Psychology in Professional Health - Essay Example

The perception of pain is more than the consequence of tissue damage By Name Module Instructor Date Introduction Senses against pain is experienced by humans same as other animals. Pain is subjectively experienced, when an individual is exposed to it and that is when the person feels it. People around a person experiencing pain can, however, sympathize and as well feel the pain themselves as a response to witnessing expressions of pain from the situation that brought it such as grimacing. It is possible to recognize if a person next to you is undergoing a painful episode; but sometimes it is not so (Kevin 2007). Out of experience individuals have learned different situations that can cause pain. Consequently, out of experience an individual is capable to point out that a particular incident is much more painful, while at the same time another person may perceive a similar incident to have lower pain. Questions then arises as to why individuals perceive feelings about pain at varying degrees even when they are exposed to similar situations? What is the significance of pain and why does it hurt? Why do personal perceptions towards pain change over time? and why after exposure to similar pain for some time becomes less than it was before? Answering the first question is by discerning the difference between the extend of pain that a person is capable to withstand as well as the degree the pain stimulus inflicts. Different people experience the former in a fairly similar manner compared to the latter. According to Fields & Levine (1984, p 352):“The intensity of sensory level needed for detection of pain threshold is usually constant, while the intensity level needed to cause wide spread complaints or intolerable threshold varies greatly” (p.352). This idea can be illustrated further by drawing on a comparison between acute and chronic pain which are the most recognized types of pain. Acute pain refers to the unpleasant feeling experienced when body tissues are either injured or undergoing injury. The purpose of acute pain is to alert the body about presence of a problem so that the body responds (Nicholas 1992). For example running a five kilometer stretch is painful since the body already recognizes the potential injury to tissues due to the pounding of your joints and ligaments resulting to muscular stress (Keefe et al. 2004). In contrast, chronic pain is due to persistence of acute pain, such that the body becomes accustomed to the acute pain, as a consequence no warning to tissue destruction is relayed. The persistence is a devastating part because eventually results to disability or death due to long destruction of the tissues. Based on Fields & Levine opinions the intensity of acute pain is higher than the level of pain tolerance, while manifestation of chronic pain may be different. However with passage of time, intensity of chronic pains may well go over the patient’s tolerance threshold (Keefe et al. 2004). There is therefore existence of a dynamic factor in relation to experiences of pain in terms of tolerance levels. At this stage it is necessary to expound further on the dynamisms of pain as well as understanding of interpreting pain stimulus in relation to pain and tolerance (Fields & Levine 1984). As earlier brought forward, pain behavior, pain is a subjective experience without measures of objectivity. This is poses great challenge to health professionals. Fear avoidance among persons experiencing pain leads to activity avoidance (Barkway 2009). This eventually results to reduction in activity levels among individuals, distress or depression, deconditioning and increased disability. According to Biopsychological model this is a definitive interaction among the levels of fear avoidance beliefs. For example, appraisal of pain at a certain level creates anxiety or fear at the next level which in turn leads to pain behaviours or disability at next level. The later aspect can be entrenched and form negative experiences about pain and establishing avoidance (Barkway 2009). Therefore, the main concern in health profession is to treat disability or suffering nut not pain itself. This then calls for learning and training as proposed by Fordyce (1976 cited in) to develop and maintain pain behavior through Operant learning. This form of learning is based on rewarding or reinforcement of behaviour in a way that will be likely to occur in future. This theory is applied during intervention through medication where, reinforcing activity synergizes return to normal functions by allowing the patient to avoid aversive tasks (Guzman et al 2001 cited in Barkway 2009). Therefore, reinforcement contingencies help in modification of pain behavior as well as influencing these behaviours development and maintenance (Barkway 2009). Reinforcement contingencies for affected persons mostly come from family or partner as postulated in a number of studies (Newton 2002 cited in Barkway 2009). In as much as social support is vital in helping an individual in pain cope, there is great chance of such support resulting to solicitous bahaviour leading to increased disability (Nicholas 1992). Similarly, cultural or family of origin influences how people manage or respond to pain experiences (Otis et al 2004 cited in Barkway 2009). Although research is not conclusive, there is consensus that pain exposure to people from family history prone to chronic pain will report pain. In contrast, cultural construct in itself may have influencing factors such as education, ethnicity, religion and gender. Based on previous information, certain ethnic background leads to conceptualization and expression of pain (Germov 2005). Identification of components of biophysical model is essential in transition from acute to chronic pain or play important impact in an individuals recovery process (Yardley 2001). It has been noticed