Psychology essay - The link between pain

In this essay I intend to explore the ways in which the psychology of pain can affect my speciality of Radiotherapy and Oncology. I will firstly consider the definition of pain and the gate control theory of pain. I will then move on to considering the ways in which pain may influence me in my career of being a radiotherapist and identify the ways in which I could control and deal with pain within the radiotherapy department. I will lastly provide a conclusion to summarise my argument and the main themes of my essay.

Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damaged or described in terms of such damage" (IASP, 1984). The gate control theory of pain was introduced in 1962 and again in 1965 by Ronald Melzack and Patrick David Wall. In this theory they suggested that we have a gating mechanism with the dorsal horn of our spinal column (Melzack and Wall, 1965). They put forward the idea that we don't feel pain because of the activation of nociceptors but instead because of interactions between inhibitory and projection neurons. In the spinal cord there are gates which receive information about pain from all over the body. Nerve fibres send signals from the skin to the brain and inform it of pain. In this theory, the gate is said to be closed when we have no input of pain. The inhibitory neuron stops the projection neuron sending signals of pain to the brain and we therefore do not feel any pain. We also do not feel pain when it is only large nerve fibres that are stimulated. This allows both the inhibitory and projection neurons to be stimulated but the inhibitory neuron does not allow the projection neuron to send signals to the brain informing it of pain. Again the gate is said to be closed. A-beta fibres are an example of large nerve fibres. They prevent A-delta fibres and C- fibres from firing and therefore don't allow for the transmission of a pain stimulus. We do feel pain however when only small nerve fibres are stimulated. This stops the inhibitory neuron coming into action and allows the projection neuron to send signals to the brain, making it aware of pain. Here the gate is said to be open. A-delta fibres and C-fibres are examples of small nerve fibres. A-delta fibres can very quickly carry information from the skin to the brain about sharp, prickling sensations and C-fibres slowly carry information from the skin to the brain about dull aches and burning sensations. Psychological factors can also influence the opening or closing of the gate.

A radiotherapist provides radiation treatment for those with cancer. Having cancer has a huge impact on the life of patients and as a result they can encounter many psychological factors which affect their behaviour and how they deal with their treatment and look after their body. These psychological factors can relate to the Gate Control Theory of Melzack and Wall as they can cause the gate to open or close, therefore altering the patients' experiences of pain. The gate can be more open if the patient feels stressed, tense, worried, anxious, angry or depressed. This causes the patient to feel more pain. The patient may be anxious as they don't know what to expect from their treatment. They may also feel tense about getting their treatment as very often patients have to remove clothing and may feel uncomfortable with doing so. Patients' often feel worried about going for their treatment and sometimes it can be painful for them to lie on the carbon-fibre bed in the required position. More pain can be felt if the patient focuses all of their attention on the pain they are already suffering. This causes the gate to open. Radiotherapists often treat in-patients of a hospital. This can mean that the patient is sitting about most of the day with nothing else to think about other than the fact that they are suffering from cancer and the pain they are in. Something which may cause them pain is a skin reaction from the radiation they receive. This makes the skin go dry, red and itchy and can be sore to the touch. The patient can also get bored and do nothing except think about their cancer and the pain they are in. The patient will tend to sit around and do nothing because they think they are or are too ill to do any kind of exercise at all which makes the bones and joints stiffen up. Tumours can often rub against bone and if the patient's bone starts to stiffen up it can cause the patient to feel excessive pain on their bone. This also does not help them to stay fit and healthy and have a strong body to help fight off the cancer. As a radiotherapist there are certain things which I can do to counteract these psychological factors and allow for the gate to close, reducing the pain experienced by patients'. One way of doing this is to try and make the patient feel relaxed and content. I should try and encourage the patient to feel happy and relaxed both in and out of the treatment room as this will help to close the gate and reduce pain. I should also get involved with the patient and take an interest into how they are doing and anything that they are going through. This is best done by talking to the patient and getting to know them so that they feel comfortable and happy around you. This should help to lift their spirits and make the gate close which helps to distract them from the pain.

In conclusion it can be seen from this essay that the suffering of pain and how to deal with it plays an important role in my speciality of Radiotherapy. The Gate Control Theory of pain also links in to how patients' with cancer can suffer from pain but also how they can minimise their suffering of pain. As a radiotherapist it is important for me to know about this theory as it helps me to understand how I can help to reduce the pain in which my patients' are suffering.

References:

http://health.howstuffworks.com/pain4.htm -bullet points 1, 2 and 3
http://en.wikipedia.org/wiki/Gate_control_theory_of_pain
http://www.derbyshirecountypct.nhs.uk/content/Health%20psychology%20service/Microsoft%20Word%20-%20The%20Gate%20Control%20Theory%20of%20Pain.pdf - page 2.

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