patients check severity of pain on a continuum from no pain to worst pain imaginable. The faces scale is a similar approach consisting of drawings of facial expressions of pain, which is suitable for children and older adults.

2. Pain Questionnaires Melzack developed the McGill Pain Questionnaire (MPQ), an inventory that categorized pain into three dimensions: sensory, affective, and evaluative. The sensory dimension includes pain described in terms of its temporal, spatial, pressure, and thermal properties; the affective dimension defines pain in terms of fear, tension, and autonomic properties of the pain experience; and the evaluative dimension includes the perceived severity of the entire pain experience. The MPQ has adequate validity, but its vocabulary is somewhat difficult.

The Multidimensional Pain Inventory (MPI) is another questionnaire that measures several aspects of pain: characteristics of the pain, patients’ perception of the responses of others to their pain, and ratings of daily activities of the patient. This inventory has allowed for the development of 13 different scales that capture different dimensions of the lives of pain patients.

3. Standardized Psychological Tests Standardized tests, such as the MMPI-2, have also been used to assess pain.

This instrument is useful in differentiating among types of pain patients and has some ability to predict which patients will respond to medical treatments for pain.

Other commonly administered tests include the Beck Depression Inventory and the Symptom Checklist-90.

B. Behavioral Assessment

Chapter 7 People in pain often behave in ways that communicate to others that they are in pain, which can be used as an informal or standardized assessment of pain. Health care workers tend to underestimate patients’ pain, but spouses and others close to pain patients can provide a better assessment. This approach is especially useful for individual who cannot provide self-reports, such as small children and some older individuals who cannot communicate verbally.

C. Physiological Measures Although pain produces an emotional response, research has failed to identify specific organic states that are strongly correlated with pain. Muscle tension and autonomic responses such as heart rate and skin temperature show some relationship to the experience of pain, but neither type of measurement shows sufficient reliability and validity to be a good measurement technique.

IV. Pain Syndromes Acute pain has the advantage of signaling injury, but chronic pain has no advantages. Such pain can be classified according to location or syndrome, symptoms that occur together and characterize a condition. Headache and low back pain are the two most frequently treated types of chronic pain, but health psychologists also deal with other pain syndromes.

A. Headache Pain Headache pain is the most common of all pains, with more than 99% of Americans suffering from some form of headache over their lifetime. The most common varieties are migraine, tension, and cluster headaches, although the symptoms overlap and clear classification is often impossible. Migraine (or vascular) headaches bring about loss of appetite, nausea, vomiting, and increased sensitivity to light. Tension headaches are muscular in origin and are characterized by contractions of the muscles of the neck, shoulders, scalp, and face. Cluster headaches produce intense pain localized in one side of the head and occur frequently over a period of days, then disappear for weeks or months.

B. Low Back Pain The most frequent causes of low back pain are injury or stress resulting in musculoskeletal, ligament, or neurological problems in the lower back. In addition, stress and psychological factors may play roles in back pain. Most of the people who experience back pain do not progress to chronic pain, but those who do tend to have persistent pain. Only about 20% of back pain patients have an identified, physical cause for their pain.

C. Arthritis Pain A variety of arthritic pains exist, and many involve inflammation of the joints.

Rheumatoid arthritis, perhaps the most frequent cause of arthritic pain, is an autoimmune disorder characterized by a dull ache within or around a joint.

Osteoarthritis is a progressive inflammation of the joints mostly affecting older people and characterized by a dull ache in the joint area. Fibromyalgia is a chronic pain condition characterized by tender points throughout the body, fatigue, headache, cognitive difficulties, anxiety, and sleep disturbances. This condition leads to a diminished quality of life that is similar to the barriers faced by those with arthritis.

D. Cancer Pain

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Understanding and Managing Pain Cancer pain is caused by either a malignancy or by treatment of a malignancy.

Pain is present in a majority of terminal cancer cases, and both chemotherapy and radiation therapy produce pain. Often pain goes untreated for cancer patients.

E. Phantom Limb Pain Phantom limb pain is the experience of chronic pain in an amputated part of the body. People who have had arms, legs, or breasts removed nearly always continue to feel some sensation (frequently pain) despite the removal of that body part and the nerves that underlie sensation.

V. Managing Pain Managing chronic pain is a challenge because this type of pain has no identifiable cause. Thus, several approaches to treatment exist, including medical and behavioral techniques.

A. Medical Approaches to Managing Pain Treatment of acute pain is easier than for chronic pain, but both present challenges.

1. Drugs Analgesic drugs are the most common treatment for acute pain. These drugs fall into two groups: opiates and nonnarcotic analgesics. Opiate drugs have powerful analgesic effects but also produce tolerance and dependence. However, the fear of drug-related problems, such as addiction, leads to under-medication more often than to drug abuse. The recent increase in the use of prescription analgesic drugs was due mostly for the demand for oxycodone and hydrocodone, both of which are opiates with a potential for abuse. Low back pain patients may receive more drug treatment than the ideal level for their condition.

Aspirin and the other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium, as well as acetaminophen drugs, are all useful in managing minor pain, especially pain due to injury. Antidepressant drugs and antiseizure drugs also affect pain perception and may be useful in pain management for some people.

2. Surgery Surgery may be directed either to repairing damage that causes pain or to altering the nervous system to change pain perception. Surgery is an attempt to control low back pain more often than other pain syndromes, and specific nerves or the spinal cord may be targets. Surgery may also be used to implant devices to stimulate the spinal cord to decrease pain. Surgery is not always effective, either in repairing damage or in producing pain relief, especially for people with low back pain. A related technique is transcutaneous electrical nerve stimulation (TENS), which uses electrical impulses to stimulate skin stimulation to block pain messages. Spinal cord stimulation is more effective than TENS. B. Behavioral Interventions for Managing Pain Some people classify behavioral techniques as alternative treatment or mind-body medicine, but psychologists focus on the behavioral aspects of these treatments and consider them part of psychology.