among sick persons that continued consumption of healthcare resources does not lead to recovery or assumption of normal activities. Therefore, it becomes necessary at this stage to predict transition to chronic pain at early phases so that appropriate interventions can be commenced. Linton and Hallden (1998 cited in Barkway 2009). proposed a model for screening known as Orebo Musculosketal Pain Questionnaire (OMPQ) which allows healthcare practitioners to predict the ‘Yellow flags’ or environmental and psychological risk factors that would predispose a patient to future disability. Red flags in biomedical practice refer to signs and symptoms which require immediate attention, hence Kendall (1997) used the term ‘yellow flags’ to differentiate the two. Biomedical interventions emphasizes on acute pain management, in order to facilitate healing and relief. A variety of intervention measures involving medications depend on the cause of the pain (Yardley 2001). For example analgesics and non-steroidal anti-inflammatory agents are used to treat mild pain, moderate pain is treated by weak opioids such as tramadol, while strong opioids such as Morphine for severe pain. Chronic pain in the past 20 years has basically favoured strong opioids in its management(Yardley 2001;Yezierski et al. 2004). However, there is growing debate due to the side effects of such drugs for example dependability, nausea, ulcerations and others. Chronic pain is devastating (Schonstein et al 2007, cited in Barkway 2009), it is necessary for healthcare professionals to encourage patients to engage in exercises as a means of exposure to avoided or feared activities. This activities act as stepping stones in the eventual attainment of functional goals (Grbich 2004). On the other hand pain management can assume psychological approaches. Strategies applied in psychological approach are helpful in managing both chronic and acute pain. Self-hypnosis and mediation training to patients helps in calming or relaxing them. In acute pain for example, attentional strategies such as distraction are employed although success rate for such approaches vary. In chronic pain, beneficial strategies emphasizes on shifts to long-term management. However, for better results biomedical and psychological interventions can be applied in a sequential plan. This approach leads to reduction in pain rather than adjustment to pain. Another approach in pain management involves application of cognitive-behavioural approaches. Pain can be self-managed especially chronic pain through cognitive behavioural therapy. Achievements through this strategy include improved mood, increased function, return to work and reduction in use of medication (Bandura 2004). The administration of intensive and comprehensive cognitive-behavioural programs targets improvement of presentation aspects except for pain. This is achieved by psychologists and physiotherapists who are vastly trained in chronic pain management (Yezierski et al. 2004). Such programmes involve a myriad of activities and tasks for example, change of unhelpful beliefs, effective learning in problem resolution techniques, reduced reliance on medication, programmed stretches and exercises all geared towards formulation of return to work and avoiding the fear-avoidance activities (Bandura 2004). The bio-psychosocial model of pain management outlines effects of pain as a consequence of cultural, social and psychological contributing factors (Grbich 2004). Pain intervention in this model involves strategies which aim at behaviour and attitude change through psychosocial mechanisms (Gray 2006). There exists relative high inter-relationship between depression and pain (Hayden et al. 2005; (Yezierski et al. 2004). established concepts that associate experiences of pain to their effective size by measuring behavioural expression and coping in relation to control medication known as meta-analysis (Hoffman et al. 2007) Alternatively, differences in pain experiences can be explained based on biomedical model, where neurons in the nervous system play major role in pain expressions. Nociceptors are neurons that play role in determination of pain threshold. The nociceptors react to stimuli and inform the body of the existence of injured tissue or ongoing damage (Wall 1978). They react to stimuli at the point of contact and pass information regarding presence of unfavorable stimuli to other parts of the nervous system. The strength of stimuli needed to elicit reaction from receptor ends of nociceptors is what can be regarded as the threshold of pain (Wall 1978). The dynamics of stimulus detection involve simple nerve cells that render pain thresholds ‘constant’ (Melzack & Wall 1965). Pain tolerance thresholds differ from one individual to another in relation to a painful incident due to activity of the interneurons in the nervous system. They determine what signals may be allowed to access the brain in relation to stimuli in affected area of the body. However, this information to the projection cells is applied selectively in diverse situations. It is now possible to appreciate why pain tolerances differ from one individual to another (Melzack & Wall 1965). Yet this pain tolerance threshold is known to either increase or decrease in certain circumstances in an individual. How could the phenomenon of less pain to an individual if exposed to pain for sometime be explained, though the body is subjected to equal amount of damage as before? This question can be answered by understanding the concept of neuronal plasticity in biomedical model ((Yezierski et al. 2004; Melzack & Wall 1965). Neuronal plasticity has the capacity to change the balance of interneurons that relay information via the nervous system or interneurons that inhibit the pain signal. Increase or decrease of the effect of either group of neurons tends to greatly affect pain tolerance threshold. This