A PRESENTATION ON PSY 413; HEALTH PSYCHOLOGY

GROUP 1

GROUP TOPIC: THE NERVOUS SYSTEM, HYPERTENSION

AND CHRONIC PAIN AS ILLNESSES (APPLICATION OF
HEALTH PSYCHOLOGY MODELS TO EXPLAIN BELIEFS AND
DECISION MAKING PROCESSES EMBARKED ON BY
SUFFERERS)

LECTURER IN CHARGE: DR MOJI S. AJAYI

GROUP MEMBERS:
1. CHRISTOPHER DANIEL OMOKHOGIE- 206554
2. EGBUNE ONANI ELIZABETH- 208238
3. OYEDOKUN WURAOLA DORCAS- 207523
4. PEREKPO FERANMI VICTORIA- 198338
5. AKINYEMI MERCY OLUWAFUNMILAYO-207510
6. ANENE CHUKWUDUMEBI BENEDICTA- 208236
7. ADEGBOYE MIRACLE OLUWABUNKUMI-206549
8. ADESUNLOYE KIKELADE ANUOLUWAPO- 207505
9. AKPOI GRACE BARIFAA- 205784
The Nervous System
Introduction
The nervous system is the master control segment of living beings. It is responsible for the
coordination of activities within the body. The nervous system comprises of two other sub-
systems: central nervous system and peripheral nervous system (PNS).
.
To understand our nervous system, we must first comprehend that the nervous system has two
cells present in the nervous system- Glia and Neurons.
Neurons
Neurons are the basic structural unit of the nervous system.Neurons are also called nerve
cells/nerves and they function as pathways for electrical impulses between your brain and the
rest of your body.

These impulses assist you in feeling sensations and moving your muscles. They also perform
autonomic activities such as breathing, sweating, and digestion.

The structure of neurons varies depending on whether they receive information from a few or
many sources and whether they deliver impulses over a short or long distance. Local Neurons is
the name given to neurons that deliver impulses over only short distances.
Types of Neurons according to function.
● Motor neurons: Controls muscular movements and are present in the central nervous
system (CNS). When motor neurons are triggered, neurotransmitters are released that
bind to receptors on muscles to cause a reaction, which results in movement.
● Sensory neurons: Nerve impulses are carried to the spinal cord and brain via receptors in
the eyes, ears, tongue, and skin. When nerve impulses reach the brain, they are converted
 into 'sensations' like vision, hearing, taste, and touch. Some sensory neurons, however, do
not reach the brain because they stop at the spinal cord, allowing for quick reflex actions.
● Relay neurons: Serves as a link between sensory input and motor output/response Relay
neurons, which are present in the brain and spinal cord. Allows sensory and motor
neurons to communicate with one another.

Types of neurons according to the number and placement of axons.

● Unipolar neurons possess one structure extending from the soma(Cell body.)
● Bipolar neurons possess one axon and one dendrites that extends from the soma.
● Multipolar neurons possess one axon and many dendrites.
● Pseudounipolar neurons possess a single structure extending from the soma and this
single structure branches into two distinct structures.
Parts of the neuron.
Nucleus: Each neuron has a nucleus that defines the position of the soma. The nuclear envelope
is a bilayer membrane that fuses at intervals to generate pores that allow molecular
communication with the cytoplasm.

The nucleus contains the chromosomes, the cell's genetic material, through which the nucleus
controls protein synthesis, cell development, and differentiation into its final form. Enzymes,
receptors, hormones, and structural proteins for the cytoskeleton are among the proteins
generated in neurons.

Axon: The axon emerges from the soma at a location known as the axon hillock or first segment.
The plasma membrane creates nerve impulses in this region, and the axon transmits these
impulses away from the soma or dendrites and toward other neurons. Large axons develop an
insulating myelin covering and become myelinated or medullated fibers.
Dendrites: Aside from the axon, neurons have additional branches called dendrites that are
usually shorter and unmyelinated than axons. Dendrites are hypothesized to form synaptic input
receiving surfaces for other neurons.
Myelin Sheath: The myelin sheath is a fatty layer that surrounds the axons of neurons. Its goal is
to insulate one nerve cell from another, preventing one neuron's impulse from interfering with
another's. The myelin sheath's second role is to accelerate the conduction of nerve impulses
along the axon.
Cell Body: The soma, or cell body, is essentially the core of the neuron. The soma’s function is
to maintain the cell and to keep the neuron functioning efficiently (Luengo-Sanchez et al., 2015).
Node of Ranvier: Their function is to accelerate action potential propagation along the axon via
saltatory conduction.
Axon Hillock: This is the area of a neuron that regulates the commencement of an electrical
impulse based on input from neighboring neurons or the environment.
Axon Terminal: The axon terminals (terminal buttons) at the neuron's end are in charge of
transmitting signals to other neurons.
Synapse: the gap at the end of a terminal button.

