WEEK5 A social psychology of pain PDF

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Week 6 Lecture Notes in 2019. useful in reviewing the lecture...

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Week 5 A social psychology of pain 1. Pain - What is pain?  an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage”  Donald Price (Science, 2000) - The affective dimension of pain: unpleasantness and emotions associated with future implications, termed secondary affect. 

Bud Craig (2003) - Pain is like hunger or thirst, it is a homeostatic emotion. This implies motivation and behavioural drive

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Theories of pain Early 1900’s theories of pain were mechanistic  Specificity theory stated that the body has its own separate sensory system for detecting pain, with dedicated nerves, pathways and part of the brain  Pattern theory stated that the receptors for pain were shared with other senses, such as touch, but only transmitted pain signals when appropriate types of activity reach excessively high levels in the brain as a result of intense stimulation Neither theory adequately explained pain as they failed to account for psychological factors  Pain is first experiences in brain, then a bunch of psychological factors moderate it

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Gate-control theory of pain  Centres around a gating mechanism that is located in the substantia gelatinosa of the dorsal horns, part of the grey matter that runs the length of the spinal cord

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Three factors are theorised to control the opening and closing of the gating mechanism o The amount of activity in the pain fibres – the stronger the stimulation, the more active the pain fibres, this tends to open the gate o The amount of activity in peripheral fibres – large diameter A-beta fibres that carry information about harmless stimuli or mild irritation; activating these tends to close the gate

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Messages that descend from the brain – efferent pathways from the brainstem and cortex send signals that may have general or specific effects on opening or closing the gate

Believed that opening and closing of the gate is determined by the interaction of these three factors Mixed evidence for the gate-control theory of pain, but generally well-supported

Changing the meaning of pain  Benedetti et al., (PAIN, 2013)  One group was informed about the aversive nature of the task, as done in any pain study.  A second group was told that the ischemia would be beneficial to the muscles, thus emphasizing the usefulness of the pain endurance task.  Framing the meaning of the pain makes POS group higher tolerance at base line Pain and meaning  Gray and Wegner (2008) – intentional pain hurts more o Experience electric shock in lab study, half were told intentional hurt happen. Half were told unintentional hurt happen  World war II o his wound suddenly releases him from an exceedingly dangerous environment, one filled with fatigue, discomfort, anxiety, fear, and real danger of death, and gives him a ticket to the safety of the hospital” Pain and control  Having control over pain moderates or down-regulates the aversiveness of painful stimuli  Salomons, et al., (2004) found that control also attenuates neural responses to pain Pain and fear  Pain-related fear is more disabling than pain itself (Crombez et al., 1999)  Feel anxious about the experience Descending influences on pain – expectation plays a key role in our experience of pain  Effect of expectancy on opioid analgesia o Expectancy is about the effectiveness of the drug o Big drop down in pain anxiety when pos. expectation o Neg. expectation Similar to baseline

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The central role of patient expectations in placebo effects

All the six work in a positive way therefore the expectation going better and leads to improvement

Placebo effect: The placebo still works even the patient were told they were given the placebo. The power of expectation is strong Summary  Pain is a psychological state  Our expectations of pain fundamentally determine how we experience and respond to pain  What are our cultural expectations of pain? 2. Pain is not just unpleasant - All positive thing is pleasant but not all negative things are unpleasant - This quality of pain is also one reason that the pain killing industry is predicted to reach 34.6 billion by the year 2015. Pain killing is big business. - It is an important part of healing process Pain keeps us alive - Pain’s primary function is to warn of present and potential harm, thereby promoting survival (Bateson, 1991; Wall, 1999).  The congenital absence of pain significantly increases the risk of injury and death (Damasio, 1999).  Pain prompts the avoidance of harm and signals the need for escape, a function it serves ruthlessly by interrupting other goal pursuits (Eccleston & Crombez, 1999) and triggering swift instinct-based action (Damasio, 1999).  Just as importantly, a range of evolved responses to pain have developed to promote recovery and healing (Walters, 1994; A. C. Williams, 2002). This threatsignalling quality of pain triggers a range of biological, psychological, and social responses aimed at promoting action, escape, and recovery.

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We develop a pleasure for chili which is actually an unpleasant feeling

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Sometimes we need to have the neg experience to have the benefit Pain is not the same thing as the harm We need to have pain to have a definition of what’s happy, positive affect needs negative affect to exist

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We know that pain must be able to do something for us, because of the fact that people seek out pain This is evident within religious contexts where pain is an explicit element of many religious practices and ceremonies. People willingly engage with pain in these contexts. In the context of sport: Pain is often used as a tactic for overcoming one’s opponent within the context of martial arts. A sense of pain is often evidence that one has tried their hardest, pushed themselves to their limit. In the context of therapy: Deep tissue massage can be very painful, and yet it is often a pain that we enjoy or find rewarding. In the context of culinary practices and food choice: In fact, pain is even a selling point and has been used by some manufacturers to market their products. In the context of subcultures

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Why do people seek out pain? - A different perspective  Dominant focus has obscured the benefits of pain  Aim: focus on how pain produces a range consequence that may be considered beneficial. o Move from focusing on “what we can do for pain” to an account of “what pain can do for us” -

Why is this perspective important?  The role of pain has been largely overlooked in our understanding of well-being and health  Beyond protecting us from harm, pain also may contribute to well-being in critically important ways  In fact – pain may be necessary for health and happiness o Endless pleasure: consuming chococlate, eating more will make you sake hence painful o Marathons: feels good to overcome something challenging, if there is not pain in marathons, no one will try that.