1. Relaxation Training

Chapter 7 Progressive muscle relaxation involves learning to relax the entire body, one muscle group at a time, and to breathe deeply and exhale slowly. This technique had been used to manage a variety of pain problems, including headaches, rheumatoid arthritis, and low back pain. A National Institutes of Health Technology panel’s evaluation for pain treatments gave relaxation training its highest rating.

2. Behavioral Therapy Behavior modification techniques are based on the principles of operant conditioning and are used by health psychologists to help people cope with stress and pain. The goal of behavior modification is to shape behavior, not to alleviate feelings of stress or sensations of pain. People in pain may continue their pain behaviors because they receive positive reinforcers such as attention, sympathy, financial compensation, relief from work, and other rewards. Positive reinforcers may create pain traps that turn acute pain into chronic pain. The rationale behind behavior modification is to train people in the pain patient’s environment to discontinue reinforcement for pain behaviors, thus avoid the pain trap. Progress is measured in terms of observable behavior, such as amount of medication, absences from work, physical activity, and so forth. Behavior modification does not address the cognitions that underlie behavior.

Cognitive therapy rests on the assumption that a change in the interpretation of an event can change people's emotional and physiological reaction to that event. Because pain is at least partially due to psychological factors, cognitive therapy attempts to get patients to think differently about their pain experiences and to increase their confidence that they can cope with them.

Cognitive behavioral therapy aims to develop beliefs, thoughts, and skills to make positive changes in behavior. Dennis Turk and Donald Meichenbaum have developed a cognitive behavioral program for pain management called pain inoculation, which parallels stress inoculation (described in Chapter 5). These techniques involve the cognitive stage of reconceptualization and the behavioral stages of acquisition and rehearsal of skills and follow-through.

Research indicates that behavior modification, cognitive therapy, and cognitive behavioral therapy are effective for a wide variety of pain conditions (see Table 7.2).

Exploring Health on the Web Several websites provide information about many aspects of pain, including types of pain, theories, syndromes, and treatment options. http://www.americanpainsociety.org This website is the one maintained by the American Pain Society, which is a professional society for those researching the topic of pain. http://www.americanheadachesociety.org The website for the American Headache Society is oriented toward professionals but also includes information accessible to students. http://www.theacpa.org

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Understanding and Managing Pain This website is maintained by the American Chronic Pain Association, an organization devoted to raising awareness and offering support to those with chronic pain problems.

Suggested Activities Personal Health Profile — Charting Pain As an activity for their Personal Health Profile, your students should begin a pain diary, which will supplement the stress diary they began with Chapter 6. This diary should extend for at least a week, during which time everyone will experience some type of pain.

Many of those pains will be acute, but nearly everyone suffers from headaches, at least occasionally, and some students will have other chronic pains, such as low back pain or pain from various injuries. As part of their pain diary, your students should rate the intensity of their pain on perhaps a 10-point scale, record time of day when the pain is most intense, and note environmental or psychosocial events that seem to relate to the pain's onset. They should also describe their attempts to cope with the pain. Did they try to relax, take aspirin or other analgesic drugs, rest in bed, or use some other means to seek pain relief? With such a detailed diary, your students can make some predictions concerning when, where, or why a pain will return.

Creating Chronic Pain Many factors contribute to the development of chronic pain, and social learning theory holds that reinforcement for pain behaviors is a major contributor. To develop a better understanding of how people reinforce pain, arrange a role-playing activity for your students. Choose someone to be the person in pain and work with this person so that he or she can display a realistic variety of pain behaviors. Choose others to play the roles of family members and friends and decide who will reinforce and who will fail to reinforce the person’s pain. (Make sure that someone ignores the person’s pain behaviors without being mean or unkind to this person.)

This activity should be presented as a skit in which the person in pain manifests pain behaviors, and others react to the pain behaviors in various ways. After observing the interactions, ask your class how they felt about those people who rewarded the pain behaviors. Did they feel that these people were being kind and helpful? What does learning theory say about the consequences of such “help?” How did they feel about those who failed to reward the person’s pain? Is it acceptable to fail to be solicitous to those in pain? What problems does this dilemma pose for people who want to be helpful but also know that reinforcement can increase the frequency of undesirable behavior?

Understanding the Impact of Chronic Pain The common experience of acute pain does not lead to an understanding of chronic pain. People who do not experience chronic pain have little understanding of what life is like with everyday pain. To better comprehend life with chronic pain, arrange for your students to interview someone who has a chronic pain syndrome. Instruct them to ask questions about the person’s sensations; what barriers pain has imposed on his or her life, what treatments the person has sought, and which treatments were more effective.

Exploring a Neurological View of Pain

Chapter 7 Physicians often have views that differ from those of psychologists, and you can allow your students to become acquainted with these differences by inviting a neurologist to be a guest lecturer on the topic of pain. A neurologist who specializes in pain treatment would be ideal, but any neurologist should be very familiar with the puzzles of pain and its treatment.

Describing Pain The textbook chapter highlights a number of different pain measures. Here are links to some of the pain measures mentioned: McGill Pain Questionnaire: http://www.chcr.brown.edu/pcoc/shortmcgillquest.pdf A sample Visual Analog Pain Scale: http://www.partnersagainstpain.com/printouts/A7012AS1.pdf West Haven Yale Multidimensional Pain Inventory http://www.tac.vic.gov.au/media/upload/west_haven_yale_multidimensional_pain _inventory.pdf Living with No Pain Living without pain might seem like a blessing, but it is not always. Students will be fascinated to read about Ashlyn Blocker, the “girl who could feel no pain”, in this NY Times article (http://www.nytimes.com/2012/11/18/magazine/ashlyn-blocker-feels-nopain.html). The camp mentioned in the article has the following website that has additional links about Congenital Insensitivity to Pain: http://www.painlessbuthopeful.org/Information_and_Media.html Relaxation Training One behavioral technique for managing pain is relaxation training. Below are two sample scripts you could read aloud to students to have them gain a better understanding of this technique works. http:/www.amsa.org/healingthehealer/musclerelaxation.cfm http://prtl.uhcl.edu/portal/page/portal/COS/Self_Help_and_Handouts/Files_and_ Documents/Progressive%20Muscle%20Relaxation.pdf

Video Recommendations From Films for the Humanities & Sciences: Pain: The Language of the Body and the Mind (2000) is a 3-part series of short videos. This series includes "The Physiology of Pain," featuring the neurology underlying pain perception and how the nervous system can modulate these signals, "The Psychology of Pain," which shows how emotion and behavioral factors can increase or decrease pain, and "The Management of Pain," which examines medical and behavioral treatments.

