Intricate Correlation between Personality Type and Pain Perception

Chapter I
INTRODUCTION

Background of the Study

Pain is a critical component of patient care. In the Physical Therapy world, Pain is

one of the most common symptoms that may lead someone to seek the help of a physical

therapist or other health care professional. Since pain is mainly measured using subjective

reports of intensity and symptom behavior, it is often misinterpreted despite its popularity of

being considered the fifth vital sign. (Nair et al., 2009)

In 1968, McCaffery defined pain as whatever the experiencing person says it is,

existing whenever s/he says it does. This definition emphasizes that pain is a subjective

experience with no objective measures. It also stresses that the patient, not clinician, is the

authority on the pain and that his or her self-report is the most reliable indicator of pain. In

1979, the International Association for the Study of Pain (IASP) introduced the most widely

used definition of pain. The IASP defined pain as an unpleasant sensory and emotional

experience associated with actual or potential tissue damage, or described in terms of such

damage. This definition emphasizes that pain is a complex experience that includes multiple

dimensions. ( IS there no Update on this)

Pain that is classified on the basis of its presumed underlying pathophysiology is

broadly categorized as nociceptive or neuropathic pain. Nociceptive pain is caused by the

ongoing activation of A- and C-nociceptors in response to a noxious stimulus (e.g., injury,

disease, inflammation). Pain arising from visceral organs is called visceral pain, whereas that

arising from tissues such as skin, muscle, joint capsules, and bone is called somatic pain.
Somatic pain may be further categorized as superficial (cutaneous) or deep somatic pain.

( Source )

In contrast to neuropathic pain, the nervous system associated with nociceptive pain

is functioning properly. Generally, there is a close correspondence between pain perception

and stimulus intensity, and the pain is indicative of real or potential tissue damage.

Differences in how stimuli are processed across tissue types contribute to the pains varying

characteristics. For example, cutaneous pain is often described as a well-localized sharp,

pricking, or burning sensation; deep somatic pain, as a diffuse dull or aching sensation; and

visceral pain, as a deep cramping sensation that may be referred to other sites (i.e., referred

pain). ( Source )

Neuropathic pain is caused by aberrant signal processing in the peripheral or central

nervous system. In other words, neuropathic pain reflects nervous system injury or

impairment. Common causes of neuropathic pain include trauma, inflammation, metabolic

diseases (e.g., diabetes), infections (e.g., herpes zoster), tumors, toxins, and primary

neurological diseases.81 Neuropathic pain can be broadly categorized as peripheral or

central in origin. Painful peripheral mononeuropathy and polyneuropathy, deafferentation

pain, sympathetically maintained pain, and central pain are subdivisions of these categories.

Neuropathic pain is sometimes called pathologic pain because it serves no

purpose. A chronic pain state may occur when pathophysiologic changes become

independent of the inciting event.Sensitization plays an important role in this process.

Although central sensitization is relatively short lived in the absence of continuing noxious

input, nerve injury triggers changes in the CNS that can persist indefinitely. Thus, central

sensitizatiaon explains why neuropathic pain is often disproportionate to the stimulus (e.g.,

hyperalgesia, allodynia) or occurs when no identifiable stimulus exists (e.g., persistent pain,

pain spread). Neuropathic pain may be continuous or episodic and is perceived in many
ways (e.g., burning, tingling, prickling, shooting, electric shock-like, jabbing, squeezing, deep

aching, spasm, or cold).

Acute pain was once defined simply in terms of duration. It is now viewed as a

complex, unpleasant experience with emotional and cognitive, as well as sensory, features

that occur in response to tissue trauma. In contrast to chronic pain, relatively high levels of

pathology usually accompany acute pain and the pain resolves with healing of the underlying

injury. Acute pain is usually nociceptive, but may be neuropathic. Common sources of acute

pain include trauma, surgery, labor, medical procedures, and acute disease states.

Acute pain serves an important biological function, as it warns of the potential for or

extent of injury. A host of protective reflexes (e.g., withdrawal of a damaged limb, muscle

spasm, autonomic responses) often accompany it. However, the stress hormone response

prompted by acute injury also can have adverse physiologic and emotional effects. Even

brief intervals of painful stimulation can induce suffering, neuronal remodeling, and chronic

pain; associated behaviors (e.g., bracing, abnormal postures, excessive reclining) may

further contribute to the development of chronic pain. Therefore, increasing attention is being

focused on the aggressive prevention and treatment of acute pain to reduce complications,

including progression to chronic pain states.