activity is known as sensitization. When the reverse process occurs, the threshold levels rises. This process is called habituation. Acute pain can develop into chronic pain through sensitization. The dynamisms of habituation attempt to explain why an individual suffers less pain when exposed to similar pain inducing situation for later (Melzack & Wall 1965). Clinicians especially those working with patients suffering from complex regional pain syndrome (CRPS) recognize that success of syndrome management is significantly challenging. Absence of a definitive medical treatment, calls for a multidisciplinary approach in CRPS management. Currently there is a general agreement success in treatment of such cases requires simultaneously to address the psychological, medical, and social aspects the syndrome presents (Turk 2002). Likewise, use of hypnosis is emphasized by health care providers working in senior centers, adult day care centers, hospices, assisted living facilities, continuing care retirement centers or nursing facilities. This is recognized as an effective and safe intervention for pain management especially if incorporated in their daily activities for the older adult. This is because the older adults’ pain is often mistreated, minimized or misdiagnosed thus if left unattended to the outcomes of chronic pain may result to depression, sleep problems, social isolation and difficulty engaging in daily life activities. Studies show that benefits of alternative and complementary therapy positively improve pain management if appropriately applied as intervention measures (Turk 2002). The importance of using psychological interventions especially in CRPS cases derives from recognition that utility in management of non-CRPS chronic pain situations as a result of direct interactions between behavioral and psychological factors with pathophysiological mechanisms is underlies CRPS. Thus psychological interventions may not only be palliative in CRPS as and assurance but also could have a potentially beneficial impact on the underlying pathophysiology disorders based on multidisciplinary treatment context. Examples of these approaches include; various forms of relaxation, biofeedback, training and behaviorally and cognitive interventions (Koes et al. 2006). According to appraisals by experienced health professionals’ application of techniques described above through an integrated multidisciplinary context results to significant improvements in ability and functioning to control pain (Turk 2002). Conclusion The body’s complex mechanisms that protect us from harm are certainly a marvel. Acute pain is mainly a warning system alerting us of tissue damage, but apparently sometimes the pain serve no discernable reason resulting to chronic pain. Pain is a personal thing (Turk 2002). You cannot measure it, and you cannot always describe it to others convincingly, thus aspects of pain are difficult to research or quantify. However, it’s comparatively easier to have sympathy with a victim of experiencing acute pain than that of chronic pain. This is because we can easily identify with the cause of pain such as when a person is hit on the head with a cudgel in our presence. As for chronic pain people can only guess what the victim is going through. For example it would be very difficult for anyone to grasp the magnitude of pain for someone who walks ten floors to his office daily. The bio-psychological strides made in the understanding of acute pain will aid in further understanding of chronic pain (Yezierski et al. 2004). In the meantime let us take advantage of our knowledge of acute pain. The idea is to act quickly when our body gives signal of tissue damage. Otherwise not attending to acute pain will easily tip over to chronic pain with disastrous result (Yardley 2001). Bibliography Bandura, A. 2004. Health promotion by social cognitive means. Health Education & Behavior, 31, 143-164. Barkway, P.2009. Psychology for Health Professionals, Churchill Livingstone Australia. Fields, H. L. & Levine, J. D. 1984. Pain- Mechanisms and Management, Medical progress, 141(3): 347-357. Germov, J. (ed).2005. Second opinion: an introduction to health sociology, 3rd ed. South Melbourne: Oxford University Press. Gray, D. 2006. Health Sociology: An Australian Perspective, Forest NSW: Pearson Education Australia Grbich, C. 2004. Health in Australia: Sociological Concepts and Issues, (ed), Forest NSW: Pearson Education Australia Hayden, J.A., van Tulder, M.W., Malmivaara, A.V. & Koes B.W. 2005. Meta-analysis: exercise therapy for nonspecific low back pain. Annals of Internal Medicine 142: 765-775. Hoffman, B.M., Papas, R.K., Chatkoff, D.K. & Kerns, R.D. 2007. Meta-analysis of psychological interventions for chronic low back pain, Health Psychology, 26:1-9. Keefe, F.J., Rumble, M.E., Scipio, C.D., Giordano, L.A. & Perri, L.M. 2004. Psychological aspects of persistent pain: current state of the science, Journal of Pain, 5:195-211. Kevin, D.2007.Health Sociology: An Australian Perspective/Health In Australia: Sociological Concepts And Issues. Health Sociology Review. Koes, B. W., van Tulder, M. W., & Thomas, S. 2006. Diagnosis and treatment of low back pain. British Medical Journal, 332:1430-1434. Melzack R & Wall, P.D. 1965. Pain mechanisms: a new theory. Science. 150 (699):971–979. Nicholas, M.K. 1992. Chronic pain. In PH Wilson (ed.), Principles and practice of relapse prevention. New York: Guilford Press. pp. 255-289. Turk, D.C. 2002. Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clinical Journal of Pain, 18: 355-365. Wall, P.D. 1978. The gate control theory of pain mechanisms: A re-examination and re-statement. Brain.101 (1):1–18 Yardley, L. 2001.Developing a Dynamic Model of Treatment Perceptions, Journal of Health Psychology, 6(3):269-282. Yezierski, R. P., Radson, E. & Vanderah, T. W. 2004. Understanding Chronic Pain. Nursing, 34(4): 22-23. Read More