*Saltatory Conduction illustrates how an electrical impulse bounces from node to node along the
entire length of an axon, accelerating the impulse's arrival to the nerve terminal in comparison to
the slower continuous process of depolarization spreading down an unmyelinated axon.

Glial cells.
The other primary components of the nervous system, glia (or neuroglia), do not transmit
information over great distances like neurons do, although they do exchange chemicals with
neighboring neurons.

In some situations, this exchange causes neurons' activity to fluctuate. The term glia, derived
from a Greek word that means "glue," refers to early researchers' belief that glia were like glue
that held neurons together. Although that premise is no longer valid, the phrase lives on.

Glia are both smaller and more numerous than neurons.

Types of glial cells.
● Astrocytes: forms the blood brain barrier, regulates neurotransmitters, regulates blood
flow to the brain, synchronizes the activity of the axon, regulates metabolism in the brain
and cleans up when a neuron dies.
● Microglia: serves as the brain's own immune system.
● Oligodendrocytes: helps information get to the brain at a faster rate.
● Schwann cells: assists in nerve transmission.
● Radial cells: develops neurons.
● Satellite cells: delivers nutrition to the neuron and absorbs heavy metal toxins, keeping
the toxins from damaging the neurons. They also help with cell damage and in
transporting several neurotransmitters and other substances such as hormones like
acetylcholine.

The nervous system is divided into two subsystems: the central nervous system(CNS) and the
peripheral nervous system (PNS).
The central nervous system.
The central nervous system is the processing center of the body. The brain and spinal cord is
found here. The brain and spinal cord are both covered by membranes known as meninges.

The membranes connect the skull to the brain and the vertebrae to the spinal cord. They are
named dura, arachnoid, and pia mater, in that order. The subdural space is a possible space
between the dura and the arachnoid. The subarachnoid space, which contains cerebrospinal fluid,
separates the arachnoid and pia.

The spinal cord is an extension of the brain. It sends and receives messages to and from the
brain via a network of peripheral nerves.

Nerves also connect the spinal cord to the brainstem, a region of the brain.
Grey matter and white matter make up the tissue of the central nervous system. Neurons, cells,
and blood arteries make up gray matter. Axons, which are lengthy cords that extend from
neurons, make up white matter. They are covered in myelin, a fatty insulation.
A transparent liquid called cerebrospinal fluid, three layers of membranes called the meninges,
and the strong bones of the skull and backbone protect the brain and spinal cord from harm.

The spinal cord is the portion of the CNS that is located within the spinal column. Except for the
brain, the spinal cord connects with all sense organs and muscles. It is a segmented structure with
sensory and motor neurons on each side of each segment. The incoming dorsal roots (axon
bundles) convey sensory information, whereas the outgoing ventral roots carry motor
information.

Cell bodies and dendrites are tightly packed in the H-shaped gray matter at the core of the cord.
Many spinal cord neurons transport axons from the gray matter to the brain or other areas of the
spinal cord via the white matter, which is primarily made up of myelinated axons.

Each segment of the spinal cord communicates with the brain and receives motor signals from
the brain. All of that information travels via the spinal cord via axon tracts. When a piece of the
spinal cord is severed, the brain loses sensation from that segment and below. Motor control is
also lost in the brain.
According to the Bell-Magendie law, which was one of the first findings regarding the
functioning of the nervous system, the incoming dorsal roots (axon bundles) convey sensory
information, whereas the outgoing ventral roots carry motor information.

The sensory neurons' cell bodies are found in clusters of neurons outside the spinal cord known
as the dorsal root ganglia. (Ganglia is the plural of ganglion, which is a neuronal cluster.)

In most circumstances, a neuron cluster outside the CNS is referred to as a ganglion, while a
cluster within the CNS is referred to as a nucleus.) The motor neuron cell bodies are found
within the spinal cord.

The brain is in charge of the majority of the body's operations, including awareness, movement,
thinking, speaking, and the five senses of seeing, hearing, feeling, taste, and smelling.

The brain is located within the cranial cavity (the head) and has four irregular-shaped cavities, or
ventricles, that contain cerebrospinal fluid (CSF).

