Psycho-social Complications of Chronic Pain
1. Counterproductive coping
a. Isolation
b. Negative beliefs
2. Social Support:
a. Hazards of positive support
b. Hazards of no support
3. Negative stereotypes
4. Medical complications and risks
5. Double binds (1-4, above)
Pain and Depression
Wrong model:
Pain  Depression
--- What’s missing?
Correct model:
Pain  ↓ activity  ↓ mastery  ↓ control  Depression
Pain Prone Personality
Are some personalities more prone to
experiencing, reporting pain?
MMPI = Minnesota Multiphasic Personality Inventory
a. Acute pain pats:
Hypochondriasis – overly attend to body
Hysteria – extreme emotionality/exaggerate symps.
b. Chronic pain pats: Neurotic triad: Hypcondriasis + hysteria + depression
Secondary gain: What are social benefits of pain? Attention, special identity
“Functional type”: neurotic triad + schizo / psychopathology / paranoia
Danger of “Pain Prone
Personality” concept?
1. Negative stereotypes
2. Causal direction
Sensory Control: Counter-irritation
Guided Imagery
Cognitive Reframing
Pain Management Programs
Pain Relief Through Virtual Reality
Severe burns one of most painful conditions
to treat: cleaning, re-bandaging excruciating.
Pennebaker symptom research suggests that
distraction should do what to pain?
Reduce it.
Competition of cues.
SnowWorld: Virtual Reality program
designed for pain relief.
Patients enter SnowWorld during procedures
Shoot snowballs at snowmen, penguins
Report pain reductions 30%-50%
Note SnowWorld colors. Why?
Summary Benefits of Psychosocial Approaches
Change meaning of experience
Provides skill set, reduces helplessness
Gives patients an active role in pain management
Success with techniques increases self-efficacy
Changes ways of thinking
Pain Management Programs
1. Evaluation
a. pain
b. functional status: life style changes, limitations
c. Emotional and mental functioning
2. Treatment plan
a. Pre-set time. Not indefinite.
b. Specific goals.
c. Contract
3. Program
a. Education
1. Nature of pain: physio, psychological
2. Pain reduction techniques
b. Therapy
1. Psycho therapy
2. Cognitive therapy:
c. Family therapy
d. Relapse prevention
Class 7: Stress I
Health Psych
Integrates mental states, bodily states,
environmental conditions
Window to core psych processes:
* How we make sense of events,
and how interpretations affect health.
• Emotions, emotions & thinking, emotional control
• Social relations in coping and in failed coping
Stress is where psych can do most for health.
Causes of illness, Treatment of illness, illness prevention
What Are Stressful Events?
Broken Heart Syndrome
“Stress cardiomyopathy”
Temporary heart condition due to loss-related stress
Chest pain, due to surge of stress hormones.
Loss-related stress?
Duration: typically 1 week
Stress Defined
Stress is a negative emotional experience accompanied by
predictable biochemical, physiological, cognitive, and behavioral
changes that are directed either toward altering the stressful
event or accommodating to its effects. Taylor, p 168.
Cannon Model of Stress
Walter Cannon, 1932
Fight or Flight response
SNS + endocrine mobilizes body for fight or flight
Stressful events
_____You can fight: .....
_____You can flee ...
can neither fight nor flee, "traps"
Which are the most stressful?
General Adaptation Syndrome (GAS)
Hans Selye (1956)
All stressors produce same pattern:
Per Selye: Prolonged stress -->
Enlarged adrenals
cardiovascular disease
Shrunken thymus
Shrunken lymph
Ulcerated stomach
compromised immune system
Physiology of Stress
1. SAM: Sympathetic-adrenomedullary
Event  cortex  hypothalamus  SNS  adrenal medulla 
 catecholamines  charged feeling increased BP, HR, etc.
SAM Corresponds to Cannon's stress model
2. HPA: Hypothlamic-pituitary-adreocortical
Event  cortex  hypothalamus  coritcotrophin releasing factor (CRF)
 pituitary  adrencorticotropic hormone (ACTH)  adrenal cortex
 conserves carbos
 reduces inflammation
HPA corresponds to Selye's stress model
SAM and HPTA Stress Patterns
Health Implications of Sustained Stress
Catecholamine elevation, sustained, inhibits immune system
Cardiovascular effects
1. Arteriosclerosis
2. Senility: neurons in hippocampus
3. Depression
4. Fat distribution: Higher waist-to-hip ratio
5. Sudden death syndrome
Stress, Opioids, and Illness Susceptibility
Opiates are?
Pain-reducing drugs, from plants. Morphine, heroin
Endogenous opiods (aka endorphines): Like opiate, produced by body.
Stress triggers endorphine production
Stress  opioid release  immune suppression  ? ↑ illness susceptibility
Prolonged Stress Widens
“Window of Vulnerability”
Chronic stress  ↑ recovery phase  ↑ cortisol phase 
↑ immune suppression  ↑ illness risk.
Allostatic load = effects of cumulative stress exposure
Reactivity and Stress Vulnerability
People vary in stress reactions
NOT just a matter of being mentally tough / whimpy
Physical constitutions differ
Autonomic NS
Neuroendocrine response
Immune response
Study of children 3-5 yrs old, reactivity
Measure reactivity to stressor -- a. cardio (HR, BP) b. immune
Parents track stressor reactions, illness for 12 weeks
Result: stress leads to illness among
____ Low Reactive
X High Reactive
Stress as Function of Person-Environment Fit
Low Stress:
Moderate Stress:
High Stress: