The Impact of Psychological Factors on Patients Pain Experience - Coursework Example

ANALYSE THE IMPACT OF PSYCHOLOGICAL FACTORS ON PATIENTS PAIN EXPERIENCE AND COPING WITH THEIR CONDITION Instructor name: Date due: Introduction Behaviour in humans is learnt. As a result, any acquired behaviour can be unlearnt, and new ones adopted (Bouton 2007, p.2). Behavioural studies are concerned with the observable aspects of human behaviour that are easy to measure and/or alter. Behaviourists usually make the assumption that the things that give us more information about a person are those that can be observed such as behaviour responses. Through the behaviour, we can make inferences about the unobservable aspects of humans such as the mind, the id and the unconscious. Behavioural studies are applicable in several settings such as child learning, clinical settings and in other areas where people are required to learn new ways of doing things (Washington 2011, p.2; Peel 2005, p.18). From a psychological reasoning, a person’s behaviour can be used to assess the state of the mind emotionally, clinically or physiologically. Behavioural studies can be used by clinicians to assess the impact of a treatment regime on a patient or while deciding the most effective method of treatment for a particular patient based on their behaviour responses. This paper will investigate the role of different behavioural approaches and learning principles in coping with pain. Classical conditioning Classical conditioning is a process involving modification of behaviour whereby a response to a biological stimulus is expressed when a previously neutral stimulus is presented. This method of learning was made popular by Ivan Pavlov through his numerous experiments with dogs. It later formed a basis for behaviourism; a school of psychology developed in the mid-20th century and had great influence in the society. Classical conditioning occurs when two stimuli, one conditioned and another unconditioned are paired. Normally, the conditioned stimulus is a neutral stimulus while the unconditioned stimulus is a biologically potent incentive such as the smell or taste of food (Gottleib & Begej 2014, p.3). The unconditioned response is an unlearned reflex that occurs in response to the unconditioned stimulus, for example, salivation after smelling or seeing food. After a repeated pairing of the two stimuli, the subject responds positively to the conditioned stimulus when it is present alone. The conditioned response is usually analogous to the unconditioned response. However, the conditioned response is learnt through experience and is relatively less permanent (Courtin, Gonzales & Herry 2012, p.2443). Classical conditioning can be observed in various situations in different settings. For instance, in the case study, the woman with the long history of low back pain can develop certain responses to stimuli, even though they were previously neutral. Association of pain with non-relevant stimuli is common with such patients. For example, the woman may associate painful experiences with the sight of a doctor or simply any person dressed in a white lab coat. Also, certain terms which would not have meant anything before her diagnosis begin to elicit certain behavioural responses in the patient. As a manual therapist, it is vital to understand these behaviour responses in patients as it makes it easier to manage them. Throughout the recovery process, the patient may associate certain stimuli with pain and discomfort, such as the sight of clinicians or prescription pills (Miguez, Laborda & Miller 2014, p.10). The manual therapist should be able to understand and explain to the patient since such behaviour may impact the recovery process negatively. In addition, the patient can be counselled on the appropriate behaviour changes that she might have to adopt or abandon to ease her back pain. Alternatively, since all behaviour can be learnt or unlearnt, the manual therapist can condition the patient to start a behaviour change process that will speed up her recovery. Other methods of behavioural modification include operant or instrumental conditioning and learning principles such as avoidance and escape learning. Operant conditioning Operant conditioning is a more complex behaviour modification process whereby it integrates both negative and positive conditioning in the learning process, unlike classical conditioning which utilises only one (Hahn 2013, p.2). Basically, operant conditioning suggests that a response is usually generated as a result of a reinforcing stimulus. Another form of operant conditioning, instrumental conditioning, involves grading the responses elicited based on their form, frequency and/or strength. Operant conditioning differs from classical conditioning in the sense that operant behaviour occurs within the environment and is maintained through antecedents and consequences associated with the behaviour. Classical conditioning, on the other hand, does not make use of consequences to maintain conditioned behaviour (Hahn 2013, p.2). Operant conditioning is as per the assumption that consequences of certain behaviour will either increase