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Understanding and Managing Pain The Anatomy of Pain (2003) presents various types of pain, outlines how pain is conveyed through the nervous system, distinguishes between acute and chronic pain, and addresses treatment through medication and acupuncture.

Chronic Pain (2005) explores causes and treatments for pain by presenting pain experts and patients who have used a variety of approaches to manage pain.

World of Pain: Coping and Caring (2001) combines dramatization and information to show a hypothetical family and real case studies of pain. Both pain perception and pain management are featured.

Headache: The Painful Truth (2001) explores tension, migraine, and cluster headaches and those who suffer from them. In addition, this video includes prominent experts who present research and findings about this pain syndrome.

Migraines (2007) focuses on this common and debilitating type of headache, including diagnosis and treatment.

Low Back Pain (2005) explores this pain syndrome that as many as 80 percent of people experience at some point in their lives. This program focuses on the physical injuries that can result in back pain and the medical treatments.

From Fanlight Productions: A Disease Called Pain (2003) explores chronic pain through the experience of chronic pain patients. This program clearly distinguishes between acute and chronic pain and presents some of the approaches to managing chronic pain.

Other Films: 127 Hours –A major motion movie about Aron Ralston (played by James Franco) who needed to cut off his arm to save his life. Available for DVD rental.

Videos from the Web: http://youtu.be/b3fX96OugmA –This video examines the relationship between pain and depression, how both should be treated, and why this is difficult (1:07; “Depression and Chronic Pain is Extremely Common”). http://youtu.be/SPOcqXkygoQ – This video explains possible reason why pain patients often feel as though they should “tough it out” and why this is problematic (1:53;“Pain Patients Shouldn’t Tough It Out”). http://youtu.be/_IUmVcwGbWE – This video explains how pain patients track their pain (1:46). http://www.youtube.com/watch?v=6qocxopS5fc&feature=share&list=PL9DF1AB9AE98 3C82B – This video showcases the treatment for a chronic pain patient (4:09).

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http://youtu.be/YL_6OMPywnQ - This video explains how mirror therapy is used to help decrease phantom limb pain (2:32).

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Multiple Choice Questions 1. The ______ system allows us to interpret certain sensory information as pain. a. somatosensory b. endocrine c. skeletal d. muscular ANS: a REF: Pain and the Nervous System 2. Primary afferents convey sensory impulses to the a. spinal cord. b. peripheral nervous system. c. brain. d. motor neurons.

ANS: a REF: Pain and the Nervous System 3. Myelinated afferent neurons are called a. A fibers. b. beta afferents. c. C fibers. d. delta afferents.

ANS: a REF: Pain and the Nervous System 4. More than half of all sensory afferents are a. A-beta fibers. b. A-delta fibers. c. C fibers. d. myelinated.

ANS: c REF: Pain and the Nervous System 5. Sherman stubbed his toe on the sidewalk. His sensation of pain traveled first to the a. muscles in the foot. b. brain. c. spinal cord. d. cranial nerves.

ANS: c REF: Pain and the Nervous System 6. This system conveys sensory information from the body to the brain. a. endocrine system b. digestive system c. somatosensory system d. immune system ANS: c REF: Pain and the Nervous System 7. _________ neurons carry nerve impulses away from the brain and toward the muscles.

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Chapter 7 a. Efferent b. Afferent c. Beta afferents d. Delta afferents ANS: a REF: Pain and the Nervous System 8. Nociception refers to the process of perceiving ________. a. stress b. pain c. anger d. oxygen ANS: b REF: Pain and the Nervous System 9. Stimulation of the A-delta fibers, since they are myelinated, leads to a _______, whereas the unmyelinated C fibers often result in _____________. a. “slow pain” response; “fast pain” response b. “no pain” response; “slow pain” response c. “fast pain” response; “slow pain” response d. “no pain” response; “fast pain” response ANS: c REF: Pain and the Nervous System 10. Afferent fibers group together after leaving the skin, forming a _____. a. nerve b. cell c. cell body d. ganglion cell ANS: a REF: Pain and the Nervous System 11. When pain is experienced in some other location than the site where the pain was inflicted, this is called a. phantom limb pain. b. referred pain. c. prechronic pain. d. chronic recurrent pain.

ANS: b REF: Pain and the Nervous System 12. Recent research gave participants __________ to reduce people’s feelings of social pain. a. a shock b. a hug c. Tylenol d. Morphine ANS: c REF: Pain and the Nervous System 13. Participants who are socially excluded show more activity in the anterior cingulate cortex, similar to people who are experiencing _____________. a. physical pain b. depression

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Understanding and Managing Pain c. anxiety d. all of the above ANS: a REF: Pain and the Nervous System 14. _____ are chemicals that carry information between nerves. a. Afferent neurons b. Efferent neurons c. Neurotransmitters d. Interneurons ANS: c REF: Pain and the Nervous System 15. _______ are neurochemicals that help modulate, or lessen, the experience of pain. a. Endorphins b. Interneurons c. Glutamates d. Proinflammatory cytokines ANS: a REF: Pain and the Nervous System 16. These proteins produced by the immune system increase pain sensitivity, along with increasing fatigue and sickness: a. proinflammatory cytokines b. endorphins c. opiates d. both a and b ANS: a REF: Pain and the Nervous System 17. The dorsal horns are located in the a. brain stem. b. kidneys. c. midbrain. d. spinal cord.

