Handbook of Health Psychology

By Andrew Baum; Tracey A. Revenson et al. | Go to book overview
Save to active project

8
Physiological and Psychological Bases of Pain
Dennis C. Turk
University of Washington

Pain has existed since time in memoriam. Perhaps the first documented mention of pain was in the Ebers papyrus dating back to the fourth century B.C. that indicated the use of opium for the treatment of headaches. Since that time, pain has been the focus of philosophical speculation and scientific attention, yet it continues to remain a challenging problem for the sufferer, health care providers, and society.

Pain has been classified in a number of different ways, including the use of a single temporal dimension ranging from acute (momentary pain or pain extending from several hours, days, and weeks) to chronic (persisting over periods of months) to single categorical systems, such as presumed etiology (e.g., neuropathic, somatic, psychogenic), to more multiaxial diagnoses in which multiple factors are included in the classification (e.g., location, system involved, temporal characteristics and pattern of occurrence, intensity, and etiology; Merskey, 1986). For s implicity this chapter uses a categorical approach referring to four c ategories of pain: acute, acute recurrent (e.g., migraine headache), chronic nuncancer pain (e.g., low back pain), and pain associated with a malignant disease process (i.e., cancer).

Pain is essential for survival because of its alarm function. In acute pain states, nociception (activation of sensory transduction in nerve fibers that convey information about tissue damage) has a definite purpose, it acts as a warning signal that requires immediate attention, reflexive withdrawal, and other actions in order to prevent further damage and to facilitate the healing process. In chronic pain states, this adaptive function plays a significantly smaller role and can often no longer be discerned. In the case of recurrent acute pain diagnoses, such as migraine headaches, the role of pain is even less clear because there is no protective action that can be taken or any tissue damage that can be prevented. Pain associated with neoplastic disease has some features in common with acute pain in that it may be a warning signal; whereas in others it is more like chronic pain because the pain may serve no purpose.

Pain is a common symptom in people who seek medical assistance accounting for over 70 million office visits to physicians each year (National Center for IIealth Statistics, 1986). Each of the four pain categories are extremely prevalent. Consider a sample of some available statistics. Over 23 million surgical procedures were performed in the United States in 1989 (Peebles & Schneidman, 1991) and most of these involved acute pain. Acute recurrent and chronic pain affect over 70 million Americans, with over 10% reporting the presence of pain over 100 days/year (Osterweis, Kleinman, & Mechanic, 1987). Estimates suggest that over 11 million Americans suffer from recurring episodes of migraine headaches (Stewart, Lipton, Celentano, & Reed, 1991), over 30 million experience chronic or recurrent back pain (IIolbrook, Grazier, Kelsey, & Staufer, 1984), and 37 million have pain associated with arthritis (Lawrence et al., 1989). Approximately 3.5 million people in the United States have cancer (Raj, 1990). Bonica (1979) estimated that moderate to severe pain is reported by from 40% to 45% of patients initially following the diagnosis, from 35% to 45% at the intermediate states of the disease, and from 60% to 85% in advanced states of the cancer.

Given the. lengthy history of pain and the statistics on its prevalence, it might be assumed that pain is well understood and readily treated. Despite advances in the understanding of anatomy and physiological processes and innovative and technically sophisticated pharmacological, medical, and surgical treatments, pain continues to be a perplexing puzzle for health care providers and a source of significant distress for

-117-

Notes for this page

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this page

Cited page

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited page

Bookmark this page
Handbook of Health Psychology
Table of contents

Table of contents

Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this book

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen
/ 962

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?