In contrast, chronic pain is due to the persistence of acute pain, such that the body becomes accustomed to the acute pain, as a consequence, no warning to tissue destruction is relayed. The persistence is a devastating part because eventually results in disability or death due to the long destruction of the tissues. Based on Fields & Levine's opinions the intensity of acute pain is higher than the level of pain tolerance, while the manifestation of chronic pain may be different. However, with time, the intensity of chronic pains may well go over the patient’s tolerance threshold (Keefe et al. 2004).There is therefore the existence of a dynamic factor about experiences of pain in terms of tolerance levels.

At this stage, it is necessary to expound further on the dynamism of pain as well as an understanding of interpreting pain stimulus about pain and tolerance (Fields & Levine 1984). As earlier brought forward, pain behavior, pain is a subjective experience without measures of objectivity. This poses a great challenge to health professionals. Fear-avoidance among persons experiencing pain leads to activity avoidance (Barkway 2009). This eventually results in a reduction in activity levels among individuals, distress or depression, reconditioning, and increased disability.

According to Bio psychological model, this is a definitive interaction among the levels of fear-avoidance beliefs. For example, appraisal of pain at a certain level creates anxiety or fear at the next level which in turn leads to pain behaviors or disability at the next level. The latter aspect can be entrenched and form negative experiences about pain and establishing avoidance (Barkway 2009).Therefore, the main concern in the health profession is to treat disability or suffering but not pain itself.

This then calls for learning and training as proposed by Fordyce (1976 cited in) to develop and maintain pain behavior through Operant learning. This form of learning is based on rewarding or reinforcement of behavior in a way that will be likely to occur in the future. This theory is applied during intervention through medication where reinforcing activity synergizes return to normal functions by allowing the patient to avoid aversive tasks (Guzman et al 2001 cited in Barkway 2009). Therefore, reinforcement contingencies help in the modification of pain behavior as well as influencing these behaviors' development and maintenance (Barkway 2009).

Reinforcement contingencies for affected persons mostly come from family or partner as postulated in several studies (Newton 2002 cited in Barkway 2009). In as much as social support is vital in helping an individual in pain cope, there is a great chance of such support resulting in solicitous behavior leading to increased disability (Nicholas 1992).Similarly, culture or family of origin influences how people manage or respond to pain experiences (Otis et al 2004 cited in Barkway 2009). Although research is not conclusive, there is consensus that pain exposure to people from family history prone to chronic pain will report pain.

In contrast, cultural construct in itself may have influencing factors such as education, ethnicity, religion, and gender. Based on previous information, certain ethnic background leads to conceptualization and expression of pain (Germov 2005).Identification of components of the biophysical model is essential in the transition from acute to chronic pain or play an important impact in an individual's recovery process (Yardley 2001). It has been noticed among sick persons that continued consumption of healthcare resources does not lead to recovery or assumption of normal activities.

Therefore, it becomes necessary at this stage to predict transition to chronic pain at early phases so that appropriate interventions can be commenced. Linton and Hallden (1998 cited in Barkway 2009). proposed a model for screening known as Orebro Musculoskeletal Pain Questionnaire (OMPQ) which allows healthcare practitioners to predict the ‘Yellow flags’ or environmental and psychological risk factors that would predispose a patient to future disability.

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