ANS: d REF: Pain and the Nervous System 18. The substantia gelatinosa is a. in the dorsal horns of the spinal cord. b. in the midbrain region, adjacent to the thalamus. c. composed of a gelatin-like material that surrounds the lower portion of the brain. d. a hypothetical structure that has not yet been confirmed.

ANS: a REF: Pain and the Nervous System

19. Which structure is most capable of modulating sensory input? a. primary afferents b. secondary afferents c. substantia gelatinosa d. spinothalamic tract

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Chapter 7 ANS: c

REF: Pain and the Nervous System

20. Sensory input information passes through what brain structure? a. the parietal lobe of the cerebral cortex b. the pons c. the cerebellum d. the thalamus ANS: d REF: Pain and the Nervous System 21. What brain structure contains a representation of the skin’s surface? a. somatosensory cortex b. parietosensory area c. sensorimotor cortex d. occipital cortex ANS: a REF: Pain and the Nervous System 22. Neurotransmitters like _____ decrease pain, but those like ________ increase the experience of pain. a. serotonin . . . dynorphin b. endorphin . . . glutamate c. substance P . . . serotonin d. endorphin . . . enkephalin ANS: b REF: Pain and the Nervous System 23. Which of the body's own neurochemicals does NOT have opiate-like effects? a. serotonin b. dynorphin c. endorphin d. enkephalin ANS: a REF: Pain and the Nervous System 24. Pain is usually defined as a. a sensory experience only. b. an emotional experience only. c. neither a sensory nor an emotional experience. d. both a sensory and an emotional experience.

ANS: d REF: The Meaning of Pain

25. Victoria has just cut her hand with a sharp knife. The pain she feels can best be described as a. acute. b. prechronic. c. chronic intractable. d. chronic.

ANS: a REF: The Meaning of Pain

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Understanding and Managing Pain

26. Which of these is NOT a distinction between chronic and acute pain? a. Acute pain is usually adaptive; chronic pain is not. b. Acute pain is physical; chronic pain is psychological. c. Chronic pain is frequently perpetuated by environmental reinforcers; acute pain needs no such reinforcement. d. Chronic pain has no biological benefit; acute warns the person to avoid further injury.

ANS: b REF: The Meaning of Pain 27. Henry Beecher reported that soldiers wounded at the Anzio beachhead during World War II experienced ______ pain. a. chronic intractable b. stress-related c. severe, excruciating d. very little ANS: d REF: The Meaning of Pain 28. Kyle is experiencing headaches and his partner has taken over the household chores. Research by Pence et al. (2008) would suggest that Kyle’s headaches are likely to a. increase in intensity. b. decrease in intensity. c. completely disappear. d. disappear until his partner makes him do the chores again.

ANS: a REF: The Meaning of Pain 29. This personality trait has been associated with a “pain-resistant” personality. a. Conscientiousness b. Extraversion c. Neuroticism d. There is no “pain-resistant” personality.

ANS: d REF: The Meaning of Pain 30. Physicians are likely to underestimate the pain of a. Asian Americans. b. African Americans. c. European Americans. d. no ethnic group; doctors treat all patients equally.

ANS: b REF: The Meaning of Pain 31. According to the gate control theory, emotions such as ______ could increase pain by affecting the gate to open, whereas emotions such as _____ could decrease pain by affecting the gate to close. a. happiness; depression b. joy; anxiety c. anxiety; happiness d. depression; anxiety ANS: c REF: The Meaning of Pain

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32. Matthew is running a marathon and trips over a pile of acorns, but finishes the race. Afterwards, he finds out his ankle is sprained. What theory best accounts for the fact that Matthew did not immediately stop running after tripping? a. specificity theory of pain b. gate control theory of pain c. delay of gratification theory of pain d. none of the above ANS: b REF: The Meaning of Pain 33. People in pain frequently receive attention and sympathy, which may provide ____________ for these pain behaviors. a. reinforcement b. negative scheduling c. punishment d. generalization ANS: a REF: The Meaning of Pain 34. In some cultures, people undergo initiation rituals that call for them to have their body pierced, cut, tattooed, burned, or beaten. These individuals a. feel no pain. b. show little or no pain from an accidental injury. c. feel pain, but their culture trains them to exhibit no pain during these initiation rituals. d. offer proof that pain is totally psychological.

ANS: c REF: The Meaning of Pain 35. What is the relationship between the experience of pain and some types of psychopathology? a. People with personality disorders have heightened pain perception. b. People with pain-prone personalities tend to have borderline personality disorder. c. People with pain-resistant personalities tend to have bipolar disorder. d. It is not clear whether psychopathology makes one vulnerable to pain or whether being in pain produces psychopathology.

ANS: d REF: The Meaning of Pain 36. During the birth process, women in some cultures exhibit many more signs of pain than women in other cultures. This observation shows that a. the experience of pain varies from culture to culture. b. cultural practices can influence the expression of pain. c. natural childbirth produces less pain than opiate drugs. d. women who express little pain during childbirth are undergoing selfhypnosis.

ANS: b REF: The Meaning of Pain 37. With regard to gender,

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Understanding and Managing Pain a. women sense pain more quickly than men. b. women are more likely to hide their pain. c. men are more likely to be aware of their pain. d. men are less likely to report pain.

ANS: d REF: The Meaning of Pain 38. Specificity theory hypothesizes that a. a person's interpretation of pain is more important that tissue damage in determining the intensity of pain. b. acute pains intensify over time. c. the experience of pain is approximately equal to the amount of tissue damage or injury. d. chronic pain can become acute pain over time.

