CHPT 9: Pain

-Pain referred to as Nociception: activation of specialized nerve fibers

and receptors in response to noxious or harmful stimuli such as heat,
cold, pressure, or chemical stimuli.
-When our body detects a noxious stimulus, the autonomic nervous
system jumps into action and the heart beats faster, blood pressure
rises, and the hypothalamic-pituitary-axis is activated.
- Pain is defined as unpleasant sensory and emotional experience
associated with actual or potential tissue damage.
-Nociception is accompanied by cognitive, behavioral and affective
states.
Psychogenic pain: psychological pain without physiological pain.
Neuropathic pain: nociception without psychological pain.
Somatic pain: physiological pain without tissue damage.
-Cognitive behavioral model:
people get conditioned to experience pain on the basis of learned
expectations.
(hearing that going to the dentist is painful, so before you go you are
fearful and experience even more pain when you actually go.)
- Cognitive-behavioral model, pain-prone personality idea, and
diathesis stress model-physiological predispositions to pain that
interact with psychological factors to cause pain.
Predisposing factors include: reduced threshold of nociception,
precipitating stimuli: injury, maintaining processes: expectation that
pain will persist.
Gate control theory: action takes place in dorsal horn substantia
gelatinosa of spinal cord, influence by the brain.
Pain receptors in our body, under our skin (on foot)- inform us when we
are poked, scratched, cut, scraped.
Neural impulses from the PNS are modulated by gate like mechanism
in the dorsal horn before they flow into the CNS up to the brain.
Interneurons on spinal cord are gate; they dont allow pain sensations
to be sent up to the brain if they are stimulated by the A-beta fibers
(activators), gate remains closed.
If stimulated by C-fibers (deactivators), gate remains open, pain
sensation goes to brain.
Interneurons are inhibitors.
CHPT 11: Psychoneuro Immunology
Biology of physiological and psychological affects the immune system
Interactions between nervous system, endocrine system and immune
system

Sadness: increase in immune cells

Happiness: decrease in immune cells
First major pillar: CS is able to instigate immune changes to those
instigated by the unconditional stimulus.
Immunity reacts to the CS because it thinks its a drug.
Second major pillar: immune system and stress
The more stress, the less lymphocyte your body produces, shrinking of
the thymus, killing T cells (suicide killing).
Major autoimmune diseases: thyroid, lupus, rheumatoid arthritis, HIV,
multiple sclerosis.
CHPT 11: HIV
Social support: lesser decline in T cells.
People with HIV and AIDS have a harder time getting social support
because the label of having HIV or AIDS becomes stigmatizing, and
people tend to avoid the patient thinking that the disease can easily be
transmitted to them.
CHPT 7: Alcohol
Fetal Alcohol Syndrome in prenatal infants caused by mothers drinking
while pregnant.
Alcohol related motor accidents are the leading consequence for
underage drinkers.
- Alcohol Abuse: 1. Failure to fulfill major role of obligations; 2.
Recurrent physically hazardous use; 3. Recurrent alcohol related legal
problems continued use despite persistent alcohol-related social or
interpersonal problems.
Binge drinkers
Beer > 12oz. is most consumed of alcohol, then liquor > 1.5 oz. then
wine > 5oz.
CHPT 8: treatment seeking behavior
1. social interference-work & social events
2. interpersonal crisis- relationships
3. # of severity of symptoms
4. Fear of symptoms
5. Social sanctioning-social pressure
CHPT 7: Smoking: Behavioral Reinforcements
-As soon as cigarette is puffed, nicotine brings good moods, increased
alertness & attention, reduced feels of hunger.
-start smoking for many social and cultural reasons
- individuals with low self-esteem and who like nicotine mostly smoke.

- Eriksons theory: overcome inferiority and establish identify can make

someone want to smoke.
CHPT 8: Cultural factors influencing treatment seeking behavior
Nonadherence: not complying to doctors orders
Social, political, economic barriers may contribute to noncompliance to
practitioners prescriptions.
Dietary practices: certain religions being restricted to eat certain
foods/drinks that are in their culture. Ex: restricting Asians from eating
white rice.
Recognizing symptoms, seeking treatment, adherence to treatment.
Patient-Practitioner Interactions:
1.active passive: doctor makes decisions for patient, patient cant
because of his/her medical condition.
2. Guidance cooperation: doctor takes primary role in diagnosis and
treatment, patient answers doctors questions, patient does not take
part in decision making regarding treatment.
3. Mutual cooperation: both patient and doctor work together on tests
of diagnosis and treatments,etc.
Collectivism: communicate all but the most important piece of info to
the doctor, doctor needs important info to make decision on
treatment/diagnosis. (collectivist does not want to disrupt harmony)
Individualist: gets straight to the point. Does not care about making
social harmony.
Doctors dont listen to everything patient says, cutting them off half
way.
Doctors use too much medical jargon- latin root medical words that
patients dont understand.
Doctors talk down to some patients.
Communication Uncertainty: patients not understanding what doctors
are telling them, information wise. Sometimes due to language
mismatch. (Ex: Puto in Spanish means male prostitute, Puto in another
language means rice cake.)
-Cultural Stereotyping
-Cultural Competency
Bio/psycho/social Alcohol
Alcoholism tends to run in families, and identical twins have a higher
rate of alcohol use and misuse. There is genetic predisposition to
drinking. Children of alcoholics have different brain activity waves in

response to the presentation of alcohol related stimuli material and are

less sensitive to the subjective intoxicative effects of alcohol. The lower
sensitivity to alcohol may lead them to drink greater amounts.
Psychologically, people who are high in neuroticism, who are impulsive,
and extroverted are more likely to become alcoholic. Bio/psychoalcohol is also used to reduce stress. Consumption of alcohol serves as
a reinforcement: positive feelings after alcohol consumption increase
the behavior of drinking, and drinking is associated with a decrease in
stress. Children with alcoholics are more likely to drink, as are people
with friends who drink. Drinkers do not just pick friends or drink; they
make nondrinkers turn into drinkers.
Socially if young adults have a positive outcome expectancy of alcohol
before the first time they drink, they are more likely to drink more
subsequently. College students also feel that their close friends
consume alcohol more than they did. On campuses where there is
accuracy of alcohol use, students are more likely to drink on more days
throughout the year than at campuses where students have greater
misperceptions of alcohol use.
Problems: Fetal alcohol syndrome results in developmental
abnormalities in prenatal infants due to mothers who drink during
pregnancy. Alcohol related motor accidents are the leading
consequence of drinking for underage drinkers. Underage drinkers face
a greater risk of damage to the prefrontal regions of their brains.
Underage drinking retards brain cell growth. Liver disease and cirrhosis
of the liver is a common consequence for drinking excessively for older
adults. Also, increases risk of CVD and stroke. Drinking frequently has
been linked to hypertension. Problems with pancreas, memory loss,
blackouts, and chronic brain disease.
Leads to psych problems and social behaviors. More fighting, conflict,
and child injuries are involved in alcoholic families. People who drink
are more involved in risky sex, sexual assault, reckless driving. More at
risk of anxiety and mood disorders.
It is a good idea to consume two standard drinks per day have 20%
lower risk for coronary heart disease and can help hider HDL.