Download Chapter 1 Introducing Health Psychology

Chapter 8 Managing Stress and Pain
prevalence of pain - According to the International Association for the Study of
Pain (IASP), at a minimum, "20%" of the world's population suffers from some
type of persistent pain.
analgesic drugs - relieve pain without the loss of consciousness. They fall into
two varieties (1) opiate types and (2) non-opiate types (NSAIDS). Both can be
derived from plants or synthesized artificially. The opiate types are the more
powerful of the two.
nonsteriodal analgesic drugs (NSAIDS) - the second major grouping of
analgesics (1) fight pain, and (2) fight inflammation and fever. Aspirin and
ibuprofen are examples.
history - Extracts of the opium poppy have been used for at least 5,000 years.
Morphine was derived from the opium poppy in 1803 and was widely used for
pain relief during the civil war and its addictive quality became clear. Demand for
analgesics increased dramatically during the last years of the 20th century,
particularly for two new opiate type drugs, "oxycodone and hydrocodone."
undermedication - Because of addiction concerns, pain patients tend to be
undermedicated. Use of an "intravenous self administration pump" has helped.
Patients can take more medication as they need it, AND actually tend to (1) use
less medication, and (2) get better pain relief.
aspirin - a nonsteroidal anti-inflammatory drug (NSAID) has analgesic
properties and acts against inflammation and fever. Aspirin works a the site of
the injury (not in the brain) by blocking production of "prostaglandins." Many
people take low dose aspirin daily as a blood thinner to help control CAD.
Aspirin's biggest drawback is that it can irritate the lining of the stomach, even
producing ulcers.
prostaglandins - are endogenous (produced by the body) chemicals produced
when injury occurs. They (1) promote inflammation and (2) lead to an increase in
pain messages.
acetaminophen - another nonnarcotic analgesic does (brand name Tylenol) is
NOT an NSAID. It does not have the gastric upsetting properties of aspirin so is
a good alternative for those whose stomachs cannot tolerate aspirin.
surgery - usually has one of two goals (1) to repair the source of the pain or (2)
to in some way alter the nervous system to alleviate or reduce the pain.
Recently, surgery has been used to implant electronic devices that stimulate the
spinal cord or brain to help close the pain "gate."
transcutaneous electrical nerve stimulation (TENS) - is an older treatment for
pain involving electrical stimulation of neurons through the surface of the skin.
TENS has demonstrated "only very limited effectiveness."
tolerance - The need for increasing levels of a drug in order to maintain the
original (constant) level of effect. This is a problem with the opiates.
dependence - A condition in which a drug becomes incorporated into the
functioning of the body’s cells so that it is needed for “normal” functioning.
Another problem with the opiates.
withdrawal symptoms - unpleasant psychological or physical symptoms that
occur when a drug-dependent person is deprived of the drug.
acute vs. chronic pain management - Because of their tolerance and
dependence characteristics, the opiates are better suited for alleviation of "acute"
pain. However, sometimes there is no choice but to use them for treating
"chronic" pain.
alternative medicine - A group of diverse medical and health care systems,
practices, and products that are not currently considered part of conventional
medicine and are used as alternatives to conventional treatment. Three
examples are (1) massage, (2) high dose vitamins, and (3) herbal remedies.
complementary medicine - A group of diverse medical and health care
systems, practices, and products (i.e., the above mentioned alternatives) that are
not currently considered part of conventional medicine BUT may be used in
addition to conventional techniques.
Complementary and Alternative Medicine (CAM)- is the technical name used
when traditional and alternative approaches are combined.
Chinese medicine - most promising movement based therapies, Oi gong and tai
chi show some benefits for stress and pain relief. The most specific
demonstrated benefit has been improvement of balance in older people.
manipulation techniques - include massage, chiropractic manipulation and
acupuncture.
massage - the manipulation of soft tissue (skin and muscles) to produce health
benefits like relaxation and stress relief. A meta analysis revealed that one
session is NOT likely to help but a series of sessions may.
chiropractic - Introduced around 1900, the American Medical Association
opposed during the mid 1900s. Chiropractors prevailed and now all 50 states
license chiropractors and many insurance companies pay for it. It is still a "highly
controversial" field with many feeling that its claims are unfounded. However,
spinal manipulation may provide some pain relief.
acupuncture - An ancient Chinese form of analgesia that consists of inserting
needles into specific points on the skin and continuously stimulating the needles,
either via electrical impulses or by continuously "twirling" the needles.
acupressure - The application of pressure rather than needles to the same
points used in acupuncture.
basis in Chinese philosophy - The flow of the body's vital energy "qi"
(pronounced chi) through the "meridians" (pathways) may become blocked.
Acupuncture or acupressure restores the flow. These treatments are considered
safe and may help with nausea and pre/post operative pain.
movement-based therapies - consists of a series of exercises or movements
that are intended to concentrate and balance the body's vital energy. Tai chi has
received much support for improving balance among older people who are at risk
for falling.
who uses CAM? - European Americans are more likely to use alternative
methods than are African or Hispanic Americans. Women are more likely to use
these methods than are men.
religion and health - starting with sociologist Emile Durkheim a century ago, the
question of whether or not religious belief can benefit healing has been debated.