The three main parts of the brain are

● The forebrain (Cerebrum)
● The brain stem (which includes the midbrain, pons, and medulla oblongata)
● The hindbrain (Cerebellum)
The brain accounts for approximately one-fiftieth of the body's weight and receives around 15%
of the blood pumped by the heart, or approximately 750 ml each minute.

The Forebrain consists of two hemispheres, left and right. Each hemisphere controls sensation
and movement on the opposite side of the body. The outer covering of the forebrain is known as
the cerebral cortex. It is very prominent in humans.
There are four lobes that can be used to describe the cerebral cortex. These are- The occipital
lobe, the temporal lobe, the parietal lobe and the frontal lobe.
The occipital lobe, located at the back of the head, is dedicated to vision. Cortical blindness
occurs in people who have damage in this area: they have no conscious vision, no object
recognition, and no visual imagery (even in dreams), though they still have eye blinks and other
visual ref l exes that do not require the cerebral cortex. They also wake up during the day and
sleep at night because an area outside the cerebrum controls the wake-sleep cycle.

Each hemisphere's temporal lobe, located on the left and right sides of the head, is the primary
area for hearing and some of the more complex aspects of vision. Damage to the temporal lobe
can result in striking and specialized deficits. One region of the temporal lobe, found in both
monkeys and humans, responds only to the sight of faces.
The amygdala, a subcortical structure deep within the temporal lobe, is extremely sensitive to
emotional stimuli. People who have amygdala damage process emotional information slowly,
such as facial expressions and descriptions of emotional situations.

The parietal lobe is specialized for touch, pain, temperature, and awareness of the position of
body parts in space
The primary somatosensory (body-sensory) cortex, a strip in the anterior parietal lobe, contains
touch-sensitive cells in various body areas.

The frontal lobe which includes the primary motor cortex, located at the anterior (forward) pole
of the brain, is important for the planned control of fine movements, such as moving one finger
at a time.
Each area of the primary motor cortex, like the primary somatosensory cortex, controls a
different part of the body, and larger areas are devoted to precise movements of the tongue and
fingers as opposed to, say, the shoulder and elbow muscles, which have smaller representations.

The thalamus is located in the center and is the final stop for almost all sensory information on
its way to the cerebral cortex. The limbic system surrounds the thalamus.
(A limbus is a margin or border.) One of these areas, the hippocampus, is important for memory.
The thalamus and hypothalamus form the diencephalon, a section distinct from the
telencephalon, which is the rest of the forebrain. The thalamus is a pair of structures (left and
right) in the center of the forebrain.

The term comes from the Greek word for "anteroom," "inner chamber," or "bridal bed." It looks
like two avocados joined together, one in the left hemisphere and one in the right. Most sensory
information is processed by the thalamus before being sent to the cerebral cortex. Olfactory
information is an exception to this rule, as it travels from the olfactory receptors to the olfactory
bulbs and then directly to the cerebral cortex.

The hypothalamus is a small region of the brain located near the base of the brain, just ventral
to the thalamus. It is highly connected to the rest of the forebrain and midbrain.

The hypothalamus sends messages to the pituitary gland, which influences hormone release. Any
hypothalamic nucleus damage causes abnormalities in motivated behaviors such as feeding,
drinking, temperature regulation, sexual behavior, fighting, or activity level.

The pituitary gland is an endocrine (hormone-producing) gland connected to the hypothalamus

by a stalk containing neurons, blood vessels, and connective tissue. In response to hypothalamic
messages, the pituitary gland synthesizes and releases hormones into the bloodstream, where
they are carried to other organs.

The caudate nucleus, putamen, and globus pallidus are three major structures in the basal
ganglia, a group of subcortical structures lateral to the thalamus.
Other structures are also included in some authorities. The basal ganglia have been conserved
throughout evolution, and the basic organization in mammals and amphibians is similar.

The cerebrum is the largest part of the brain. It is located in the front and centre of the brain.
The cerebrum is responsible for the following mental activities:
• mental activities such as memory, intelligence, sense of responsibility, thinking, reasoning,
moral sense, and learning.
• sensory perception, which includes pain, temperature, touch, sight, hearing, taste, and smell.
• skeletal (voluntary) muscle contraction start and control.

The cerebrum has 3 significant parts which are- The precentral area, premotor area and the
frontal area.
The cells in the precentral area are for contraction of the skeletal muscles- motor movement.
Cells in the premotor area help in carrying out sets of orderly movements that require manual
dexterity.
The frontal area serves as a means to communicate whatever information these parts have to the
brain, also responsible for the behaviour, character and emotional state of an individual.

