Health Psychology.

Biomedical and Biopsychosocial Approaches to Pain.

LEARNING OUTCOMES
1.Have an understanding of the basic structure of the human brain.
2.Have an understanding of theories of pain and methods of pain management.

INSTRUCTIONS:

Analyse and evaluate the biomedical and biopsychosocial approaches to pain and critically evaluate methods of assessing and controlling pain.

In this essay, you will need to explain what is meant by health before analysing and evaluating the biomedical and biopsychosocial approaches in relation to theories of pain i.e. Goldschneider’s Pattern theory and Melzack and Wall’s Gate Control theory of pain including the role of learning, the role of emotion and the role of cognition. You will need to outline how each theory explains the sensation of pain and the role of psychology in the perception of pain. To evaluate the theories you need to outline the strengths and weaknesses of the theories, with fully detailed explanations of all of the evaluative points you make.
The essay will also need to critically evaluate the main methods of assessing pain e.g. observation, self-report and physiological, and controlling pain e.g. cognitive, medication, respondent methods. To critically evaluate you need to seek a balanced debate, therefore you should consider the positive aspects of the methods of assessing pain and controlling pain alongside the negative aspects .

Solution.

Introduction

Governments and the international community collectively work towards the promotion of health and the protection of the wellbeing of all global citizens. The essence is to alleviate sickness and promote health, socio-economic, and human development. In this regard, the World Health Organization defines health as the state of a complete mental, physical, and social wellbeing and not just the absence of disease. Similarly, Godlee (2011) defines health as the ability of an individual or the body to adapt and self-manage when faced with emotional, social, and physical challenges. Understanding health is critical for the development of strategies and measures for dealing with the existing and future limitations towards health promotion and development.

This essay offers an in-depth discussion and critical analysis of health psychology. It evaluates and analyses biomedical and biopsychosocial approaches of pain, a major impediment towards the promotion of health. Additionally, it evaluates the methods of pain control and assessment and integrates different theories of pain into the discussion.

Analysis and Evaluation of Biomedical and Biopsychosocial Approaches of Pain

The biopsychosocial approach focuses on disease and illness in dealing with pain. The approach views illness as the complex interaction of psychological, biological, and social factors. According to Pickering and Gibson (2015), the approach defines disease as an objective biological event that disrupts specific organ systems of body structures following anatomical, physiological, or pathological changes. While this is the case, the biopsychological approach to pain chronic pain presents illness as the subjective experiences depicting the presence of disease. According to the approach, sickness is depicted by how the sick individual, his/her family, or friends live with or respond to the symptoms of disease. According to Gurung (2014), the approach offers a clear distinction between pain and nociception. As the approach stipulates, while nociception encompasses the stimulation of the nerves to convey information concerning tissue damage to the brain, pain is experienced after the transduction, relay, and the modulation of the information (specifically sensory information) to the brain. The genetic composition of an individual, history of prior learning, the psychological status of the person, and social and cultural factors influence the filtration of the input significantly.

The Gate Control Theory, which was developed by Patrick Wall and Ronald Melzack for the control of pain asserts that the introduction of non-painful input plays a critical role in the prevention of pain. As Gurung (2014) posits, the theory argues that stimulating non-noxious input allows the suppression of pain. The approach integrates the psychological and physiological explanations and other theories to develop highly influential arguments. As Melzack and Wall argued, the interplay of different structures of the central nervous system play a significant role in the determination of the degree to which a specific stimuli causes pain. The authors argue that the peripheral nervous system has the points of pain stimuli regulation at the spinal cord’s dorsal horn, which receives pain stimuli from the laminae. Moreover, the authors acknowledge the influence of psychology in the amplification of the effects of emotions and cognitive evaluation (Pickering & Gibson, 2015).  

