Day 9: Antecedent, Behavior, Consequence
My activities today are:
- OT Individual
- PT individual
- Psychology group
- PT group
- Relaxation Group
Nociception (also called nocioception or nociperception) is defined as “the neural processes of encoding and processing noxious stimuli.” It is the afferent activity produced in the peripheral and central nervous systems by stimuli that have the potential to damage tissue. This activity is initiated by nociceptors (also called pain receptors), that can detect mechanical, thermal or chemical changes stimuli approaching or exceeding harmful intensity. Once stimulated, a nociceptor transmits a signal along the spinal cord to the brain. Nociception triggers a variety of autonomic responses and may also result in a subjective experience of pain in sentient beings. Nociceptive neurons generate trains of action potentials in response to painful stimuli, and the frequency of firing signals the intensity of the pain.
Nociceptive pain may be classified according to the mode of noxious stimulation; the most common categories being “thermal” (heat or cold), “mechanical” (crushing, tearing, etc.) and “chemical” (iodine in a cut, chili powder in the eyes).
Nociceptive pain may also be divided into “visceral”, “deep somatic” and “superficial somatic” pain. Visceral structures are highly sensitive to stretch, ischemia and inflammation, but relatively insensitive to other stimuli that normally evoke pain in other structures, such as burning and cutting. Visceral pain is diffuse, difficult to locate and often referred to a distant, usually superficial, structure. It may be accompanied by nausea and vomiting and may be described as sickening, deep, squeezing, and dull. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles; it is dull, aching, poorly localized pain. Examples include sprains and broken bones. Superficial pain is initiated by activation of nociceptors in the skin or other superficial tissue, and is sharp, well-defined and clearly located. Examples of injuries that produce superficial somatic pain include minor wounds and minor (first degree) burns.
Pain: Pain is an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the “funny bone”. The International Association for the Study of Pain’s widely used definition states, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Pain motivates the individual to withdraw from damaging situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.
Pain is the most common reason for physician consultation in the United States. It is a major symptom in many medical conditions, and can significantly interfere with a person’s quality of life and general functioning. Psychological factors such as social support, hypnotic suggestion, excitement, or distraction can significantly modulate pain’s intensity or unpleasantness.
In 1968, Ronald Melzack and Kenneth Casey described pain in terms of its three dimensions: “sensory-discriminative” (sense of the intensity, location, quality and duration of the pain), “affective-motivational” (unpleasantness and urge to escape the unpleasantness), and “cognitive-evaluative” (cognitions such as appraisal, cultural values, distraction and hypnotic suggestion). They theorized that pain intensity (the sensory discriminative dimension) and unpleasantness (the affective-motivational dimension) are not simply determined by the magnitude of the painful stimulus, but that “higher” cognitive activities can influence perceived intensity and unpleasantness. Cognitive activities “may affect both sensory and affective experience or they may modify primarily the affective-motivational dimension. Thus, excitement in games or war appears to block both dimensions of pain, while suggestion and placebos may modulate the affective-motivational dimension and leave the sensory-discriminative dimension relatively undisturbed.” (p. 432) The paper ends with a call to action: “Pain can be treated not only by trying to cut down the sensory input by anesthetic block, surgical intervention and the like, but also by influencing the motivational-affective and cognitive factors as well.” (p. 435)
Suffering, or pain in a broad sense, is an experience of unpleasantness and aversion associated with the perception of harm or threat of harm in an individual. Suffering is the basic element that makes up the negative valence of affective phenomena.
Suffering may be qualified as physical or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and frequency of occurrence usually compound that of intensity. Attitudes toward suffering may vary widely, in the sufferer or other people, according to how much it is regarded as avoidable or unavoidable, useful or useless, deserved or undeserved.
Suffering occurs in the lives of sentient beings in numerous manners, and often dramatically. As a result, many fields of human activity are concerned, from their own points of view, with some aspects of suffering. These aspects may include the nature of suffering, its processes, its origin and causes, its meaning and significance, its related personal, social, and cultural behaviors, its remedies, management, and uses.
The word suffering is sometimes used in the narrow sense of physical pain, but more often it refers to mental or emotional pain, or more often yet to pain in the broad sense, i.e. to any unpleasant feeling, emotion or sensation. The word “pain” usually refers to physical pain, but it is also a common synonym of suffering. The words “pain” and “suffering” are often used both together in different ways. For instance, they may be used as interchangeable synonyms. Or they may be used in ‘contradistinction’ to one another, as in “pain is physical, suffering is mental”, or “pain is inevitable, suffering is optional”. Or they may be used to define each other, as in “pain is physical suffering”, or “suffering is severe physical or mental pain”.
Qualifiers, such as mental, emotional, psychological, and spiritual, are often used for referring to certain types of pain or suffering. In particular, mental pain (or suffering) may be used in relationship with physical pain (or suffering) for distinguishing between two wide categories of pain or suffering. A first caveat concerning such a distinction is that it uses physical pain in a sense that normally includes not only the ‘typical sensory experience of physical pain’ but also other unpleasant bodily experiences such as itching or nausea. A second caveat is that the terms “physical” or “mental” should not be taken too literally: physical pain or suffering, as a matter of fact, happens through conscious minds and involves emotional aspects, while mental pain or suffering happens through physical brains and, being an emotion, involves important physiological aspects.
At Two Dreams, we work with the concept of the cycle of thoughts → feelings → behavior—that a thought may evoke a feeling, a feeling may stimulate a behavior (reaction), a behavior may create a thought, or any other combination of pairs may occur. We teach that an individual should insert a [PAUSE] after a feeling before acting—that thoughtless actions following a feeling can be dangerous. We teach that an individual should insert a pause after a thought before acting on it—the pause again can avoid reactive, non-deliberative knee jerks that may cause damage to oneself or others. Likewise, a thought that is examined may be then linked to true and current interpretations and feelings—rather than “old tapes” created in the past. We have learned that individuals who suffer from the disease of chemical dependency are often at great risk of the rash actions associated with a fleeting thought or an urge to medicate a feeling.
Today this concept is reviewed for me in my psychology group. The antecedent, noiciceptive reception, leads to the perception of PAIN, my feeling. This triggers SUFFERING, which is pain and what I think of it, my thoughts. This results in a variety of behaviors.
CONSEQUENCES of PAIN
- increased tension
- Increased inflammation
- Increased cortisol
- Decreased sleep
- Increased sympathetic nervous system activity
These behavioral/physiological consequences of noicieception/pain lead to the following heightened emotional states:
- Fear of loss of function, income, autonomy, etc. (future loss)
- Sadness over the situation (current loss)
These emotions lead to these thoughts:
- My pain will go on.
- My pain will get worse.
- I’d rather be dead than go through this anymore.
- This is not fair.
- Am I being punished?
- Why am I being punished?
- Why is this happening to me?
The consequence of this pain → feeling → thought cycle is more pain.
So, to avoid the cycle that heightens pain, I am taught to relax, use my PT and OT tools, use thermal or chemical strategies, and diet.
If you learn about yourself, you can help yourself. These are the questions I am asked to answer:
- Are you guarding? What part of your body is tense?
Are you deconditioned? Which activities have you decreased or stopped doing?
Is your sleep disrupted? Do you wake up feeling tired?
Are you under stress? What stressors besides the pain?
Are your moods affected by the pain? How?
Are you taking narcotic analgesics or muscle relaxants every day? Which ones?