Page 64 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Factors Influencing Pain 37

Table 2.2 Factors influencing pain
Opens the gate Closes the gate
Emotional factors Anxiety Happiness
Worry Optimism

Tension Relaxation
Depression
Cognitive and Focusing on More involvement and
behavioural the pain interest in life activities
factors
Boredom Distractions or focus on
other activities
Other reactions Other reactions
Physical factors Extent and Medication
type of injury
Low activity Counter-stimulation
level (e.g. rubbing)

• The amount of activity in other peripheral fibres: some
small fibres and A-beta fibres, carry information about
harmless stimuli (e.g. touching or rubbing of the skin) and
tend to close the gate. This is why you can rub a cut
better.
• Messages that descend from the brain: impulses from
neurons in the brainstem and cortex can open or close the
gate. The effects of some of these (e.g. anxiety or excite-
ment) may open or close the gate, so what would normally
bring a child to tears goes unnoticed when they are having
fun with their friends at their birthday party. Similarly,
self- efficacy – the extent to which somebody believes they
are able to cope with pain – can influence their pain
perception (Walker 2001 ). Research has also shown that
anxiety can lead to increased self reported pain intensity
(Jones et al. 2002 ), reduced pain tolerance (Carter et al.
2002 ), and decreased pressure pain thresholds (Michelotti
et al. 2000 ).