ANS: c REF: The Meaning of Pain 39. Which of these findings cast doubt on the specificity theory of pain? a. Researchers have failed to find specific skin receptors devoted to relaying pain. b. Phantom limb pain occurs in 70% of amputees. c. Injury can occur without pain, such as that experienced by the soldiers at Anzio beach. d. all of these ANS: d REF: The Meaning of Pain 40. The theory of pain proposed by Melzack and Wall has been called the _____ theory. a. gate control b. sensory decision c. cognitive-emotional d. tension-reduction ANS: a REF: The Meaning of Pain

41. According to the gate control theory of pain, the structure that is the likely location of the gate is a. the substantia gelatinosa. b. the ventral horns of the spinal cord. c. the transverse section of the medulla. d. supraspinal nerve endings.

ANS: a REF: The Meaning of Pain 42. According to the gate control theory of pain, the spinal cord a. mechanically relays sensory input information. b. modulates the input of sensory information. c. does not have the physiological capacity to affect pain perception.

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Chapter 7 d. is less important in pain perception than the cerebellum.

ANS: b REF: The Meaning of Pain 43. The gate control theory of pain assumes a. the physiological reality of pain. b. the nature of motor output factors in pain perception. c. that chronic pain is heavily influenced by both spinal cord and brain activity. d. that sensory input is not the only factor in pain perception.

ANS: d REF: The Meaning of Pain 44. Melzack proposed the _______ theory, which is an extension of the gate control theory. a. sensory decision b. specificity c. neuromatrix d. cerebellar ANS: c REF: The Meaning of Pain 45. Valid and reliable measures of pain are important to health psychologists primarily because a. such measurements permit accurate evaluation of various pain therapy programs. b. self-reports are more useful than physiological measures. c. pain is a product of both physiological and emotional factors. d. behavioral assessments are more reliable and valid.

ANS: a REF: The Measurement of Pain 46. Which of these methods have been used to measure pain? a. self-reports b. behavioral assessment c. physiological measures d. all of these ANS: d REF: The Measurement of Pain 47. The Visual Analog Scale is considered to be a. a self-report. b. an evoked potential measure of pain. c. a behavioral assessment of pain. d. a pain questionnaire.

ANS: a REF: The Measurement of Pain 48. The most widely used pain questionnaire was developed by Ronald Melzack and is known as the a. Melzack and Wall Pain Questionnaire. b. Visual Analog Scale. c. Minnesota Multiphasic Personality Inventory. d. McGill Pain Questionnaire.

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REF: The Measurement of Pain

49. A personality inventory sometimes used to assess pain is the a. California Personality Inventory. b. Minnesota Multiphasic Personality Inventory. c. Edwards Personality Schedule. d. Guilford-Zimmerman Temperament Survey.

ANS: b REF: The Measurement of Pain 50. Heart rate predicts perceptions of pain, but only for ________. a. children b. the elderly c. men d. women ANS: c REF: The Measurement of Pain 51. Which of these techniques measures muscle tension as an index of pain? a. electromyography b. thermography c. blood flow in the temporal artery d. heart rate ANS: a REF: The Measurement of Pain 52. _____ pain is the most common of all syndromes of pain with a lifetime incidence rate of more than 99%. a. Headache b. Low back c. Burn d. Knee ANS: a REF: Pain Syndromes 53. Rosa suffers from recurrent attacks of pain that are accompanied by exaggerated sensitivity to light, loss of appetite, and nausea. From these characteristics you would diagnose Rosa as having a. migraine headaches. b. tension headaches. c. cancer pain. d. phantom limb pain.

ANS: a REF: Pain Syndromes 54. With regard to migraine headaches, a. men are somewhat more likely than women to have migraines. b. women are much more likely than men to have migraines. c. women are slightly more likely than men to have migraines. d. women and men are about equally susceptible to migraines.

ANS: b REF: Pain Syndromes

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Chapter 7 55. Carlos is a 45-year-old civil engineer who has never had a migraine headache. His chances of a first migraine are a. very high. b. about 50/50. c. very low. d. nonexistent.

ANS: c REF: Pain Syndromes 56. What type of pain has a gradual onset, sensations of tightness around the neck and shoulders, and a steady ache on both sides of the head? a. low back pain b. migraine headache c. cluster headache d. tension headache ANS: d REF: Pain Syndromes 57. Wendy suffers from headaches that occur nearly every day for about a month, but then go away for about a year or more. From this description, it appears that Wendy suffers from a. cluster headaches. b. migraine headaches. c. tension headache. d. none of the above.

ANS: a REF: Pain Syndromes 58. The two most common types of pain are a. cancer and headache. b. arthritis and low back. c. headache and low back. d. cancer and low back.

ANS: c REF: Pain Syndromes 59. Which of these conditions may contribute to low back pain? a. pregnancy b. improper lifting of heavy objects c. aging d. all of these ANS: d REF: Pain Syndromes 60. Low back pain has many causes. About what percent of back pain patients have an identified, physical cause for their pain? a. 20% b. 50% c. 75% d. about 40% of men and about 60% of women ANS: a REF: Pain Syndromes 61. Unlike rheumatoid arthritis, osteoarthritis a. frequently occurs in younger as well as older people.

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Understanding and Managing Pain b. affects mostly men. c. is an autoimmune disorder. d. affects mostly older people.

ANS: d REF: Pain Syndromes 62. Chronic pain affects approximately ____ of the population in the United States. a. 50% b. 10% c. 75% d. 30% ANS: d REF: Pain Syndromes 63. The three primary kinds of headaches are: a. migraine, cluster, chronic b. chronic, tension, cluster c. migraine, cluster, tension d. tension, migraine, chronic ANS: c REF: Pain Syndromes 64. What types of headaches are more common in men than in women? a. chronic b. cluster c. migraine d. tension ANS: b REF: Pain Syndromes

65. Almost ____ of all cancer patients’ pain was untreated. a. 10% b. 20% c. 50% d. 90% ANS: c REF: Pain Syndromes 66. Jesse’s leg was amputated when he was 20. 10 years later, he still occasionally feels pain in that missing limb. This pain is called a. missing limb pain. b. phantom limb pain. c. amputation pain. d. neuroses.

ANS: b REF: Pain Syndromes 67. For phantom limb pain, the pain is more likely in the missing limb when: a. there was much pain before the amputation. b. there was no pain before the amputation.