Chronic pain was once defined as pain that extends 3 or 6 months beyond onset or

beyond the expected period of healing. However, new definitions differentiate chronic pain

from acute pain based on more than just time. Chronic pain is now recognized as pain that

extends beyond the period of healing, with levels of identified pathology that often are low

and insufficient to explain the presence and/or extent of the pain. Chronic pain is also

defined as a persistent pain that disrupts sleep and normal living, ceases to serve a

protective function, and instead degrades health and functional capability. Thus, unlike

acute pain, chronic pain serves no adaptive purpose.

 Chronic pain may be nociceptive, neuropathic, or both and caused by injury (e.g.,

trauma, surgery), malignant conditions, or a variety of chronic non-life-threatening conditions

(e.g., arthritis, fibromyalgia, neuropathy). In some cases, chronic pain exists de novo with no

apparent cause. Although injury often initiates chronic pain, factors pathogenetically and

physically remote from its cause may perpetuate it. Environmental and affective factors also

can exacerbate and perpetuate chronic pain, leading to disability and maladaptive behavior.

Pain associated with potentially life-threatening conditions such as cancer is often

called malignant pain or cancer pain. However, there is movement toward the use of new

terms such as pain associated with human immunodeficiency virus (HIV) infection or pain

associated with cancer. (The term cancer pain is used in this monograph for the sake of

brevity.) Cancer pain includes pain caused by the disease itself (e.g., tumor invasion of

tissue, compression or infiltration of nerves or blood vessels, organ obstruction, infection,

inflammation) and/or painful diagnostic procedures or treatments (e.g., biopsy, postoperative

pain, toxicities from chemotherapy or radiation treatment).

There are several reasons why some experts feel that cancer pain merits a discrete

category. First, its acute and chronic components and multiple etiologies make it difficult to

classify based on duration or pathology alone. Second, cancer pain differs from chronic

noncancer pain (CNCP) in some significant ways (e.g., time frame, levels of pathology,

treatment strategies). However, there is little evidence to support a distinction between these

pain types based on underlying neural processes. Therefore, many pain experts categorize

cancer pain as acute or chronic pain.

Perception, Lezak defines perception as the integration of sensory impressions

into information that is psychologically meaningful. It is the interpretation and recognition

of the objects and events that we sense.

 Direct approach to perception argues that the usually reliable cues in the optic

array of a scene directly provide information about depth and distance. The direct view

assumes that the perceiver picks up the information afforded by the environment

naturally and essentially, without reflecting on them. Indirect approach to perception

argues that our judgements of depth are made on the basis of our past experience with

the depth cues. (Gibson, 1979)

The perception of pain is a complex phenomenon that is influenced by the

emotional state and past experiences of the individual. Pain is a sensation that warns of

potential injury and alerts the person to avoid or treat it.

In pain science, thresholds are measured by gradually increasing the intensity of

a stimulus such as electric current or heat applied to the body. The pain perception

threshold is the point at which the stimulus begins to hurt, and the pain tolerance

threshold is reached when the subject acts to stop the pain. (https://en.m.wikipedia.org)

The pain threshold is, of course, raised by local anesthetics and by certain

lesions of the nervous system as well as by centrally acting analgesic drugs.

Mechanisms other than lowering or raising the pain threshold are important as well.

Placebos reduce pain in about one-third of the groups of patients in which such effects

have been recorded. Acupuncture at sites anatomically remote from painful operative

fields also reduces the pain in some individuals. Distraction and suggestion, by turning

attention away from the painful part, reduce the awareness of and response to pain but

not the threshold for its perception. Strong emotion (fear or rage) suppresses pain,

presumably by activation of the above-described descending noradrenergic system.

 The experience of pain appears to be lessened in manic states and enhanced in

depression. Anxious individual in general have the same pain threshold as normal

subjects but their reaction may be excessive or abnormal.