The brainstem is the lower portion of the brain. It resembles a stalk connecting the rest of your
brain to your spinal cord. The brainstem transmits signals from the brain to the rest of your body.
It regulates several subconscious body activities, such as breathing and heart rate control. The
following are the parts that make up the brain:
● The midbrain
The roof of the midbrain is called tectum. On each side of the tectum, dwellings can be found
called the superior colliculus and the inferior colliculus. They both are important for sensory
processing—the inferior colliculus for hearing and the superior colliculus for vision majorly.
● Pons
The pons is a portion of the brainstem, which connects your brain to your spinal cord. It is in
charge of unconscious processes and jobs like your sleep-wake cycle and breathing. It also has
multiple junction places for nerves that govern muscles and carry information from your brain
and face's sensors.
● Medulla oblongata.
The medulla, also known as the medulla oblongata, is placed slightly above the spinal cord and
can be thought of as an expanded extension of the spinal cord but located in the skull.
Through the cranial nerves, which govern sensations from the head, muscle movements in the
head, and much of the parasympathetic output to the organs, the medulla regulates some vital
reflexes, such as breathing, heart rate, vomiting, salivation, coughing, and sneezing.
Some cranial nerves have both sensory and motor components, while others only have one or the
other. Damage to the medulla is typically deadly, and high doses of opiates are lethal because
they decrease medulla activity.

The cerebellum is a big region in the hindbrain with many deep folds. It has long been
recognized for its contributions to movement control and many older textbooks refer to the
cerebellum as being crucial for "balance and coordination."

Persons who have cerebellar injury may be awkward and lose their equilibrium, but the
cerebellum's functions extend far beyond balance and coordination. People who have cerebellar
damage have difficulty changing their attention between auditory and visual stimuli. They are
also pretty bad at sensory timing.

Division Of The Nervous System

The Peripheral Nervous System.
The peripheral nervous system (PNS) is the component of your nervous system that is not
connected to your brain or spinal cord. It is responsible for both transmitting information from
various sections of your body back to your brain and carrying out commands from your brain to
various parts of your body.

The PNS is divided into the somatic nervous system and the autonomous nervous system.
The autonomic nervous system: This is a group of nerves that are in charge of self-regulating
the actions of internal organs. It is automatic and involuntary, meaning that it is not within the
control of will. These activities begin below the level of the cerebrum. Even if the individual is
unaware of the stimulation, the effects, such as the desire to urinate, may be felt. Its purpose is to
respond to urgent changes in the body and the requirement to maintain homeostasis, or
physiological balance.

The autonomic nervous system is related to the nervous system but is in fact situated outside of
the nervous system. This system is further divided into the sympathetic and the parasympathetic.
The sympathetic system has to do with preparing the body to react. Eg. Increasing the heart rate
in preparation to run away from danger.

Parasympathetic system regulates bodily functions once the body enters a state of rest. The
ANS's critical purpose is to prepare the body for action via the "fight or flight" response. When
the body detects a threat in the environment, the sympathetic neurons of the autonomic nervous
system (ANS) respond by:
● Raising heart rate
● Enlarging the airways to improve breathing
● Releasing stored energy increasing muscular strength
● Slowing digestion and other body functions that are not necessary for action
These changes prepare the body to respond appropriately to an environmental hazard.

*The reticular formation is a group of neurons in the brain stem's core that are surrounded by
neural pathways that carry ascending and descending nerve impulses between the brain and the
spinal cord. It is connected to other areas of the brain and receives information transmitted in
ascending and descending pathways.

It is in charge of skeletal muscle activity associated to voluntary motor movement and balance
maintenance. It coordinates autonomic nervous system-controlled processes such as respiration,
digestion, and cardiovascular activity. The reticular activating system, which selectively blocks
or passes sensory input to the cerebral cortex, is likewise controlled by this area.