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Chapter 7 c. the amputated limb is a leg. d. all phantom pain is the same pain intensity.

ANS: a REF: Pain Syndromes 68. _______ occurs when the body needs more and more of the drug to reach the same effect and _______ occurs when removal of the drug causes withdrawal symptoms. a. Withdrawal; dependence b. Dependence; withdrawal c. Tolerance; dependence d. Dependence; tolerance ANS: c REF: Managing Pain 69. The tendency to catastrophize is associated with ________. a. magnification of pain. b. lessening of pain. c. no differences in perception of pain. d. magnification of pain, but only when other people are present.

ANS: a REF: Pain Syndromes 70. Cognitive behavioral therapy has been shown to be effective in relieving pain for a. headache patients b. fibromyalgia patients c. patients with AIDS pain d. all of the above ANS: d REF: Pain Syndromes 71. One variation of cognitive behavioral therapy, encourages participants to _____ their pain and focus their attention on valued activities. a. deny b. accept c. enjoy d. commit to ANS: b REF: Pain Syndromes 72. Approximately _____ % of all terminal cancer cases experience pain. a. 15-20 b. 25-40 c. 45-65 d. 98 to 99 ANS: c REF: Pain Syndromes 73. Medical procedures used in pain management have traditionally included a. cognitive therapy. b. drugs. c. surgery. d. both drugs and surgery.

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REF: Managing Pain

74. Opiate drugs a. are effective analgesics. b. produce dependence. c. produce tolerance. d. all of these.

ANS: d REF: Managing Pain 75. About what percentage of people who receive opiates during a hospital stay becomes addicted? a. less than 1% b. more than 5% but less than 25% c. about 50% d. almost 100% ANS: a REF: Managing Pain 76. Systems of self-paced administration of analgesic drugs a. overcome the problem of undermedication. b. increase the probability of addiction. c. lead to a situation in which about 45% of patients overmedicate themselves. d. all of these.

ANS: a REF: Managing Pain

77. Aspirin-type analgesic drugs are most effective in a. treating gastric disorders. b. relieving cancer pain. c. treating injuries that are accompanied by inflammation. d. treating patients who are candidates for surgery.

ANS: c REF: Managing Pain 78. Analgesic drugs are effective for pain control, but a. most people misuse these drugs, using dangerous amounts. b. NSAIDS are more effective than opiates. c. anesthetic drugs are preferable for controlling chronic pain. d. antidepressant drugs may also be useful in treating some types of pain.

ANS: d REF: Managing Pain 79. Bailey has tried many treatments for chronic back pain. His treatment of last resort would probably be a. surgery. b. TENS. c. opium-based drugs. d. hypnosis.

ANS: a REF: Managing Pain

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80. Researchers have found that transcutaneous electrical nerve stimulation (TENS) a. is effective for acute but not chronic pain. b. increases pain during stimulation, but patients report less pain after stimulation. c. is not very effective in relieving pain. d. has no advantage over other medical methods.

ANS: c REF: Managing Pain 81. The type of spinal stimulation that is most effective in controlling pain is a. transcutaneous electrical nerve stimulation (TENS). b. stimulation from implanted devices that stimulate the spinal cord. c. subcutaneous chemical stimulation (SCS). d. alternating stimulation of the peripheral nerves near the site of injury and stimulation close to the spinal cord.

ANS: b REF: Managing Pain 82. Relaxation training has been used successfully to a. treat rheumatoid arthritis. b. treat low back pain. c. reduce headache pain. d. all of these.

ANS: d REF: Managing Pain

83. Behavior modification techniques rely most heavily on a. classical conditioning concepts. b. operant conditioning principles. c. observational learning theory. d. cognitive learning strategies.

ANS: b REF: Managing Pain 84. Wilbert Fordyce, along with others who advocate a behavior modification view of pain, claimed that a. pain itself is rewarding to the individual pain patient. b. pain sensations can be eliminated by the use of behavior modification. c. pain behaviors may have reinforcing consequences for the pain patient. d. cognitive therapy is the most effective means of pain control.

ANS: c REF: Managing Pain 85. Pain authority Frank Andrasik proposed that pain traps occur when a. situations push people experiencing pain toward chronic pain. b. a person with a pain-prone personality experiences pain. c. A-delta fibers are stimulated at the same time as C fibers. d. a person experiences pain at the same time as some positive situation.

ANS: a REF: Managing Pain

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Understanding and Managing Pain 86. In behavior modification programs for pain management, pain behaviors are a. ignored. b. punished. c. rewarded. d. Any of these can be a component of a behavior modification program for pain.

ANS: a REF: Managing Pain 87. What might be a reinforcer for pain behavior? a. the sensory input b. the motor output c. the disapproval of family members d. monetary compensation for injury ANS: d REF: Managing Pain 88. Cognitive therapists emphasize a change in a. personality traits. b. overt behavior. c. thinking patterns. d. philosophy of life.

ANS: c REF: Managing Pain

89. In comparison to behavior modification techniques, cognitive therapy a. is less effective. b. is more solidly based in learning theory. c. places more emphasis on the interpretation of events. d. has a longer tradition of use for pain management.

ANS: c REF: Managing Pain 90. According to cognitive therapists, beliefs, personal standards, and ________ strongly affect people's behavior. a. history of reinforcement b. “catastrophizing” c. suggestibility d. implicit memory ANS: b REF: Managing Pain 91. Of the medical and psychological interventions for managing chronic pain, __________ is/are probably the most effective. a. surgery b. opiate drugs c. biofeedback d. cognitive behavioral therapy ANS: d REF: Managing Pain

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True/False Questions 1. The largest organ of the body is the skin.

ANS: T 2. A recent study examined social rejection and found that the resulting emotional pain affected brain activity similarly to physical pain.

ANS: T 3. Based on recent research by Yoshino et al. (2010) on mood and pain, if Courtney is feeling happy, she should experience less pain than when she is feeling sad.

