PAIN: Types, Theories and Assessment of pain-Organic Versus Psychogenic pain,Acute Versus Chronic pain,Types of Chronic pain

1. PAIN: Types, Theories and
Assessment of pain
Hena Joy
Assistant Professor
Department Psychology
St. Mary’s College Thrissur

2. PAIN: Types ,theories and assessment, Hena Joy, St. Mary’s College
What is Pain?..........
Pain is the sensory and emotional experience of discomfort, which is
usually associated with actual or threatened tissue damage or irritation
(AMA, 2003).
It is composed of physical, emotional and cognitive.
It will affect day to day life, sleep pattern, mobility, nutrition, social
relationship and emotional adjustment.
Protective mechanism
Pain is subjective
Medically significant

3. PAIN: Types ,theories and assessment, Hena Joy, St. Mary’s College
Organic Versus Psychogenic pain
The pain we experience that is clearly linked to tissue
pressure or damage is described as organic pain.
Psychogenic pain is a pain disorder associated with psychological
factors. No tissue damage appears to exist and medical examinations fail
to find an organic basis.

4. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
Acute Versus Chronic pain
Acute pain refers to the discomfort people experience with temporary
painful conditions that last less than a few months.
When a painful condition lasts longer than its expected course or for
more than a few months, it is called chronic pain.

5. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
Types of Chronic pain
Chronic-recurrent pain: benign causes and involves repeated and
intense episodes of pain separated by periods without pain.
Example: migraine headaches
Chronic-intractable-benign pain : refers to discomfort that is
typically present all of the time, with varying levels of intensity, and is not
related to an underlying malignant condition. Example : Back pain
Chronic-progressive pain : is characterized by continuous discomfort,
is associated with a malignant condition, and becomes increasingly
intense as the underlying condition worsens.
Example: Rheumatoid arthritis. Cancer

6. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
Neuropathic pain
Neuropathic pain which result from current or past disease or
damage in peripheral nerves.
Medical exams find no current cause for them.
No noxious stimulus is present.
Three common neuropathic pain syndromes are :
Neuralgia
Causalgia
Phantom limb pain

7. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
Theories of pain
In the early 1900s, the dominant theories of pain took a very mechanistic
view of pain perception. They proposed that if an appropriate stimulus
activates a receptor, the signal travels to the spinal cord and then the
brain, and sensation results.
Specificity Theory
Pattern Theory
Gate control Theory

8. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
Specificity Theory
The body has a separate sensory system for perceiving pain.
Just as it does for hearing and vision.
 This system was thought to contain its own special receptors for
detecting pain stimuli.
 Its own peripheral nerves and pathway to the brain, and its own area
of the brain for processing pain signals.
 But this structure is not correct.

9. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
There is no separate system for perceiving pain.
The receptors for pain are shared with other senses, such as of touch.
According to this view, people feel pain when certain patterns of
neural activity occur, such as when appropriate types of activity reach
excessively high levels in the brain.
These patterns occur only with intense stimulation. Because strong
and mild stimuli of the same sense modality produce different patterns
of neural activity, being hit hard feels painful, but being caressed does
not.
Pattern Theory

10. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
In the 1960s, Ronald Melzack and Patrick Wall (1965,1982)
introduced- the gate-control theory of pain perception.
Describing a physiological mechanism by which psychological
factors can affect people’s experience of pain.
Neural gate is the heart of the gate control theory.
It can be opened or closed in varying degrees.
Theory proposes that the gating mechanism.
Located in the spinal cord.(substantia gelatinosa of the dorsal horns)
Gate control theory of pain

11. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
Noxious stimulation enter the gating mechanism (substantia
gelatinosa) of the spinal cord from pain fibers (A-delta and C fibers).
 After these signals pass through the gating mechanism, they activate
transmission cells, which send impulses to the brain.
When the output of signals from the transmission cells reaches
a critical level
The person perceives pain
The greater the output beyond this level, the greater the pain intensity.
Gating mechanism

12. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
The gating mechanism controls the output of impulses by the
transmission cells.
When pain signals enter the spinal cord
The gate is open, the transmission cells send impulses freely
But to the extent that the gate is closed,
The output of the transmission cells is inhibited.
Gating mechanism

13. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
The amount of activity in the pain fibers.
The amount of activity in other peripheral fibers.
Messages that descend from the brain.
Factors

14. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
 Physical conditions
Extent of the injury, Inappropriate activity level
Emotional conditions
Anxiety or worry, Tension, Depression
 Mental conditions
Focusing on the pain, Boredom; little involvement in life activities
Conditions that can open the gate

15. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
 Physical conditions
Medication, Counterstimulation (e.g., heat or massage)
 Emotional conditions
Positive emotions (e.g., happiness or optimism), Relaxation, Rest
 Mental conditions
Intense concentration or distraction, Involvement and interest in life
activities
Conditions that close the gate

16. PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College
Self Report methods:
Interview Methods in Assessing Pain
Pain Rating Scales and Diaries
Pain Questionnaires
Behavioral assessment approaches:
Assessing Pain Behavior in Structured Clinical Sessions (Pain Behavior
Scale).
Assessing Pain Behavior in Everyday Activities
Psycho physiological measures :
Electromyography (EMG)
Measures of autonomic activity ( Heart Rate and skin conductance)
Electroencephalograph (EEG)
Assessing pain

17. Reference
Edward, p. Sarafino and Timothy, W. Smith Health Psychology.7th
Edition. John Willey & Sons, Inc.
PAIN: Types, theories and assessment, Hena Joy, St. Mary’s College