or decrease the probability of the behaviour happening again. The basic elements that constitute operant conditioning include the antecedents, behaviour and consequences. Consequences are usually the result of behaviour elicited by a stimulus, and can be categorised as either reinforcement or punishment. When a stimulus or a consequence is added, the learning process is referred to as positive. Consequently, the learning process is termed negative if the stimulus or consequence is removed. However, certain behaviours fail to produce a favourable or unfavourable consequence, thus are referred to as extinct. As a result, there can be five possible outcomes of operant conditioning: • Positive reinforcement: It occurs when behaviour is followed by a rewarding or appetitive stimulus, thus increasing the frequency of that behaviour. It is usually referred simply as reinforcement. • Negative reinforcement (escape): It occurs when behaviour is associated with the elimination of an aversive stimulus, thereby increasing the occurrence of that behaviour. For instance, in the Skinner box experiment, negative reinforcement can be posed by sounding a loud noise continuously inside the rat’s cage until it engaged in the preferred behaviour (Skinner 1938). • Positive punishment: It is also referred to as punishment by contingent stimulation. It occurs when behaviour is followed by an aversive stimulus resulting to a decrease in the frequency of the behaviour. • Negative punishment: It is also called punishment by contingent withdrawal. It occurs when behaviour is followed by the elimination of a stimulus, for example, a misbehaving student who is denied certain privileges. • Extinction: it occurs when a behaviour that had been previously associated with a certain stimulus ceases to be effective. Most reinforced behaviours are not permanent. In the case of the woman with low back pain, operant conditioning can be used by the patient to adopt certain personal remedies or means of reducing the discomfort caused by the pain. For instance, it is usually common to find such patients with their mechanisms of handling the pain, such as finding comfortable positions and certain herbal remedies among others. Past experiences play a very important role in operant conditioning since the person develops behaviour based on the consequences. Favourable consequences increase the frequency of the behaviour while unfavourable consequences discourage certain behaviours. The manual therapist should take into consideration the fact that the patient might have developed certain adaptive mechanisms over the period she has been suffering from chronic low back pain. It is important for clinicians too to ensure that they seek the patient’s opinion on the kind of therapy they are prescribing since such patients have acquired a lot of experience regarding their conditions and what makes them comfortable. To effectively influence positive behaviour change, the manual therapist can teach the woman through reinforcement and punishment based on her experiences. However, most elderly patients are usually less responsive to behaviour change (Karlin 2011, p.3). Thus, the therapist should ensure that they work together with the patient to manage the condition effectively. Cognition and Pain Although there is a link between cognition and pain, the perception of pain has remained elusive to scientists to date (Wager & Atlas 2013, p.91). The mechanisms involved in the perception of pain are still not well understood, owing to the great degree of subjectivity involved in the perception of pain. Some people may report pain in situations where others may not feel any pain at all, and it is also difficult to produce physiological evidence of pain (Velucci 2012, p.3). Also, conducting research on pain is challenging due to the strict ethical regulations that prevent animal subjects from being subjected to pain and suffering (Compagnone et al. 2014, p.1). Furthermore, environmental factors and individual differences make it hard for researchers to assess pain. However, several theories have been proposed that try to explain the different mechanisms involved in perceptions of pain between the sensory organs and the brain. Three of the most common theories include the Specificity Theory, the Pattern Theory, and the Gate Control Theory. Specificity Theory The specificity theory postulates that there are dedicated pathways for each of the five somatosensory modalities. The basic tenet of the specificity theory is that every modality has a specific receptor coupled with an associated sensory fibre that is sensitive to only one specific stimulus (Moayedi & Davis 2013, p.5). For example, the theory suggests that the low-threshold mechanoreceptors encode non-noxious mechanical stimuli. These receptors are connected to dedicated primary afferents that relay the information to mechanoreceptor second-order neurons present in the spinal cord or brain stem, depending on the location of the input. The specificity theory was first described in 1664 by Descartes. He described a single nerve that runs from the peripherals to the brain and is sensitive to only one type of stimulus. The hypothesis has been revised over the years, with most of the items being proven wrong by the scientific evidence. However, it played a big role in setting the foundation for subsequent theories, especially the Pattern Theory. There are several facts that are correct in the theory such as the claim that there are sensory nerves that eventually send signals to the brain (Apkarian, Hashmi & Baliki 2011, S.49). Also, the brain is referred to as the source of pain perceptions. Some of the major shortcomings of the theory include the fact that it does not account for the vast range of psychological factors that are associated with pain and how we perceive it. For instance, in the case of the woman in the case study, she may start reporting pain while previously painless activities after she was diagnosed with low back pain. The therapist can take advantage of this connection between pain and cognition to alleviate the woman’s pain. For example, the therapist may recommend certain activities or regimens that he claims reduce pain, even though they may only have a placebo effect. The Pattern Theory Goldschneider in 1920 proposed a different model to the Specificity Theory. According to the theory, there are no dedicated nerves that send only one type of signal to the brain. Rather the different signals such as touch, heat and other damaging or non-damaging stimuli share the same routes while sending signals to the brain (Handwerker 2014, p.1). The difference in perception occurs due to the difference in patterns generated by the various stimuli. Therefore, people feel pain when certain patterns of activity in the neurons are generated in different intensities. The differing intensities of the stimuli produce different variations of the same perception (Schmelz 2015, p.285), for instance, pain when hit hard and no pain when caressed. The main concept in the Pattern Theory is that signals reach the brain only when they combine to form a particular pattern, thus triggering specific neural activity in the nervous system. The theory disregards the previous suggestions of other theories such as the existence of dedicated nerves that send signals to the brain. In addition, the brain is portrayed only as a recipient of signals or messages, rather than the source of pain perceptions. Some of the facets of this theory have been proven to be true such as the absence of dedicated nerves. However, both the Pattern and Specificity Theories have been termed inadequate in explaining the perception of pain due to their inability to specify the psychological factors that affect the perception of pain (Melzack & Wall 2013, p.233; Koestler 2010, p.199). Such factors include culture, environment and individual differences among others. The Gate Control Theory of Pain It is the most conventional theory of pain in existence today. The model was proposed by Melzack and Wall in 1965 and reconciles the shortcomings of the previous two theories with psychological data. According to the theory, there are two categories of receptors that receive information from the sensory organs i.e. pain fibres and touch fibres. These fibres synapse in two different locations within the dorsal horn of the spinal cord i.e. the “transmission” cells and the substantia gelatinosa. The gate in the spinal cord is the substantia gelatinosa, while the activities of the small and large fibres control the gating mechanism. The activity in the large fibres inhibits or closes the gate, whereas the activity in the small fibres opens the gates, thus allowing signals to be sent to the brain. When nociceptive information surpasses the threshold elicited by the inhibition, it ‘opens’ the gate and signals of pain perception and its related behaviour are sent to the brain (Duan et al. 2014, p.1417). Through this explanation, a neural basis was introduced to the findings that helped reconcile the differences between Specificity and Pattern Theories of Pain. Conclusion To recap, there are different approaches that can be used in the management of pain by a therapist. The patient is likely to react positively to the therapist’s advice. Thus, any information relayed to the patient should be assessed keenly beforehand. For instance, the therapist can utilise operant or classical conditioning to discourage the maladaptive behaviour by the patient. Also, these behaviour modification methods may be utilised in encouraging the patient to adopt new behaviour that may help them recover faster. The theories of pain and perception are important for the therapist as well as the patient. Various methods may be used to alleviate pain in the patient such as the use of placebos or the effects of drugs that treat the condition. Most importantly, the therapist should ensure that they work together with the patient to achieve the goals of treatment (Grumbach & Grundy 2010, p.1; Sia et at. 2004, p.1473). Bibliography APKARIAN, A. V., HASHMI, J. A., & BALIKI, M. N. (2011). Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain, 152(3), S49-S64. BOUTON, M. E. (2007). Learning and behavior: A contemporary synthesis. Sinauer Associates. 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