《臨床心理學》雙語教學課件-chapter-7-understanding-pain

Chapter7understandingpainTheMeaningofPainAbout100yearsago,painwasmostfrequentlyconsideredadirectconsequenceofphysicalinjury,specificallyrelatedtothedegreeoftissuedamage.C.A.Strong(1895)hypothesizedthatpainwasduetotwofactors:thesensationandtheperson’sreactiontothatsensation.DefinitionofpainPainisremarkablydifficulttodefine.IASP(theInternationalAssociationfortheStudyofPain)SubcommitteeonTaxonomydefinedpainas“anunpleasantsensoryandemotionalexperienceassociatedwithactualorpotentialtissuedamage,ordescribedintermsofsuchdamage.”TheexperienceofpainBeecher(1956):painisatwo-dimensionalexperienceconsistingofbothasensorystimulusandanemotionalcomponent.IndividualdifferenceIndividualfactorsandpersonalexperiencemakeadifferencefortheexperienceofpain.ClassicalconditioningOperantconditioning:rewardsforpain,suchasreceivingattention,sympathyandsoon,isimportantforbuildingacutepainintochronicpain.IndividualdifferenceIndividualvariabilitytendtobeexaggerated.thereisno“pain-resistantpersonality”or“pain-pronepersonality”.Culturalandsituationalfactorsaremoreimportant.CulturaldifferenceThevariationinpainbehavioramongdifferentculturesmayreflectbehavioraldifferencesinlearningandmodeling,differencesinsensitivitytopain,orsomecombinationofthesefactors.GenderdifferenceArewomenmoresensitivetopainthanman?Researchesshowedthat:womenmayreporthigheranxietyrelatedtotheirexperienceofpain.TheoriesofpainSpecificitytheoryThegatecontroltheorySpecificitytheorySpecificpainfibersandpainpathwaysexist,makingtheexperienceofpainvirtuallyequaltotheamountoftissuedamageorinjury.Painistheresultoftransmissionofpainsignalsfromthebodytoa“paincenter”inthebrain.Specificitytheoryfailstointegratethevariabilityoftheexperienceofpainwiththephysiologyofthesomatosensorysystem.ThegatecontroltheoryRonMelzackandPeterWallin1965:ThegatecontroltheoryofpainPainisnottheresultofalinearprocessthatbeginswithsensorystimulationofpainpathwaysandendswiththeexperienceofpain.Structureinthespinalcordactasagateforsensoryinputthatthebraininterpretsaspain.ThegatecontroltheorySensoryinformationdorsalhornsofthespinalcordamplifyingordecreasingtheincomingneuralsignals.ThegatecontroltheoryCentralcontroltrigger:consistingofnerveimpulsesthatdescendfromthebrainandinfluencethegatingmechanism.Theseimpulsesfromthebrainaffecttheopeningandclosingofthegateinthespinalcordandareaffectedbycognitiveprocesses.ThemeasurementofpainSelf-reportratingsBehavioralassessmentsPhysiologicalmeasure

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0不痛

1-4輕度疼痛

5-6中度疼痛7-10重度疼痛VASPainquestionnaireandstandardizedpsychologicaltestsMPQMMPIThebeckdepressioninventoryThesymptomchecklist-90BehavioralassessmentGroanGrimaceRubSighLimpMissworkRemaininbedLowerlevelsofactivityUseofpainmedicationBodypostureFacialexpressionsUsefulespeciallyforchildrenandelderpeoplePhysiologicalmeasuresEMG:electromyographyThroughotherp