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The primary function of pain is in assisting survival, but the benefits may extend to context of cultural, political and ideological concepts

3. How does pain relate to pleasure? Are they opposites? - Pain facilitate pleasure Pain enhances subsequent pleasure: Pain provides a contrast for pleasure, and this increases the relative pleasantness of subsequent experiences. Pain and pleasure in the brain

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Leknes & Tracey (Nature Reviews Neuroscience, 2008): Pain and pleasure both activate similar brain systems, triggering the release of opioids and dopamine If pain activates the reward centers in the brain, then it may also enhance subsequent pleasure For example, research shows that relief from pain is a pleasurable experience: o Franklin et al (2013) showed that pain-offset relief simultaneously enhanced positive affect and reduced negative affect o Leknes et al (2008) found similar evidence and suggest that this is related to opponent processes

Opponent process theory

Increase in pleasure if goes through pain first

Pain to pleasure via brain activation  Pain activates dopamine and opioid transmission which has been linked to learning, motivation, and the experience of pleasure (Could help to explain why sometimes people repeatedly seek out painful experiences)  The opioid system remains activated after the cessation of pain: The ongoing release of opioids after the cessation of pain may explain why the relief of pain is pleasant Boecker et al., (2008)  Had athletes run for 2 hours  Showed that ratings of euphoria were correlated with activation of opioidergic systems. Physical vs. emotional pain  Disruptions in opioidergic brain activity have also been linked to sadness and depression  This suggests that physical pain may help regulate emotional pain by activating endogenous opioid release  Doyne et al. (1987) showed that exercise is beneficial for depression Pain facilitates pleasure seeking Pain provides a justification for indulgence of pleasures that might otherwise arouse a sense of guilt. If pain reduces guilt after unethical deeds - what happens when good people experience (unjust) pain?

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People feel justified and less guilty about indulging in self-rewarding behavior when they have been the victims of injustice In these context self-indulgence provides for a sense of justice thereby annulling feelings of guilt.

Pain and self-indulgence  Offering a bowl of sweet after the pain  What we found was that compared to the other conditions participants who wrote about a past ethical deed and experienced pain took more sweets.  People who did something good but receive the pain think they deserve it Study 2: pain group more likely to have chocolate than pen compare to no-pain group  The relationship between pain and self-indulgence is moderated by sensitivity to personal injustice. - Pain heightens sensory sensitivity Pain heightens arousal and constrains attention on sensory experience, thereby increasing sensory receptivity. Pain may keep us connected to our immediate sensory experience in ways that are often considered desirable  Pain recruits resources aimed at action and escape: capturing attention and focusing awareness on immediate sensory experience o Heightened responsiveness to immediate sensory experience may extend to other sensory input occurring close to the offset of pain. Pain increases responsiveness to taste  Bastian, Jetten, & Hornsey (2014) Appetite: What we found was that participant rated the Tim Tam as more pleasurable and more enjoyable after pain that those in the control condition. Did people enjoy the Tim Tam more because they were actually experiencing the taste more intensely  Pain increased the intensity of taste across the entire spectrum. This replicated our findings from Study 1 but extended them to non-pleasurable tastes and provided some pretty solid evidence that pain increases taste sensation and that the likely mechanism is increased awareness. Reporting or sensitivity?  More sensitive and more accurate report the flavor, more engaged and focus Converging evidence  Increased taste intensity perception (and lower thresholds for taste detection – marginal finding) exhibited by patients with chronic back pain (Small & Apkarian, 2006)

Pain enables self-regulation and enhancement - Increase cognitive-affective regulation People who engage in self-harm often cite affect regulation as a primary motivation

 Opioid release Pain increases cognitive-affective regulation: Pain captures attention and brings cognitive resources on-line for effective problem solving in response to the threat of pain.  Distraction o Pain is ontogenetically and evolutionarily disposed to recruit resources aimed at action and escape o Pain interrupts other goal pursuits by directing attention to the immediate pain event o Distraction is an effective emotion regulation strategy and pain fulfils this function very effectively. o Physical pain associated with self-harm serves as a distraction from emotionally distressing thoughts and feelings, thereby reducing the tendency to ruminate on these mental states. Nock (2010) o In a sense pain brings us in touch with our immediate physical experiences, and away from our thoughts  Provides a short-cut to mindfulness 

Enhanced cognitive-affective control o Shackman et al., (2011) – pain and cognitive control integrated in the anterior midcingulate cortex (aMCC). o Franklin et al., (2010) found that participants who were exposed to pain (cold-pressor task) showed increased affect regulation compared to a no-pain control group. o Borsook & McDonald (2010) found that mildly negative social encounters reduce pain sensitivity Experienced either a positive interaction with a confederate or a “standoffish” interaction Participants who experienced the “standoffish” interaction reported reduced physical pain intensity and reduced physical pain unpleasantness when exposed to laboratory induced pain

- Pain demonstrate virtue Pain demonstrates virtue: Pain may be interpreted as providing a symbolic test of a range of personal virtues.  Pain is an early physical experience that is used to ground abstract moral concepts  Pain grounds abstract concepts of punishment o Pain commonly used as punishment (spanking children, used as negative reinforcement – classical conditioning) o Latin word for pain – poena – “to pay the penalty”  Painful experiences activate justice related concepts Pain as justice  Pain may be useful in the context of guilt, e.g. self-flagellation Pain may resolve guilt?  3 conditions: “Unethical Pain” / “Unethical no-pain” / “Control Pain”  Mental Acuity – ‘Unethical deed’ vs. ‘Everyday experience’: PANAS T1

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Physical Acuity – Ice water vs. Warm water: PANAS T2 Guilty participants held hand in ice-bath longer (M=87secs) than non-guilty participants (M=64 secs) (p...