The somatic nervous system: The somatic nervous system sends and receives sensory and
motor signals from the central nervous system; it is made up of motor neurons and sensory
neurons.
These motor and sensory neurons are divided into 2, namely the cranial nerves and the spinal
nerves.
Cranial nerves: Your brain is served by 12 pairs of nerves, 11 of which are part of your
peripheral nervous system (the second cranial nerve, which controls your vision, is part of your
central nervous system).
The olfactory nerves- sense of smell, optic nerves- for sight(Part of the CNS.), oculomotor
nerves- moves four extraocular muscles, ultimately moving the eyeballs, trochlear nerves-
supplies the oblique muscles of the eyes, trigeminal nerves- controls chewing and mastication,
abducents nerves- moving the lateral rectus muscle of the eye to move the eyes, facial nerves-
controls the muscles of facial expression and also transmits impulses from the taste buds in the
anterior two-thirds of the tongue to the taste perception area in the cerebral cortex, vestibulo-
cochlear nerves- controls the muscles of the tongue, pharynx and secretory cells of the salivary
(parotid) gland, glossopharyngeal nerves- controls the muscles of the tongue, pharynx and
secretory cells of the salivary (parotid) gland, vagus nerves- supply the gastrointestinal tract,
heart, kidneys, ureters, and blood vessels in the thoracic and abdominal cavities, accessory
nerves- supply the sternocleidomastoid and trapezius muscles and hypoglossal nerves- supply
muscles of the tongue and hyoid bone to contribute to swallowing and speech, are the 12 cranial
nerves.
These nerves are associated with your perceptions of smell, sound, taste, and touch in the skin
on your head, face, and neck. The vagus nerve, one of the 11, extends down and connects to all
vital organs from your neck to your intestines.

Spinal nerves: are 31 pairs of nerves that connect to your spine at around the same level as each
segment bone (vertebra). All of the nerves mentioned above branch out and become smaller
nerves.They eventually end at places like the tips of your fingers and toes or just underneath the
surface of your skin.

The spinal nerves are given names based on the vertebrae with which they are linked. The spinal
nerves exit from both sides of the spinal cord via the intervertebral foramina.
Each nerve is a mixed nerve because it is formed by the junction of a motor and sensory nerve
root.

The somatic nervous system governs voluntary movements, sends and receives sensory
messages, and participates in reflex activities without the involvement of the CNS, allowing the
reflex to occur swiftly.
They are also shown to predict significant life outcomes including education and health.
The somatic nerves also respond to their surroundings through somatosensory and motor
function. For example, when humans or animals are cold, they can relocate to a warmer location
to survive.
Homeostasis is the ability to control one's internal environment, which must be maintained in
order to survive. The SNS and ANS collaborate to regulate body functions and provide responses
to external stimuli.

The SNS not only controls all voluntary muscle systems in the body, but it also processes reflex
arcs. Reflex arcs are brain pathways that cause reflexive movements in reaction to stimuli
considered as dangerous.
This happens when sensory neurons detect something in the environment and transfer the
information directly to the spinal cord, but not to the brain.

Due to the SNS being in charge of receiving sensory information and motor movements,
symptoms associated with SNS injury include numbness, muscle weakness, and discomfort.

In psychology, the nervous system plays a crucial role in our behavior and mental processes. It
receives and processes sensory input from the body and the environment, which is then used to
generate appropriate responses. For example, when we see something scary, our nervous system
sends a signal to our muscles to move our body away from the threat.

It is responsible for transmitting information from the sensory organs to the brain and from the
brain to the rest of the body. This information is processed by the brain, which then uses it to
make decisions and take action.

The nervous system also plays a crucial role in the functioning of the mind. It is the primary
source of information for the brain, which is responsible for processing and interpreting this
information. The brain then uses this information to make decisions, form thoughts and
emotions, and engage in various psychological processes such as memory, learning, and
decision-making.
The nervous system also plays a role in our cognitive processes, such as attention, memory, and
decision-making. It helps us to interpret and understand the information we receive, and to make
decisions based on that information.

The nervous system allows us to interact with the world around us and to make sense of various
stimuli.
The nervous system also plays a role in psychological processes such as emotion, memory, and
learning. For example, the amygdala, a part of the brain that is involved in emotional processing,
is connected to the nervous system and can influence emotional responses. Similarly, the
hippocampus, a part of the brain involved in memory formation, is also connected to the nervous
system and can influence memory processes.

Overall, the nervous system is essential in psychological processes and behaviors. It is the main
communication and control system in the body, allowing the brain to receive and interpret
information from the environment and respond accordingly

Thousands of disorders and conditions can affect the nerves. An injured nerve has trouble
sending a message. Sometimes it’s so damaged that it can’t send or receive a message at all.
Nerve injury can cause numbness, a pins-and-needles feeling or pain. It may be difficult or
impossible for you to move the area that’s injured.