ANS: T 4. Efferent neurons carry nerve impulses away from the brain, whereas afferent neurons carry nerve impulses toward the brain.

ANS: T 5. Women are more than twice as likely to develop rheumatoid arthritis as men.

ANS: T 6. Acute pain has no benefit to the person who is experiencing it.

ANS: F 7. Delmar constantly complained to his wife Merna about pain in his knee. Merna decided to stop sympathizing with Delmar and to withhold any sort of positive reinforcement to his pain behaviors, so we would expect Delmar to stop feeling pain in his knee.

ANS: F 8. Some people have a pain-resistant personality and are much more sensitive to pain than other people.

ANS: F 9. In general, women are much more sensitive to pain than men.

ANS: F 10. The gate control theory assumes that pain experiences can be increased or decreased by mechanisms in the brain and spinal cord.

ANS: T 11. Approximately 50% of people have reported severe headaches in the last 3 months.

ANS: F 12. The most common type of pain is low back pain.

ANS: F 13. People who complain about pain in an amputated limb are simply imagining the pain.

ANS: F

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14. The dangers of opiate drugs outweigh their risks for pain control.

ANS: F 15. Medication is an important treatment for people with low back pain, and undermedication is a serious problem for these patients.

ANS: F 16. Surgery is not a successful treatment for many people with low back pain.

ANS: T 17. According to the gate control theory, pain has only sensory components.

ANS: F 18. Low-back pain patients who use pain medications are at an increased risk for more health problems than patients who do not use pain medications.

ANS: T 19. Providing positive feedback and assistance are the best ways to help someone with low back pain recover.

ANS: F 20. Behavior modification attempts to change behavior without altering the environment.

ANS: F 21. Cognitive therapy and cognitive behavioral therapy both strive to alter patterns of thinking.

ANS: T

Essay Questions 1. Jonathan has just cut his left hand while chopping onions. Trace the sensory input from finger to brain, mentioning the important structures in the nervous system.

A. In the skin, the cut activates primary afferents.

1. The neurons that relay pain are called nociceptors.

2. Large A-beta fibers and smaller A-delta fibers are stimulated and rapidly transmit neural impulses toward the spinal cord.

3. Although more difficult to stimulate, the cut would activate small C-fibers, and these neural impulses would also travel to the spinal cord.

B. Sensory afferents form nerves that travel toward the spinal cord, either in sensory nerves or mixed nerves.

C. Sensory input enters the dorsal horns of the spinal cord.

1. Many primary afferents synapse with secondary afferents in the dorsal horns, but other primary afferents continue to the brain.

2. The arrangement and interconnections of laminae of the dorsal horns receive sensory input, modulate it, and relay these messages toward the brain,

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Chapter 7 D. Sensory input travels to the brain by way of the spinal cord and crosses from the left side of the body to the right side of the brain.

E. Sensory neurons synapse in the thalamus, and then go to the right somatosensory cortex in the parietal lobe of the forebrain.

1. The primary somatosensory cortex maps those receptors in the hand, providing a representation of the hand in the brain.

2. The somatosensory cortex is involved with interpretation of the sensory input, most likely as pain.

2. Did Jonathan’s cut finger hurt? What experiences and psychological factors might increase or decrease his experience of pain?

A. Jonathan’s cut finger most likely hurt.

1. If Jonathan has a congenital insensitivity to pain, then the cut did not hurt, but this disorder is very unusual.

2. The type of pain that he experienced was acute pain.

B. Jonathan’s pain would probably be increased if 1. He was alone and had no distracting stimuli.

2. He was depressed or anxious.

3. He was looking at the cut when he cut himself.

4. He focused on his cut finger.

5. He thought about how much the cut hurt.

6. He had been rewarded previously for experiencing and complaining about pain.

C. Jonathan’s pain would probably be decreased if 1. He was involved with some other activity in addition to chopping onions when he cut himself; for example, if he was talking to someone, listening to music, or watching television.

2. He was not looking at his hand when the injury occurred.

3. He did not look at his finger after the cut so that he did not see the extent of his injury.

4. He pressed tightly on the cut finger, stimulating other neurons in addition to the ones carrying pain messages and partially blocking the pain.

5. He experienced some other type and location of pain immediately after cutting his finger; for example, if he dropped the cutting board on his toe.

6. He believed that men should not be bothered by minor injuries or that he was the type of man who should not feel pain by such an injury.

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Understanding and Managing Pain 3. Differentiate among the three stages of pain.

A. Acute pain 1. This type of pain is the most common, produced by injury from lacerations, dental work, surgery, burns, abrasions, cuts, and other injuries.

2. This type of pain is adaptive, signaling injury to body tissue and alerting the person to avoid further injury.

B. Prechronic pain 1. This type of pain is experienced between acute and chronic pain.

2. The experiences that occur during this period may make the critical difference in the alleviation of pain or the onset of chronic pain.

C. Chronic pain 1. This type of pain persists after the period of healing has been completed and is often experienced without detectable tissue damage.

2. This type of pain is often involved with situations that elicit reinforcement for the person who is in pain such that continued pain ensures reinforcement although it also ensures pain.

3. This type of pain never has a biological benefit but takes a substantial psychological toll on both the sufferer and the family 4. Discuss the statement "Injury does not necessarily equal pain."

A. This statement reflects the variability of the experience of pain.

B. Some types of injuries are more likely to result in pain than other types.

1. Broken bones, sprains, and stab wounds are more likely to produce immediate pain than cuts, scrapes, and burns.

2. Unintentional injuries are less likely to produce pain than intentional injuries; for example, people who have been tortured all report pain, regardless of the severity of their injuries.

C. Some people are more likely to experience pain than others.

1. Soldiers wounded during battle in World War II were less likely to experience pain than civilians with comparable injuries.

2. Operant conditioning produces pain, and people who have prior experience with a type of pain are more likely to experience pain in similar circumstances.