The conscious awareness or perception of pain occurs only when pain impulses

reach the thalamocortical level. The precise roles of the thalamus and cortical sensory

areas in this mental process are not fully understood. It was believed that the recognition

of a noxious stimulus as such is a function of the thalamus and that the parietal cortex is

necessary for appreciation of the intensity, localization, and other discriminatory aspects

of sensation. This traditional separation of sensation (in this instance, awareness of

pain) and perception (awareness of the nature of the painful stimulus) has evolved to the

view that sensation, perception, and the various conscious and unconscious responses

to a pain stimulus comprise an indivisible process.

More on these

Theoretical/ Conceptual Framework

This study is anchored on the following theories:

The Gate Control Theory by Ronald Melzack and Patrick explains that in the

brain acts a gate to increase or decrease the flow of nerve impulses from the peripheral

fibers to the Central Nervous System. An open gate allows the flow of nerve impulses,

and the brain can perceive pain. A closed gate does not allow flow of nerve impulses,

decreasing the perception of pain. It mentioned that pain, thoughts, beliefs and emotions

may affect how much pain we feel from a given physical sensation.

The fundamental basis for this theory is the belief psychological as well as

physical factors guide the brains interpretation of painful sensation and the subsequent

response (Srivastava, 2010). This theory enabled the researcher to discover the
psychological factors play a role in the perception of pain. MORE evidence on this

Theory in relation to Personality

The study was also guided by the concept, Psychological Factors on Pain by

Hardy, Wolff, and Goodell. The theory suggested the two components of pain:

perception of pain and the reaction to pain. The perception of pain is a process that has

special structural, functional, and perceptual properties and is accompanied by means of

simple and primitive neural receptive and conductive mechanisms. The reactions to

pain, conversely, is a complex process relating the cognitive functions to pain

experience, culture, and a range of psychological factors that influence the reaction pain

stimuli (Hardy, et al, 2010).

In other words, this theory is linking the stimulus intensity and perception of pain.

The concept of total pain encompasses the multidimensional factors that contribute to

the patients experience of pain. It may include all the following: Intellectual Pain,

Emotional Pain, Interpersonal Pain, Financial Pain, Spiritual Pain, and Physical Pain

(McCaffey & Bebbe, 2010).

Pain is a completely individualized experience. We often use different terms to

describe it, but it is hard to know if you feel pain the same way as your friends or family

feel pain. Some people talk about having a high or low tolerance to pain, but because

pain is such a subjective experience, science has not developed accurate ways to

measure pain tolerance. (MoveForwardPT, 2014)

We all experience pain differently; the nature of your pain may give your physical

therapist some insight into the contributing mechanism. Pain is a symptom that all

healthy human beings experience at some point in their lives. The sensation of pain is
necessary for survival; if we did not experience it, we would not know that we were

injured or unwell. ??????

According to Eysenck, personality is a more or less stable and enduring

organization of a persons character, temperament, intellect and physique, which

determine [the] unique adjustment to the environment. Eysenck, based on own studies,

determined that the structure of personality is divided into three independent

dimensions. The traits are formed hierarchically and contain primary factors which stem

from groups of correlated habits and behaviour. The main dimensions, referred to as

super traits in this theory, are: psychoticism (P), extraversion (E) and neuroticism (N),

which are polar.

The Basic of Jungs Typology, Jung called Extraversion-Introversion preference

general attitude, since it reflects an individuals attitude toward the external world

distinguished by the direction of general interest (Jung, 1971). Sensing-Intuition

preference represents the method by which one perceives information: Sensing means

an individual mainly relies on concrete, actual information - in so far as objects release

sensations, they matter, whereas Intuition means a person relies upon their conception

about things based on their understanding of the world. (Jung & Meyers 1971)

The Judging - Perceptive index is designed to measure the primary process

individuals use when they are dealing with the outside world. Judging types tend to be

organized, and live in an orderly, planned way. They like to regulate life and control it as

much as possible (Carlyn, 1977). Perceptive types tend to go through life in a more

flexible, spontaneous fashion. They are typically curious, open-minded, and aim to

understand life and adapt to it (Carlyn, 1977).

Make a linking paragraph about the relationship of the personality and pain perception..

Statement of the Problem

Hypothesis if there are

Significance of the Study

Scope and Limitation

Definition of terms