Develops due to cognitive interpretations of pain being intense
(Vlaeyen, Kole-Snijders, Boeren, & van Eek, 1995)
FEAR AVOIDANCE MODEL
(Crombez, Vlaeyen, Heuts, & Lysens, 1999)
(Vlaeyan & Linton, 2002)
Placebo Analgesia: Expectations
Effect is further enhanced through recollection of prior experiences of similar situations which led to pain relief
(Voudouris, Peck, & Coleman, 1985)
A learning phenomenon whereby an individual learns to produce a benefit from expectations, conditioning or social learning
Influence pain perception via verbal means that anticipate a particular benefit, in turn causing expectations of pain relief.
Amanzio and Benedetti (1999):
Conditioning of the effect through repeated exposure of pharmacological treatments
Observed drug-like effects even after the active drug is replaced by a placebo
Mirror the effects of pharmacological analgesics such as morphine and ketorolac.
Colloca and Benedetti (2006, 2009):
Reinforce verbally-induced expectations when a placebo treatment is paired with lower pain intensities, thus inducing analgesia
Increase the likelihood of expecting pain relief in the future Often result in more stable and strong placebo effects in comparison to solely verbally-induced
PLACEBO ANALGESIA: NEUROLOGICAL BASIS
A top-down activation of endogenous analgesic activity via the descending modulation system
Tracey and Mantyh (2007)
Areas such as the dorsolateral prefrontal cortex (DLPFC) and rostral anterior cingulate cortex (rACC)
Activation positively correlated with level of pain relief described
Wager and colleagues (2004)
DLPFC is critical in the initiation of the placebo analgesic response
rACC’s connection with the periaqueductal grey correlates with reduced pain-related responses in somatosensory pain areas and behavioral changes
Pain Modulation Network
Krummenacher and colleagues (2010):
Report transient lesioning of key pain control network areas by transcranial magnetic stimulation negates the effect
Wager and colleagues (2004)
Neuroimaging study report reduction in activity on the somatosensory cortex, which then parallels a decrease in pain rating reported by participants
Further Literature Support
The susceptibility and sensitivity to cognitive manipulations and interrelation with other areas of the brain in processing pain.
What This Reflects
(Ely, Berner, Wierenga, & Kaye, 2006)
CATASTROPHIZING: PERCEIVED CONTROL
Individuals view the pain as greater than the reality of it
Amplifies existing pain-related symptoms, result in pessimism on treatment outcomes, helplessness, and constantly harboring cognition
(Cano, Miller & Loree, 2009)
Heightened activity in brain regions associated with anticipation of pain, such as the cerebellum, as well as attention towards the pain within the DLPFC
(Gracely et al., 2004)
Individual’s belief is a determinant of adaptation and incapacity
Individuals who lack the capacity to develop self-management skills may lack persistence, are more likely frustrated, and less compliant with treatment recommendations.
Individuals who express more catastrophizing thoughts on pain are at an increased risk of prolonging recovery
(Sullivan, Bishop, & Pivik, 1995)
(Voudouris, Peck, & Coleman, 1985)
Pain is not simply an interpretation of physical nociceptive input by the brain, instead, a highly subjective sensation between nociceptive input and perception of pain (Hartley et al., 2015)
Easily altered by varying attention, more specifically, that attention can modulate the emotional and sensation characteristics of pain (Roy, Lebuis, Peretz & Rainville, 2011)
Effect of Attention
Sprenger and colleagues (2012):
Cognitive processes such as attention, influences this multifaceted association, where less intense pain is reported by distracted individuals as compared to individuals whose attention was on the pain
Hoffman, Patterson, Carrougher and Sharar (2001):
Investigated burn victims administered opioids who still report unbearable pain, however, when distracted using a virtual-reality game during treatment, report only a fraction of the original pain
Focusing on the pain can conversely result in more detrimental results.
Attention focused on bodily sensations and attending to them can result in amplification of the sensations which results in an increased sensation of pain (Ferrari, 2002)
Works Both Ways
Evaluating the cognitive processes of an individual is crucial in treatment of pain
Treating the physical pain, the pain-related issues still remains unresolved
Exacerbate the condition of the individual.
Understanding the aspects of expectations, attention, and catastrophizing, can greatly improve the individual’s recovery
Cognitive factors aid in shifting away from the rigid concept of pain as simply sensory input
Paves the way for a broader understanding of pain perception.
Question & Answer
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