3. Individual variations in pain perception are attributable to situation and experience. a. Evidence does not support a pain-resistant (or pain-prone) personality type. b. Ethnic and gender differences in pain perception may be attributable to cultural and gender roles than allow the display of pain behaviors and also to sensory and perceptual differences in pain.

5. Compare the specificity and the gate control theory on their emphasis of psychological factors in pain.

A. Specificity theory explains pain by hypothesizing that specific pain fibers and pain pathways exist.

1. This theory views pain as mechanistic signaling of tissue damage.

2. This theory does not take individual variability or psychological factors into account in the experience of pain.

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Chapter 7 B. The gate control theory of pain emphasizes physiology but includes behavioral and situational influences.

1. Pain has motivational and emotional components, which are affected by experience and expectation.

2. Incoming stimuli are modulated in the spinal cord by the “gating” mechanism in the substantia gelatinosa.

3. The central control trigger is a brain mechanism that activates a descending control system that may modulate or suppress pain.

6. What are the advantages and disadvantages of physiological measures, behavioral assessments, and self-report measures of pain?

A. Self-reports include rating scales, pain inventories, and standardized objective tests.

1. Advantages include the ability to capture the patients’ feelings and subjective aspects of pain, the simplicity of administration for ratings scales, and the psychometric sophistication of standardized tests like the McGill Pain Questionnaire and the MMPI. 2. Disadvantages include the problems in definition of some of these tests, the high reading level of some tests, and the questionable validity of applying a personality test such as the MMPI to diagnose pain.

B. Behavioral assessments include observation by significant others or by trained professionals.

1. Advantages include direct observability, the opportunity to observe the person in many settings by significant others, and the reliability of ratings that can be achieved by trained professionals.

2. Disadvantages include the lack of observability of some aspects of pain and the lack of strong relationship between some behaviors and pain.

C. Physiological measures include muscle tension, autonomic indices, and temperature.

1. Advantages include objectivity of measurement and freedom from subject and observer bias.

2. Disadvantages include the lack of a strong relationship between autonomic indices and pain severity.

7. Evaluate the success and hazards of medical interventions for pain.

A. Medical treatments for pain have been more successful and carry less risk in treating acute rather than chronic pain.

B. Analgesic drug treatments are common for acute pain and are sometimes used for chronic pain.

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Understanding and Managing Pain 1. NSAIDs such as aspirin are very common and successful in managing mild to moderate pain, but their side effects make them unsuitable for some patients.

2. Opiate drugs are very successful in relieving severe pain, but they produce tolerance and dependence, creating the potential for abuse and making these drugs risky for treating chronic pain; these properties have created public fear of their hazards, resulting in their underuse in situations of severe pain.

C. Surgery 1. Cutting the nerves that carry sensory input or lesioning the central nervous system can bring relief from pain.

2. The hazards often outweigh the potential benefits, because any effect, including unpleasant ones, may be permanent; surgery usually does not produce relief from chronic pain; and the surgery itself is hazardous.

8. What are the similarities and differences of behavior modification and cognitive therapy as used for pain management? How does cognitive behavior therapy combine these approaches?

A. Behavior modification 1. Has the goal of shaping behavior; cognition or feelings are not a concern.

2. Has been used as a treatment for the control of pain, with the assumption that pain can be reinforcing for some people because they receive positive reinforcement for expressing pain.

B. Cognitive therapy 1. Employs the persons’ thoughts and feelings and assumes that behavior is shaped by these cognitive processes.

2. Can be used for pain management to help people change their attitudes and cognitions about the experience of pain.

C. Similarities 1. Both use a psychological approach.

2. Both share the goal of changing behavior.

3. Many cognitive therapy approaches, such as pain inoculation, combine cognitive and behavioral techniques, making a cognitive behavioral technique.

D. Differences 1. The two approaches emphasize different routes to their similar goals of behavior change; behavior modification through the shaping of overt behavior and cognitive therapy through changes in cognitions.

2. Cognitive therapies work toward improving patients’ feelings of efficacy, the feeling that they can be effective in dealing with their problems, whereas behavior modification deals only with overt behaviors.

3. Cognitive therapies tend to emphasize self-management, whereas behavior modification programs tend to rely on reinforcement from others to change behavior.

E. Cognitive behavior therapy combines the techniques and goals of the cognitive and behavioral approaches.

1. It works toward changing attitudes and thoughts.

2. It includes behavioral goals.

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Chapter 7 3. Cognitive behavioral therapy is more effective for stress and pain management than either cognitive therapy or behavior modification.

9. Eric hurt his back two years ago when he was at work, and since that time he has experienced periods during which he could not work because of his low back pain.

Workers’ compensation has helped financially during those times, but his wife has been burdened by doing Eric’s chores and caring for him when he is incapacitated.

His physician is reluctant to continue his prescription of opiate analgesics but understands that Eric’s back pain is a problem and would like to get him into a program that would help his pain. After reviewing the options, recommend a program for Eric.

A. Eric receives reinforcement for his pain behaviors, including 1. Monetary compensation.

2. Supportive care from others.

3. Relief from work and family responsibilities.

B. A behavior modification program might help Eric exhibit fewer pain behaviors.

1. This type of program would probably teach Eric’s family to ignore his chronic complaints about his pain and encourage him to resume his normal life’s activities.

2. This program would probably systematically reinforce Eric’s desirable, normal behaviors such as getting up without complaints of pain, getting dressed, interacting with his family, and so forth.

3. Such programs tend to be successful in helping patients to be more active and to request less medication.

C. A cognitive or cognitive behavioral therapy program might be a good alternative if Eric has the motivation to self-regulate his behavior.

1. Such programs place more responsibility on the patient and on the desire to change one’s own behavior than behavior modification programs do.

2. A cognitive pain management program would include stages in which Eric would reconceptualize his pain and the role of psychology in the perception of pain, acquire new skills to cope with pain, and follow-through the reconceptualization and learning by practicing these skills.

3. Some research has indicated that Eric might make slower progress in a cognitive pain management program but that his gains would increase, making this type of program potentially more successful than a behavior modification program.

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