Nerve damage can happen in several ways. Some of the most common causes of nerve damage
include:

* Disease: Many infections, cancers, and autoimmune diseases like diabetes , lupus and
rheumatoid arthritis can cause nervous system problems. Diabetes can lead to diabetes-related
neuropathy, causing tingling and pain in the legs and feet. A condition called multiple sclerosis
attacks the myelin around nerves in the CNS
* Stroke: A stroke happens when one of the brain’s blood vessels becomes blocked or suddenly
bursts. Without enough blood, part of the brain dies. Then it can’t send messages via nerves. A
stroke can cause nerve damage ranging from mild to severe.

* Accidental injury: Nerves can be crushed, stretched, or cut in an accident. Car crashes and falls
are common injuries that can damage nerves anywhere in your body.

* Pressure: If a nerve is pinched or compressed, it can’t get enough blood to do its job. Nerves
can be pinched or trapped for many reasons, such as overuse (as in carpal tunnel syndrome), a
tumor, or structural problems like sciatic 

* Toxic substances: Chemotherapy medicines, illegal drugs, excessive alcohol and poisonous
substances can cause peripheral neuropathy or nerve damage. People with kidney disease are
more likely to develop nerve damage because their kidneys have a hard time filtering out toxins.

* Aging process: As you get older, your neurons’ signals may not travel as fast as they used to.
You may feel weaker, and your reflexes may slow down. Some people lose sensation in their
fingers, toes or other parts of their body.

Diseases of the nervous system.

1. Multiple sclerosis
2. Parkinson's disease
3. Alzheimer's disease
4. Epilepsy
5. Guillain-Barre syndrome
6. Bell's palsy
7. Peripheral neuropathy
8. Stroke
9. Amyotrophic lateral sclerosis (ALS)
10. Migraine headaches
1.  Multiple sclerosis (MS): a chronic autoimmune disorder that affects the central nervous
system, causing a wide range of symptoms including muscle weakness, numbness, and problems
with vision, balance, and coordination.
2. Parkinson's disease: a chronic and progressive movement disorder that affects the brain's
ability to control body movements. Symptoms include tremors, stiffness, and difficulty with
balance and coordination.
3. Alzheimer's disease: a progressive brain disorder that destroys memory and cognitive abilities.
It is the most common cause of dementia in older adults.
4. Epilepsy: a neurological disorder characterized by recurrent seizures, which are sudden and
uncontrolled electrical discharges in the brain. Symptoms may include convulsions, loss of
consciousness, and sensory disturbances.
5. Guillain-Barré syndrome: a rare disorder in which the body's immune system attacks the
nerves, leading to muscle weakness and sometimes paralysis. Symptoms typically start in the
legs and may spread to the arms and upper body.
6. Bell's palsy: a condition that causes temporary weakness or paralysis of the muscles in one
side of the face. It is often caused by inflammation of the facial nerve.l
7. Peripheral neuropathy: a disorder that affects the peripheral nervous system, the network of
nerves that transmit information from the brain and spinal cord to the rest of the body. Symptoms
may include numbness, tingling, and muscle weakness.
8. Stroke: a sudden loss of brain function caused by a disruption of blood flow to the brain.
Symptoms may include paralysis, speech difficulties, and sensory disturbances.
9. Amyotrophic lateral sclerosis (ALS): a rare and progressive neurological disorder that causes
the death of neurons controlling voluntary muscles. Symptoms may include muscle weakness,
difficulty speaking and swallowing, and eventually, paralysis.
10 Migraine: a chronic neurological disorder characterized by recurrent headaches, often
accompanied by nausea, vomiting, and sensitivity to light and sound.

Care and Hygiene for the nervous system.

Your nervous system is the command center for your entire body. It needs care to keep working
correctly. See your doctor regularly, eat a healthy diet, avoid drugs, and only drink alcohol in
moderation. The best way to avoid nerve damage from disease is to manage conditions that can
injure your nerves, such as diabetes.

The nervous system is a complex network of nerves and cells that carries messages between the
brain and the rest of the body. To maintain good health, it is important to take care of your
nervous system. Here are some tips for maintaining the health of your nervous system:

● Exercise regularly: Exercise is important for overall health, and it can also help keep the
nervous system healthy. Regular physical activity can improve blood flow to the brain,
which can help the nervous system function properly.  
● Get enough sleep: Sleep is essential for the body to repair and restore itself, and this
includes the nervous system. Make sure to get at least 7-9 hours of sleep each night to
help keep your nervous system healthy.
● Eat a healthy diet: A balanced diet that includes fruits, vegetables, and whole grains can
provide the nutrients the nervous system needs to function properly. Avoid processed and
junk foods, as these can contribute to inflammation and other problems that can harm the
nervous system.
● Reduce stress: Chronic stress can have a negative effect on the nervous system. Try to
manage stress through relaxation techniques, such as meditation or deep breathing, or by
seeking support from friends and family.
● Avoid drugs and alcohol: Substance abuse can have a damaging effect on the nervous
system, so it is best to avoid drugs and alcohol. If you are struggling with substance
abuse, seek help from a healthcare provider or support group.

