interchangeable. For example, emotional factors may influence an individual’s physi-
ology and cognitive factors may influence an individual’s behaviour. Further, the differ-
ent components within each process also interact. For example, association may
increase pain in terms of learning. However, it is likely that this process can be explained
by changes in anxiety and focus with places and experiences that have previously been
associated with pain resulting in increased anxiety and increased attention to pain,
therefore increasing the pain experience. Likewise, pain behaviours may exacerbate pain
by limiting physical movement. But it is also likely that they operate by increasing focus
and anxiety – staying in bed leaves the individual with nothing to do other than think
and worry about their pain. Research also indicates that fear influences attention, that
fear interacts with catastrophizing and that catastrophizing influences attentional
interference (Crombez et al. 1998a, 1998b, 1999; Van Damme et al. 2002). The three
process model offers a framework for mapping out the different factors which influence
pain. However, this categorization is probably best seen as a framework only with
the different components being interrelated rather than discrete categories of discrete
factors.
THE ROLE OF PSYCHOLOGY IN PAIN TREATMENT
Acute pain is mostly treated with pharmacological interventions. However, chronic pain
has proved to be more resistant to such approaches and recently, multidisciplinary
pain clinics have been set up that adopt a multidisciplinary approach to pain treatment.
The goals set by such clinics include:
Improving physical and lifestyle functioning: this involves improving muscle tone,
improving self-esteem, improving self-efficacy, improving distraction and decreasing
boredom, pain behaviour and secondary gains.
Decreasing reliance on drugs and medical services: this involves improving personal con-
trol, decreasing the sick role and increasing self-efficacy.
Increasing social support and family life: this aims to increase optimism and distraction
and decrease boredom, anxiety, sick role behaviour and secondary gains.
In addition, current treatment philosophy emphasizes early intervention to prevent
the transition of acute pain to chronic pain.
Research shows that psychology is involved in the perception of pain in terms of
factors such as learning, anxiety, worry, fear, catastrophizing, meaning and attention.
Multidisciplinary pain clinics increasingly place psychological interventions at their
core. There are several methods of pain treatment, which reflect an interaction between
psychology and physiological factors. These methods can be categorized as respondent,
cognitive and behavioural methods and are illustrated in Figure 12.3.
Respondent methods: Respondent methods are designed to modify the physiological
system directly by reducing muscular tension. Examples are relaxation methods
which aim to decrease anxiety and stress and consequently to decrease pain and
biofeedback which is used to enable the individual to exert voluntary control over
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