Pain: managing and controlling pain

Psychology A2 · Health Psychology. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

There are three groups of treatment. Biochemical treatments are drugs. Non-opioid painkillers such as aspirin and ibuprofen act at the injury by reducing prostaglandins, the chemicals that cause inflammation and make pain receptors sensitive. Opioids such as morphine act on opioid receptors in the nervous system, as the body's own endorphins do.

Psychological treatments change what the patient thinks about. The three cognitive strategies are attention diversion, non-pain imagery and cognitive redefinition.

Alternative treatments include acupuncture, where fine needles are placed at set points, and TENS, where pads on the skin give mild electrical pulses. Both are often explained by gate control theory and the release of endorphins.

Rules to remember

Non-opioid analgesics (aspirin, ibuprofen): reduce prostaglandins and inflammation at the site of injury.
Opioids (morphine, codeine): bind to opioid receptors like endorphins; risks are tolerance and dependence.
Attention diversion: focus on something else, such as counting or music.
Non-pain imagery: build a vivid, pleasant mental scene that has nothing to do with the pain.
Cognitive redefinition: replace threatening thoughts about the pain with realistic or positive ones.
TENS (transcutaneous electrical nerve stimulation): pulses stimulate large fibres, which close the gate.
Drugs alone are a reductionist approach; combining drugs with psychological methods is holistic.

Common mistake

Non-pain imagery and attention diversion are easy to confuse. Imagery means creating a mental picture inside the mind; diversion means attending to something real, such as a task or a sound.

Worked example

During an injection a boy thinks, 'This is only a small scratch and it will be over in a few seconds.' Which cognitive strategy is he using?

He is not attending to something else, so it is not attention diversion.
He is not picturing a pleasant scene, so it is not non-pain imagery.
He is still thinking about the pain, but he is changing what it means to him so that it seems less threatening.

Answer: Cognitive redefinition.

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