Sei sulla pagina 1di 34

Presenter: Maryam Abbasi

Health Psychology Course


University of Tehran
November 2011

The single biggest problem in
communication is the illusion that it
has taken place.
George Bernard Shaw
What is chronic pain?
Gate control theory
The Communication Model of Pain (CMP)
Summary
Clinical Implications of CMP
Pain is one of the most common complaints
made by patients to primary care providers
(approximately 50% of patients).

prevalence estimates of persistent pain in
population samples range between 7% and
64%, depending on survey methodology and
population studied .

For some people pain persists and past the
point where it is considered adaptive (more
than 3 months) and

contributes to negative mood, disability,
deteriorating social functioning, and increased
use of healthcare system resources.

The high prevalence of unsatisfactory treated pain
demonstrates how pain has been to typical clinical
care, despite better understanding of the biology
of pain

Pain often remains unrecognized, poorly assessed,
underestimated, untreated, or inadequately
treated.

Therefore, Understanding the biology of pain is
vital but inadequate to challenges of pain control.

This has led to the development of
biopsychosocial models of pain
In 19
th
century advances in our understanding of
the biology of pain took place

In the mid-20
th
century, the Gate Control Theory
(GCT, Melzack and Wall, 1965) introduced pain as a
complex psychological phenomenon.

Provided a neurophysiological basis for
conceptualizing the biological substrates of
psychological and environmental determinant of
pain .

substantial elaboration of our understanding of the
facilitatory and inhibitory mechanisms that
modulate nociceptive processes.


The Gate
Control
Theory


IASP(2005) definition of PAIN:
Pain: An unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage

Nociception: the neuro-physiological
translation of events that stimulate
nociceptors and are capable of being
experienced as pain


In typical adult humans, pain is associated with
meaning, learning, and emotional reactions

This definition Leaves room for multiple causes,
mediators, and moderators.

Psychological mechanisms has resulted in novel
interventions for both acute and chronic pain

Several multi-aspect perspectives emerged: the
operant model, cognitive-oriented models,
interpersonal formulations of pain
The focus on intrapersonal processes, both
biological and psychological, leaving the social
dimension underexamined

Pain is also has major social features, occurs rarely
in silence, and is important to not only the
individual but the social environment.

Pain serves as an archetypical sign of threat and
commands the attention and responses of others in
the social environment.

Others response in turn have an important impact
upon the pain experience and wellbeing of patient
(Craig, 2009)
Consistent with biopsychosocial conceptualization

The biological mechanisms are fundamental to

Psychological processes engaged during pain
experience and expression

Directs attention to social processes as causes
and consequences of pain experience

Process of communication is seen as a three step
process (A > B > C).
Step A (Action): Internal Experience, pain
expression, and reaction of receiver

Step B (Interaction): Encoding expressive
behavior which is embedded in a broader
social context

Step C (Transaction): Decoding and Responding
with sensitivity to expressive behavior
Where a message is sent or a message is
received (e.g., a message left on a telephone
or a message is received)

It includes automatic/reflexive reactions of
observer (e.g., the gut reaction to another
persons horrifying accident)

Self-reports , and nonverbal expression are
the manifestation of pain are considered as
communication as action

Experience of pain :

consists of affective, behavioral, and motivational
components

Is affected by (and interpreted through) the
cultural, interpersonal, and situational context

Associated with brain mechanisms
where a message (verbal & non verbal) is
sent, received, and interpreted, whether as
intended or incorrectly


Effectively communicating pain , enables
observer understand feelings, thoughts,
and expressions of the patient.

Actions of patient: protective or communicative
The impact of social context on verbal and nonverbal
displays of pain
Brain correlates of pain expression
where messages are exchanged, but
something other than the exchange of
messages results (e.g., I do is not just a
report of intent but transacts the wedding
of one person to another).