Further, Goldschneider’s Pattern Theory contends that pain sensations are a consequence of the nerve impulse transmission patterns that are released and coded at the basic peripheral site. According to the author, the dissimilarities in the patterning and the quantity of the peripheral nerve fibre discharges lead to the differing sensation qualities. Additionally, Goldschneider attributed the difference to increased discharge upon the stimulation and discharge of the same nerve fibres. Pickering and Gibson (2015) assert that the theory is insufficient in the explanation of pain.  The author argues that the pain experienced from the noxious stimulus can greatly be influenced by psychological factors. As such, psychology plays a significant role in the development of pain and thus the application of a multidisciplinary approach is critical for the effective management and control of pain.

The theories are central in the explanation of biomedical and biopsychosocial approaches of pain management. According to Pickering and Gibson (2015), the biomedical approach attributes pain resulting from musculoskeletal injury to organic pathology. Dealing with the pathology translates to the effective management and control of pain. However, the application of this approach in the treatment seems ineffective since numerous types of pains are difficult to diagnose with objective findings. The application of the Pattern Theory, which calls for the multidisciplinary approach proves effective in the management of such pains. The biomedical approach excludes and disregards social and psychological factors and focus majorly on the biological factors, in this case the pathogenic factor. As such, the approach often proves ineffective in dealing with conditions that demand the application of psychological approaches or the integration of integrated methods (Leigh, 2014). However, this is not to disregard the effectiveness of the approach in treating other medical conditions.

Effectiveness in pain management demands the implementation of a multidisciplinary approach that includes and considers neurology, anaesthesiology, orthopaedics, and other integral aspects such as psychiatry. The Gate Control Theory argues for the shift of paradigm from the biomedical approach to the more integrated biopsychosocial approach in the management of pain (Ebert & Kerns, 2015). The biopsychosocial approach for managing pain asserts that the pain is caused by and its development influenced by pathology, the attitudes of the patient, beliefs and thoughts concerning the pain, socio-cultural factors, and psychological factors among other entities. The implementation of a method that only focuses on the pathology breeds ineffectiveness and limits the health of the patient. According to the approach, as guided by the Gate Control Theory, dealing with all the factors causing and developing the pain is critical for controlling and managing mild, to severe, and chronic pains. Using an integrated approach to manage the pain serves as an effective treatment model which guarantees improved health (Gurung, 2014; Ebert & Kerns, 2015).

Biomedical and Biopsychosocial Approaches To Pain Management: Assessment and Control

The management of pain is a critical process in the promotion of health. According to Gurung (2014), effective pain management involves the processes of pain assessment and control. The key pain assessment methods include observation, self-report, and psychological methods while the cognitive strategies, medication, and respondent methods are effective for pain control. However, each of the methods has various advantages and limitations. To start with, an important method of pain assessment is the patient self-report scale. This method is effective since pain is subjective and requires the patient to offer an explanation of the extent of the pain. According to Loretz (2005), this is the most effective assessment method. However, the inability of the patient to offer succinct self-report or false report makes it difficult to manage or treat the pain.

The behavioural pain assessment method relies on the health care professionals to observe and rate the severity of the pain. The method, as described by (Loretz, 2005), applies various pain behaviour indicators and tools for the description of its extent by observing body movements, facial expressions, cry, and changes in the usual behaviour among others. The application of this method with the general population has proved effective. Additionally, the method demonstrates changes with treatment effects. Its application is faced with multiple challenges such as the different ways in which people react to pains of different severity, the inability to define the usual behaviour, and inefficient verbal communication of pain. For example, in dealing with children, the assessment of the severity of pain using the method is difficult. Further, persons with cognitive impairment are difficult to assess using the method. The application of the behavioural method in such individuals proves ineffective. For instance, the avoidance of discrepancies between the self-report and behavioural assessment in paediatric patients is impossible (Pickering & Gibson, 2015) (Loretz, 2005).

