responses to pain by carl graham clinical psychologist
TRANSCRIPT
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Response to Pain
Carl GrahamClinical Psychologist
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The Pain Stew
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Central SensitisationRepeated learning principleThe more you use it, the easier it fires
off
Even as the damage heals, it doesn’t take much to maintain an active pathway
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Distress & RelaxationIn constant nocioception but not all
signals are perceived as pain. Threat → Stress → Distress → Load
Change pain by changing response... Though relaxation doesn’t change
nocioception
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AttentionSensation of waistband on tummyWas that sensation there all the time?Sensations can fade into background
“noise”If pain is going up and down periodically,
your attention will always be drawn to itAim to make the pain more constant and
less threatening so it feels like any other sensation Pacing
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MoodDepression is not a disease!
Being faced with more punishers than rewards results in endocrine system activation
Dopamine and noradrenaline
Cold pressor experiment
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The Problem of LanguageBrain scans environment for threat
Physical reality vs. imagined stimulus
Child and dog outside at night example:Bad experience is over, but humans keep
replaying it and scan the environment so it doesn’t happen again
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Inflammation & Sickness ResponseWhat happens when you get a cold/flu?PainTired/fatigueMood drops Temperature changes (fevers and chills)General malaise
Muscle stiffnessGut symptomsConcentration & memory problems
What is the function?
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ControllabilityTattoo Parlour:
Who wants the first scenario?Who wants the second scenario?
What is the difference?
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Expectancy & SupportFear avoidance:Expecting a task to promote pain and, as
a result, avoiding it
Family support is great, but only to the point that it improves your function
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The Point of RelaxationThe pain you choose is easier to have:
Notice sensations and your response Notice pain sensations and your response Learn how to fail to feed the pain via distress Lay down a new learning history:
avoid vs. approach
Every time the tiger walks into the room, relax first, then slowly approach
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“Behavioural Neuromodulation”
Goal setting – (valued activity)Activity pacingMovementIncorporate “rest” breaksDistress management (pain vs. fear of pain)Fail to avoid and learn to approachGet back into valued and pleasurable
activities