In addition to these general tips, it is important to practice good hygiene to keep the nervous
system healthy. This includes washing your hands regularly, avoiding close contact with people
who are sick, and avoid touching your face, mouth, and nose. By following these tips, you can
help keep your nervous system healthy and functioning properly.

Call your doctor right away if you have any sudden changes in your health, such as losing
coordination or noticing severe muscle weakness. You should also see your doctor if you have:
 ● Vision problems or headaches.
● Slurred speech.
● Numbness, tingling, or loss of sensation in your arms or legs.
● Tremors or tics (random muscle movements).
● Changes in behavior or memory.
● Problems with coordination or moving your muscles.

Nervous System in relation to chronic pain.

The nervous system plays a crucial role in the body's response to chronic stress. When the body
is faced with chronic stress, the nervous system activates the "fight or flight" response, releasing
hormones such as cortisol and adrenaline to prepare the body for action. This response can have
negative effects on the body, including increased heart rate and blood pressure, decreased
immune function, and increased risk of heart disease and mental health issues. Over time,
chronic stress can lead to a state of chronic inflammation in the body, which can further
exacerbate the negative effects of stress on the body.

The nervous system plays a key role in the body's response to chronic stress. When an individual
experiences chronic stress, the body releases stress hormones such as cortisol and adrenaline,
which activate the sympathetic nervous system. This leads to the fight or flight response, which
prepares the body for action.

The sympathetic nervous system increases heart rate and blood pressure, increases respiration,
and redirects blood flow away from non-essential systems such as the digestive system. It also
stimulates the release of glucose from the liver to provide energy for the body to respond to the
stressor.

Chronic stress can lead to the over-activation of the sympathetic nervous system, which can have
negative effects on the body. It can lead to increased risk of heart disease, diabetes, and other
chronic health conditions. Chronic stress can also affect the body's ability to regulate mood and
emotion, leading to increased risk of anxiety and depression.
Additionally, chronic stress can impair the functioning of the parasympathetic nervous system,
which is responsible for relaxation and rest. This can lead to further health problems and
difficulty in managing stress. It is important for individuals experiencing chronic stress to
practice stress-management techniques and engage in healthy behaviors to maintain a balance
between the sympathetic and parasympathetic nervous system.

HYPERTENSION
According to the World Health Organization, blood pressure can be defined as the force exerted
by circulating blood against the walls of the body’s arteries, the major blood vessels in the body.
Hypertension is when blood pressure is too high. So another name for hypertension is high
blood pressure.
In measuring blood pressure, two numbers are involved. the first number which is called the
systolic blood pressure measures the pressure in one's arteries when one's heart beats. The second
number which is the diastolic blood pressure measures the pressure in one's arteries when one's
heart rests between beats.
So if the measurement reads 120 systolic and 80 diastolic, one would say, “120 over 80,” or
write, “120/80 mmHg.” A normal blood pressure level is less than 120/80 mmHg.
Hypertension is diagnosed if, when it is measured on two different days, the systolic blood
pressure readings on both days is ≥140 mmHg and/or the diastolic blood pressure readings on
both days is ≥90 mmHg.
Hypertension increases the risk of heart, kidney and brain diseases.

Hypertension and the nervous system

The sympathetic nervous system plays an important role in the regulation of arterial pressure,
and increased sympathetic nervous system activity has been implicated as a primary precursor of
hypertension in both humans and animal models of the disease. To date, the mechanism that
potentiates the increase in sympathetic nervous system activity has not been fully elucidated.
Imbalances in several neurotransmitters and neuromodulators are present during the development
of hypertension, and these directly and indirectly contribute to increased release of noradrenaline
onto the postsynaptic targets of the sympathetic nerves. In sodium chloride-sensitive
hypertensive subjects, dietary sodium chloride increases sympathetic nervous system activity
both directly and indirectly. Bidirectional interactions among the immune system and the
sympathetic nervous system also appear to play a role in the development of hypertension.
Finally, recent studies suggest that insulin-glucose excess and nitric oxide deficiency may
increase the sympathetic nervous system's contribution to some forms of hypertension.
High blood pressure may also play a role in dementia and cognitive decline over time. Reduced
blood flow to the brain causes memory and thinking problems. One might have trouble
remembering or understanding things, or lose focus during conversations.
The same damage that high blood pressure causes to blood vessels and arteries in the heart can
happen to the arteries in the brain. When a larger blockage of blood to the brain occurs, it’s
called a stroke. If parts of the brain can’t get the oxygen they receive from blood, cells begin to
die.
One's survival rate and likelihood of permanent brain damage depends on how severe the stroke
is and how fast one receives treatment.
Blood vessels in the eyes can be damaged as well. If they burst or bleed, it can cause vision
difficulties, like blurriness or blindness. Fluid buildup under the retina is called choroidopathy.