The psychological assessment method studies the autonomic changes such as changes in the blood pressure, heart rate and its variability, and other crucial aspects such as hormonal-metabolic measures including the sampling of salivary hormones and plasma. The method uses measures that do not specifically assess pain but may be influenced by other factors. For example, anxiety and fear may influence the various factors that the psychologic assessment method uses. Further, the method requires the integration of the physiological measures to address concerns such as assessing pain in paediatric patients and patients with verbal and cognitive impairment (Loretz, 2005).   

Apart from pain assessment, controlling pain is important for the improvement of patient health. Controlling pain through respondent methods involves placing emphasis on the repeated exposure of indicators or cues for the increment of pain or the avoidance of painful activities or those which are expected to be painful. The individual experiencing pain is often encouraged to engage in previously avoided behaviour (Pickering & Gibson, 2015). For instance, the patient may be encouraged to lift an object of a particular weight. The method depicts effectiveness in its ability to lead the patient towards overcoming their fears and managing the pain. The end of the therapy ascertains the performance of previously avoided behaviour or activities void of distress. However, the method may pose a threat to the health of the patient or cause more psychological concerns such as anxiety, stress, or even more pain (Gurung, 2014).

The application of cognitive strategies plays an important role in the alleviation and control of pain. The methods involve assisting patients to self-monitor their emotions and thoughts to achieve self-awareness (Gurung, 2014). The process focuses on helping the patient understand whether certain thoughts or emotions influence pain and distress. The identification of the thoughts allows the development of the most effective way of dealing with the pain. The control of the pain is done by assisting the patient to develop healthy and apply alternatives to control the pain. However, it is difficult to help patients identify the negative thoughts or emotions and thus pose a great challenge in the achievement of full control of the pain (Pickering & Gibson, 2015).

Further from the aforementioned, another critical and important method of controlling pain is through medication. Considering the impact of pain on health, the health sector has focused on the development of medications for dealing with the issue. According to Pickering and Gibson (2015), there are various medications prescribed for controlling and managing mild to severe pains. The medications depict a greater degree of effectiveness in controlling pain. However, some medications such as opioids are addictive and can lead to further health concerns. As a mental illness, addiction influences the health and wellbeing of the patient significantly (Pickering & Gibson, 2015).

Conclusion

The promotion of health and the protection of the wellbeing of every citizen is a priority to every government. Health involves not only the absence of illness and disease but also the ability to cope with socio-cultural, psychological, emotional, and physical stress among other key concerns. The application of biomedical and biopsychosocial approaches in the management and control of disease and illness plays a significant role in the promotion of health. Pain influences health greatly. As such, there is a need to adopt and implement effective measures for its alleviation. The application of the above mentioned approaches in the management of pain influence the process in a major way. As a health concern whose development is influenced by various factors, the importance of an integrated approach in the management and control of pain is undeniable. Different theories such as the Pattern Theory and the Gate Control Theory have insights for controlling and managing pain. However, the latter, which argues for the implementation of a multidisciplinary approach, specifically the biopsychosocial approach of pain management proves effective. The consideration of the pathology, psychological factors such as the attitudes, thoughts, perceptions, and beliefs of the patient, and the implementation of neurology and other disciplines in the management of pain ensure effectiveness in the process.

Bibliography

Ebert, M. H. & Kerns, R. D., 2015. Behavioral . Cambridge: Cambridge University Press.

Godlee, F., 2011. What is health?. British Medical Journal (BMJ), Volume d4817 , p. 343.

Gurung, R. A. R., 2014. Health psychology : a cultural approach. Belmont, CA: Wadsworth Cengage Learning.

Leigh, H., 2014. Biopsychosocial approaches in primary care : state of the art and challenges for the 21st century. New York: Springer.

Loretz, L., 2005. Primary care tools for clinicians : a compendium of forms, questionnaires, and rating scales for everyday practice. London: Elsevier Mosby.

Pickering, G. & Gibson, S. J., 2015. Pain, emotion and cognition : a complex nexus. New York: Springer.