Koutanji, Maria; (1997) A psychological investigation of pain processing. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis investigates levels of pain processing (perceptual-motor, schematic and conceptual), following Leventhal and Everhart's (1979, 1984) parallel processing model of pain. The social context (family environment) within which pain occurs was also investigated. At the perceptual-motor processing level, chronic and acute pain patients were studied using a pharmacological manipulation. Morphine significantly reduced sensory and affective ratings in acute pain, but only affective ratings in chronic pain, indicating that different mechanisms are involved in pain intensity and affect. At the schematic level, the impact of pain experience was examined in different pain and control populations, and age groups. Memory tasks were used to study priming and elaboration, and processing time was used to assess encoding of pain related information. High pain frequency subjects showed a weak recall bias towards pain related information encoded in self-reference, faster processing of sensory words and a response bias. Children suffering from arthritis exhibited both a memory bias towards sensory information encoded in self-reference and faster encoding, when compared to a control group. Relatives of pain patients did not exhibit an implicit memory bias for pain words. The results suggest that chronic pain can induce "cognitive" as well as physiological sensitisation irrespective of the biological age of the pain patients, and that personal pain experience is necessary for cognitive biases to develop. Conceptual processing was also investigated. Chronic pain patients were characterised by higher organic beliefs compared to the controls, but no differences were found between high and low pain frequency subjects or between relatives of pain patients and control groups. The role of gender and family environment in pain experience and report were also explored. A survey of current pain symptoms and family history of pain and illnesses in a student population showed that young women reported significantly more pain models than men. An investigation of family environment and psychological adjustment in frequent and chronic pain, showed no differences in family functions, anxiety and depression measures between high and low pain frequency subjects, and between families with and without a child suffering from pain.

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