1) Pain is a complex sensory and emotional experience that involves biological, psychological, and social factors. It serves an adaptive purpose but can become chronic and debilitating. 2) Chronic pain is pain that persists beyond normal healing time, often for months or years. It can be recurrent, constant, or progressive depending on its underlying cause. Chronic pain significantly impacts quality of life. 3) Self-report measures are a primary way to assess pain, including structured interviews, rating scales, and pain inventories that evaluate sensory, affective, and evaluative dimensions of the experience.

1. PAIN
Lesson # 1

2. PAIN
• Pain is the sensory and emotional experience of
discomfort, which is usually associated with
actual or threatened tissue damage or irritation
(AMA, 2003).
• Pain involves our total experience in reacting to
an unpleasant event, an experience shaped by
biological, psychological and sociobehavioral
forces, which, in turn, reflect our genetic legacy,
previous experiences, personality, and coping
resources (Kroner- Herwig et al., 1996)

3. Pain
• Different pain experiences – different mixtures
of organic and psychogenic factors
• Somatoform disorders – Pain disorder
• However, failing to find a physical basis for
someone’s pain does not necessarily mean
there is none.

4. Significance of Pain
• Common medical complaint
• Impairs general functioning, ability to work, social relationships and
emotional adjustment
• Social and economic effects
• Essential to survival – highly adaptive – vital sign
• Quadriplegics
• Congenital insensitivity to pain, a genetic disorder that makes them
almost completely insensitive to pain – they are able to distinguish
other tactile sensations (temperature, pressure) they don’t feel pain
– do not live to adulthood.
• Fear of Pain – more stressful – assisted suicide – major obstacle to
treatment and recovery – Pain Anxiety Symptoms Scale (PASS) –
better able to develop Individualized treatment plan – stress
management, relaxation, other techniques.

5. TYPES OF PAIN
• Acute pain refers to the discomfort people experience with temporary painful
conditions that last less than a few months (Mann & Carr, 2006; Turk,
Meichenbaum, & Genest, 1983).
Sharp, stinging pain that is usually localized in an injured area of the body
Often have higher than normal levels of anxiety while the pain exists, but
their distress subsides as their conditions improve and their pain decreases
Prechronic stage – persists beyond time of normal healing – critical –
overcomes/llifelong battle – sense of helplessness (Frances Keefe,1982)
• Chronic Pain When a painful condition lasts longer than its expected course or for
more than a few months, it is called chronic. People with chronic pain continue to
have high levels of anxiety and tend to develop feelings of hopelessness and
helplessness because various medical treatments have not helped.
Pain interferes with their daily activities, goals, and sleep (Affleck et al.,
1998), and it can come to dominate their lives.

6. TYPES OF CHRONIC PAIN
The effects of chronic pain also depend on whether the underlying
condition is benign (harmless) or is malignant (injurious) and
worsening, and whether the discomfort exists continuously or occurs
in frequent and intense episodes. These factors define three types of
chronic pain (Turk, Meichenbaum, & Genest, 1983):
1. Chronic-recurrent pain stems from benign causes and involves
repeated and intense episodes of pain separated by periods without
pain. Two examples of chronic-recurrent pain are migraine headaches
and tension-type (muscle-contraction) headaches; another example is
myofascial pain, a syndrome that typically involves shooting or
radiating, but dull, pain in the jaw and muscles of the head and neck,
and sometimes the back (AMA, 2003; Hare & Milano, 1985).

7. TYPES OF CHRONIC PAIN
2. 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. Sometimes chronic low back pain has this
pattern.
3. Chronic-progressive pain is characterized by continuous discomfort, is
associated with a malignant condition, and becomes increasingly intense as
the underlying condition worsens. Two of the most prominent malignant
conditions that frequently produce chronic progressive pain are rheumatoid
arthritis and cancer.
Chronic pain lowers overall Quality of life; increases vulnerability to infection
and other diseases – devastating psychological toll – lower self-esteem,
insomnia, anger, hopelessness, and many other signs of distress;
Higher rates of depression and personality disorders and are more likely to
abuse alcohol and other drugs