A number of studies suggest that "knowing" that people are praying for you has a
beneficial effect. However, if you are prayed for, BUT, are unaware of it, there is
no benefit. So, "intercessory prayer" (prayer by others) may function mostly as a
form of "social support."
integrative medicine - The approach to treatment that attempts to integrate
techniques from both conventional and alternative medicine. This is really pretty
similar to "CAM." The main difference would be that this is more of an
"organized effort" with traditional and alternative professionals "working together,"
perhaps at the same clinic. Our authors suggest that such a clinic should include
(1) an M.D. physician, (2) a rehabilitation expert, (3) a psychiatrist or
psychologist, and (4) and alternative (e.g., massage) therapist.
multimodal treatment - is simply a term for any combination of traditional and/or
alternative treatments.
progressive muscle relaxation - Developed by Edmond Jacobson in the 1930s,
involves (1) sitting in a comfortable chair, (2) breathing slowly and deeply, and (3)
systematically tensing and then relaxing the various muscles of the body.
meditative relaxation - Developed by Herbert Benson who drew upon Asian
religious and meditative ideas, combines muscle relaxation with a quiet
environment, comfortable position, repetitive sound (such as repeating
"ohhhmmm," and passive attitude.
mindfulness meditation - In this technique based on Buddhist practices, people
do not try to avoid unpleasant thoughts. By being aware of, and actually focusing
on, these thoughts, they may gain insight into their problems.
guided imagery - As the name implies, patients conjure up a calm, peaceful
image and concentrate on it for the duration of a painful or anxiety-filled situation
such as surgery or dental work.
effectiveness of relaxation methods - According to Blanchard and Andrasik,
"relaxation is probably a necessary component but not, by itself, a sufficient
treatment for pain."
mesmerism - named for Franz Anton Mesmer (1700s) was the original name for
hypnosis. The name was changed to distance the practice from Mesmer who
had been discredited. By the 1830s, it was being used during surgery. Interest
in it waned as more effective chemical anesthetics were introduced. It again
became popular in the late 1800s when Sigmund Freud and others used it to
treat mental illness.
hypnosis - is controversial and viewed in two different ways. According to
Ernest Hilgard, it is an altered state of consciousness in which a person's stream
of consciousness is divided or dissociated. "Induction," the process of being
placed into a hypnotic state is key for Hilgard. In contrast, Theodore Barber,
sees hypnosis as a human "trait" which is basically the same as being very
"suggestible." In his view, there is nothing "unique" about hypnosis and a
suggestible person will be that way without any "induction." Though
controversial, our authors feel that hypnosis is more effective than placebo,
especially for "burn victims."
biofeedback - A sensor is attached to the skin of the person. Feedback
information about the status of a biological function (e.g., heart rate) is given to
the person (via lights or sounds) with the goal of the person learning to control or
modify the function (e.g., heart rate).
electromyograph - (EMG) biofeedback reflects activity of the skeletal muscles
via sensors placed on the skin. Tight muscles indicate stress or tension. EMG's
most common uses are for low back pain and tension headaches.
thermal biofeedback - involves placing a sensor (thermister) on the skin and
recording changes in skin temperature. When the sympathetic nervous system
is active, skin temperature drops. So, to relax, one tries to raise skin
temperature. Migraine headaches and Raynaud's disease are the disorders
most often treated with thermal biofeedback.
thermister - A temperature-sensitive resistor used in thermal biofeedback.
Raynaud’s disease - A vasoconstrictive disorder characterized by inadequate
circulation in the extremities, especially the fingers and/or toes, resulting in pain.
behavior modification - the process of shaping behavior through the
application of B. F. Skinner's operant conditioning principles. For example, if a
pain patient was making no effort to recover because not working, getting
sympathy, and getting favors from others were serving as "positive reinforcers,"
the family might be instructed to discontinue doing favors.
positive reinforcer - Any positively valued stimulus that, when added to a
situation, strengthens the behavior it follows.
cognitive therapy - Is based on the idea that thoughts, feelings, and beliefs
shape behavior. If we change attitudes and beliefs, then behavior change will
follow.
rational emotive therapy - was developed by Albert Ellis. Problems are
assumed to derive from "irrational beliefs" (e.g., I must be perfect). The beliefs
are challenged in therapy.
cognitive behavior therapy (CBT) - draws from both behavior modification and
cognitive therapy and shows greater effectiveness than either alone.
Stress Inoculation - An example of CBT developed by Donald Meichenbaum. It
prepares people for upcoming stressors and consists of three stages: 1.
conceptualization (understanding why you fear the dentist), 2. skills acquisition
(relaxation training), and 3. application and follow through (going to the dentist
and using the relaxation techniques).
emotional disclosure - A therapeutic technique whereby people express their
strong emotions by talking or writing about them. James Pennebacker et. al.
found that emotional disclosure is useful. Interestingly, it is more useful for
physical than for psychological pain.
catharsis - The spoken or written expression of strong negative emotion, which
may result in improvement in physiological or psychological health. Sigmund
Freud and Joseph Breuer made "the talking cure" an important part of
psychotherapy.