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Pages 134-147

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From page 134...
... 8Managing Pain There is encouraging evidence that people can be taught nonpharmacological ways to cope with physical pain, particularly that which results from extreme psychological stress. This chapter examines the literature on pain management for clues about how to help people survive and function when environmental challenge is so severe that stress involves physical pain.
From page 135...
... Nociception is defined as "mechanical, thermal or chemical energy impinging upon specialized nerve endings that in turn activate A-Delta and C fibers, thus initiating a signal to the central nervous system that aversive events are occurring" (Loeser, 1980:313)
From page 136...
... aversive event that must be attended to in order to prevent or minimize bodily injury. In the latter, the person's reports of suffering from pain may not be entirely, or even importantly, related to organic nociception but rather may be associated with complex psychological factors having little to do with tissue injury.
From page 137...
... themselves exacerbate pain over the long term or can contribute to chronic pain. Of course pain from a traumatic event like a serious injury often leads to depression that both causes and is itself caused by loss of occupational function, decreases in cognitive and sexual functioning, and changes in physical appearance.
From page 138...
... influenced by observation of how others respond to them (Craig and Weiss, 1975)
From page 139...
... because of lessened anxiety that comes from knowing that certain sensations are normal. Having been told that a certain kind and degree of pain is to be expected, a patient may be less concerned about the pain being experienced because it is not construed as a sign that something is wrong.
From page 140...
... until the nurse has the time to fulfill the request. This alternative obviously does not allow the patient to be distracted from the pain.
From page 141...
... basically entails three interrelated steps: educating a person about the nature of pain; describing in detail the techniques available for coping with pain; and encouraging practice in and application of techniques that make sense to the patient. (The other usage of the term refers to training techniques, as in sports, whereby a person is presented with a challenge beyond the level that is likely to be encountered in game conditions, such as setting a pitching machine to hurl a baseball at 110 miles per hour.)
From page 142...
... and disability. It should be emphasized at the outset that success in the management of chronic pain is often not associated with reduction in reports of the experience of pain; rather, with reduction in such things as medication usage and with increase in activity (Fordyce et al., 1973)
From page 143...
... administered by physicians or physical medicine specialists rather than psychologists. To the extent that counter irritation is helpful by providing a distraction, psychologists have developed many interventions (e.g., guided imagery, cognitive distraction techniques, hypnotic suggestion)
From page 144...
... perpetuating factors. In most cases this would involve combining a variety of pure behavior-learning approaches with other cognitive-behavioral and relaxation interventions to encourage a patient to increase activity level even if experiencing discomfort and pain.
From page 145...
... Druckman, D., and J Swets, eds.
From page 146...
... Kahneman, D 1973 Attention and Effort.
From page 147...
... Wilson, J.F. 1981 Behavioral preparation for surgery: benefit or harm?

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