8. Chronic pain - Hyperalgesia
• People with chronic pain may become even more sensitive to pain.
• Occurs as a normal adaptation during sickness – facilitate recovery
by stimulating recuperative behaviors such as getting extra rest and
following healthy diet.
• 1890s – Physiologists Henry Head and Mames MacKensie –
observed – most internal pain are accompanied by increased
sensitivity in the nearby tissues;
• Proposed that signals from diseased parts of the body set up an
“irritable focus” in the CNS that creates areas of enhanced pain
sensitivity in nearby body parts;
• The fact that the increased sensitivity to pain occurs in otherwise
healthy tissues strongly suggests that the signals originate in the
CNS (Cervero, 2000)

9. BASIC MEASURES OF PAIN
• PSYCHOPHYSIOLOGICAL MEASURES
Set the stage for the very earliest psychophysical
studies (Mind/Body) – one way to measure pain is
to measure specific physiological changes that
accompany pain (EMG – Electromyography –
assesses, amount of muscle tension// changes in
other indicators of autonomic arousal – Heart rate,
Breathing rate, BP, Skin temp, etc)
Failure – pain is only one of many factors (diet,
activity level, stress, etc) that contribute to
autonomic changes

10. BASIC MEASURES OF PAIN
• BEHAVIORAL MEASURES
• Wilbert Fordyce (1976) – pain behavior-training
program – asks the observer to list five to ten
behaviors that frequently signal the onset of a pain
episode. Ex., amount of time persons spends in bed
during an average day, number of verbal complaints,
number of requests for painkillers
• In Clinical settings – Pain Behavior Scale –series of
target behaviors inventory – vocal complaints, facial
grimaces, awkward postures and mobility – while
performing activities – 3 point scale (frequent,
occasional, none)

11. BASIC MEASURES OF PAIN
• SELF-REPORT MEASURES - Verbal or written
1. Structured interviews
2. Rating Scales – assign numerical values to
various aspects of pain
3. Standardized pain inventories – assess
different dimensions of pain

12. Structured interviews
Interviews with the patient and key others, such as family members and
coworkers, provide a rich source of background information in the early
phases of treatment These discussions ordinarily focus on such issues as:
• The history of the pain problem, including when it started, how it
progressed, and what approaches have been used for controlling it.
• The patient’s emotional adjustment, currently and before the pain
syndrome began.
• The patient’s lifestyle before the pain condition began: recreational
interests, exercise patterns, diet, and so on.
• The pain syndrome’s impact on the patient’s current lifestyle, interpersonal
relations, and work.
• The social context of pain episodes, such as happenings in the family before
an attack and how family members respond when the pain occurs.
• Factors that seem to trigger attacks or make them worse.
• How the patient typically tries to cope with the pain.

13. Pain Rating Scales
Individuals rate some aspect of their discomfort on a scale –
Direct and Simple
i. Visual analog scale, which has people rate their pain by
marking a point on a line that has labels only at each end.
This type of scale is very easy for people to use and can
be used with children as young as 5 years of age (Karoly,
1985).
ii. The box scale has individuals choose one number from a
series of numbers that represent levels of pain within a
specified range.
iii. The verbal rating scale has people describe their pain by
choosing a word or phrase from several that are given.

15. Pain Rating Scales – Pain Diary
• Pain ratings can also be used in a pain diary,
which is a detailed record of a person’s pain
experiences.
• The pain diary a patient keeps would include
pain ratings and information about the time
and circumstances of pain episodes, any
medications taken, and comments about each
episode.

17. Pain Inventories
• Ronald Melzack developed a system for categorizing pain along three
dimensions (Melzack & Torgerson, 1971)
i. Sensory Quality – highlighted the tremendous variations that occur in
the sensation of pain (stabbing, burning, throbbing, dull,……)
ii. Affective Quality – focus on the many different emotional reactions that
pain can trigger ( irritation, fear, anger,…..)
iii. Evaluative Quality – refers to the sufferer’s judgment of the severity of
the pain, its meaning or significance.
Derived McGill Pain Questionnaire (MPQ) from this model – overall measure
– also helpful in identifying the focus on different dimensions
Reliably differentiates a number of pain syndromes – Ex., people who suffer
from headaches tend to choose the same pattern of words while those
suffering from lower back pain choose a different pattern.
Criticism – requires subjects to make fine distinctions among words, non-
English speaking people and children – limited in use.