are sometimes used as an index of pain intensity. Such measures include an assess-
ment of inflammation and measures of sweating, heart rate and skin temperature.
However, the relationship between physiological measures and both observational
and self-report measures is often contradictory, raising the question ‘Are the indi-
vidual and the rater mistaken or are the physiological measurements not measuring
pain?’TO CONCLUDE
Early biomedical models of pain suggested that pain was a simple response to external
stimuli and within this model categorized the individual as a passive responder
to external factors. Such models had no causal role for psychology. However, the
gate control theory, developed in the 1960s and 1970s by Melzack and Wall, included
psychological factors. As a result, pain was no longer understood as a sensation but as an
active perception. Due to this inclusion of psychological factors into pain perception,
research has examined the role of factors such as learning, anxiety, fear, catastrophizing,
meaning, attention and pain behaviour in either decreasing or exacerbating pain. As
psychological factors appeared to have a role to play in eliciting pain perception, multi-
disciplinary pain clinics have been set up to use psychological factors in its treatment.
These often use psychological therapies, particularly CBT which have been shown to be
effective for adults, children and adolescents. Recently, researchers have suggested a role
for pain acceptance as a useful outcome measure and some research indicates that
acceptance, rather than coping might be a better predictor of adjustment to pain and
changes following treatment.? QUESTIONS
1 Pain is a response to painful stimuli. Discuss.
2 To what extent does the gate control theory of pain depart from biomedical
models of pain?
3 What are the implications of the GCT of pain for the mind–body debate?
4 Pain is a perception. Discuss.
5 How might psychological factors exacerbate pain perception?
6 To what extent can psychological factors be used to reduce pain perception?
7 Self-report is the only true way of measuring pain. Discuss.
8 Develop a research protocol to examine the role of secondary gains in pain
perception.FOR DISCUSSION
Consider the last time you experienced pain (e.g. period pain, headache, sports
injury) and discuss the potential cognitive, emotional and behavioural factors that
may have exacerbated the pain.304 HEALTH PSYCHOLOGY