When physician and patient communicate
interactively and the physician infers
pathophysiological process, provides a
diagnosis , and commits to treatment
Affected by clarity of patients message (verbal is
easier than nonverbal)

occurs within the context of contextual, interpersonal,
social factors all of which affect interpretation of pain
signals

Influenced by observer characteristics (age & gender)

Also sufferer's characteristics influence pain
judgments

Patient coping styles

The model serves as a synthesis of
preexisting findings and facilitates
conceptualization of a vast literature
Recognition of social and psychological
parameters affecting pain experience
and its communication
Implications for clinical assessment and
treatment

Older adults and seniors with dementia
suffering from pain
Pain assessment and interventions in
different socio-cultural contexts
Educational interventions for chronic pain
patients caregivers
Healthcare providers education in how
communicate with chronic pain patients
On one hand:
Seniors have tendency to underreport pain complaints
Dementias interfere with effective pain communication,
as cognitive functions decline as a result of dementia.
Ability to self-report and describe pain deteriorates, but,
nonverbal forms of pain expression is preserved.
On the other hand:
Effective communication has been shown to be related to
pain relief.
As a result:
Pain assessment in seniors should be different from
patients from other ages, and would be better to rely on
both verbal (also significant others reports) and
nonverbal methods.



Patients from interdependent cultures are
tend to underreport their pain in order to
keep the harmony of their social group, so
they may underreport their pain.

Hidden assumptions and rules Big boys
dont cry, take it like a man governs
people expressive pain behaviors, which in
turn mislead health care providers and
caregivers
Participants receiving painful stimuli while holding
their spouses hand communicated reduced pain
unpleasantness (relationship factors were
controlled)
From fMRI standpoint, the activity of neural system
supporting emotional and behavioral threat
responses was attenuated.
Spouses cognitions and responses to pain
behavior (e.g., punishing) contribute to patients
pain behavior, intensity, and disability.


Tell others what you can and cannot do
Inform them that the severity of your
pain varies, even if it is never completely
gone
Tell them in a friendly way what kind of
help you hope to receive and why
Tell them when they are helping! Praise
wins over blame every time
Talk to others regularly, not just when
your pain is most intense
Frustrations in accurately decoding and
interpreting pain messages occur within the
context of health care system may lead to
patient dissatisfaction and negative mood.

How the practitioner phrases the initial pain
question might affect the amount of important
information that you respond with (i.e., How
are you today?)

Oftentimes, we cannot change the external
world So what can we do?





We can help patients to:
Take the responsibility for reporting pain and
response to the treatment
Describe their pain using a pain intensity
scale
Describe their pain using pain location
Describe their pain using pain sensation
Evaluate and describe changes
Determine if the health provider understand
the message

McGill Pain
Questionnaire

Reliable in elderly

Gagliese (2001)
Craig, K. D. (2004). "Social Communication of Pain enhances protective functions." Pain 107:
5-6.

Craig, K. D. (2009). "A social communications model of pain." Canadian Psychology 50: 22-
32.

Craig, K. D., K. M. Prkachin, et al. (2011). The facial expression of pain. Handbook of Pain
Assessment. D. C. Turk and R. Melzack. NewYork, Guilford Press: 117-133.

Craig, K. D., J. Versloot, et al. (2010). "Perceiving pain in others: Automatic and controlled
mechanisms." The Journal of Pain 11(2): 101-108.

Hadjistrovropoulos, T. and K. D. Craig (2002). "A theoretical framework for understanding
self-report and observational measures of pain: a communications model." Behaviour
Research and Therapy 40: 551-570.

Hadjistrovropoulos, T., K. D. Craig, et al. (2011). "A biopsychosocial Formulation of Pain
communication." Psychological Bulletin X(X): XXX-XXX.

McDonald, D. D., G. J. Thomas, et al. (2005). "Assisting older adults to communicate their
postoperative pain." Clinical Nursing Research 14(2): 109-126.

Sullivan, M. J. L., M. O. Martel, et al. (2006). "The relation between catastrophizing and the
communication of pain experience." Pain 122: 282-288.

Vangronsveld, K. and S. J. Linton (2011). "The effect of validating and invalidating
communication on satisfaction, pain and affect in nurses suffering from low back pain
during semi-structured interview." European Journal of Pain XXX: XXXX.

Potrebbero piacerti anche