Psychology and Chronic Pain in the elderly: A brief discussion (level 1)

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Psychology and Chronic Pain in the elderly: A brief discussion.

Chronic pain is a complex condition which psychologists and other health professionals continue to attempt to understand. This essay will attempt to address: how chronic pain is defined; both the Gate control theory of pain (Melzack and Wall 1965a) and how it relates to the behaviourist models understanding of chronic pain; a short discussion on how chronic pain affects the elderly population and Cognitive behaviour therapy as an alternative to pharmacological and surgical treatment of chronic pain in this age group. To illustrate the discussion of Gate control theory Melzack and Wall 1965b) and the behaviourist model theory, this essay will include a brief reflection on two patients A and B who both presented with different kinds of chronic pain, and whom I cared for while I was working on a student nurse placement. This placement was undertaken in an acute medicine for the elderly ward.

Melzack and Wall (1965c) assert that chronic pain is independent of acute pain in diagnosis. According to Morrison and Bennett (2006) chronic pain lasts for more than three to six months and usually begins as acute pain caused by injury. Chronic pain may or may not have an identifiable cause. Chronic pain may be: intractable where pain is consistently present though intensity varies; periodic or progressive where pain increases with the progression of illness (Melzack and Wall 1965b).Chronic pain can be a symptom of injury or disease. However, Bonica (1953; cited in Melzack and Wall 1965d) points out that in some cases pain seems to remain past serving any known function. As with acute pain, chronic pain is increasingly recognised to be produced by the interaction of physical and psychological elements.

Melzack and Wall (1965e) propose the Gate Control Theory to address both the physical and psychological factors in explaining pain. The theory states that information is transmitted from sensory receptors, known as nociceptors, in the skin, tissue and organs to ‘gates’ in the spine. These gates open to transmit information to the brain. Simultaneously, connected emotions are felt such as fear and anxiety, which activate nerve fibres to transmit information from the brain. Physical and psychological information open the gate where pain signals enter the spinal column Melzack (1965 cited in Morrison and Bennett 2006b). Cognitive factors such as focusing on pain or the anticipation of pain can also open the gate and increase pain. Depression has also been noted to lower the pain threshold (Mel’nikova 1993; cited in Munafo and Turin). Conversely, relaxation and distraction can close the gate: decreasing the feeling of pain by inhibiting nerve impulses from travelling to the brain (Russell 2005a). Gate Control Theory accepts that psychological factors play an important role in the experience of pain.

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The Gate Control Theory addresses acute pain and chronic pain with physical and psychological elements. However, Loeser and Melzack (1999) argue that pain can originate without nociceptor input. Psychological factors such as positive reinforcement maintain pain once physical causes have healed, while emotional suffering may cause pain. Fordyce (1978a) proposes the behaviourist model of pain. He suggests that learned pain behaviours, which the brain associates with pain, are maintained by environmental cues and positive reinforcement. Pain behaviours include grimace, limp or groaning which can elicit sympathy, touch, help with chores or activities, and conversation which positively reinforce behaviours. Fordyce (1978b) ...

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