Causes of hypertension
Hypertension develops overtime and it could be because of unhealthy lifestyle choices such as:
unhealthy eating habits, not getting enough regular physical activity and consumption of tobacco
and alcohol.
Presence of certain health conditions such as diabetes and obesity can also increase the risk of
developing hypertension.

Symptoms of Hypertension
Hypertension usually has no warning signs or symptoms. It has been described as a silent killer.
The best way to detect it is to get a qualified health care professional to measure one's blood
pressure.
But when symptoms actually do occur, usually at a stage described as an hypertensive crisis
when the blood pressure is higher than 180/120mm Hg, the individual then experience symptoms
such as: irregular heart rhythms, buzzing in the ears, early morning headaches, nosebleeds and
vision changes.

Prevention and management

There is no cure for high blood pressure. One can only try to prevent or manage it.
Ways hypertension can be prevented include:
 Reducing salt intake (to less than 5g daily).
 Eating more fruit and vegetables.
 Being physically active on a regular basis.
 Avoiding use of tobacco.
 Reducing alcohol consumption.
 Limiting the intake of foods high in saturated fats.
 Eliminating/reducing trans fats in diet.

Ways hypertension can be managed include:

 Reducing and managing stress.
  Regularly checking blood pressure.
 Treating high blood pressure.
 Managing other medical conditions.

CHRONIC PAIN
The Ibadan Registry estimates more than 1.5 million cases of chronic pain per year in Nigeria. Chronic
pain is pain that is ongoing and usually lasts longer than three months. This type of pain can continue
even after the injury or illness that caused it has healed or gone away.
Chronic pain last months or years and happens in all parts of the body. It interferes with daily life and can
lead to depression and anxiety. The first step in treatment is to find and treat the cause. When that isn’t
possible, the most effective approach is a combination of medications, therapies and lifestyle changes.

WHAT IS CHRONIC PAIN

According to Merriam Webster's dictionary, the word chronic in medical terms means continuing or
occurring again and again for a long time, or happening or existing frequently or most of the time, or
always or often doing something specified. While the word pain means the physical feeling caused by
disease, injury, or something that hurts the body, mental or emotional suffering sadness caused by some
emotional or mental problem.
Chronic pain is pain that lasts for over three months. The pain can be there all the time or it may
come and go. It can happen anywhere in your body. Chronic pain can interfere with your daily activities,
such as working, having a social life and taking care of yourself or others. It can lead to depression,
anxiety and trouble sleeping, which can make your pain worse. This response creates a cycle that is
difficult to break.

WHAT IS THE DIFFERENCE BETWEEN CHRONIC PAIN AND ACUTE PAIN

Chronic pain differs from another type of pain called acute pain. Acute pain happens when you get
hurt, such as experiencing a simple cut to your skin or a broken bone. It does not last long, and it goes
away after your body heals from whatever caused the pain. In contrast, chronic pain continues long after
you recover from an injury or illness. Sometimes it even happens for no obvious reason. Whereas acute
pain is sudden, lasts less than three months, causes anxiety and often ends with tissue healing. Examples
include the pain of fractures, burns, cuts, dental work, childbirth or postoperative pain. Poor treatment of
acute pain may lead to chronic pain.
Chronic pain has lingered longer than six months, is persistent, and interferes with a person’s ability
to work and/or play. It may be severe, disturbing sleep and causing depression; or it may be mild and just
irritating. Chronic pain has greater physical and emotional effects. Physically there can be muscle tension,
lack of appetite and energy, and loss of mobility. Emotionally, there may be depression, anxiety,
withdrawal, guilt and anger.

WHERE DO PEOPLE HAVE CHRONIC PAIN

Chronic pain can come in many different forms and appear across your body. Common types of
chronic pain include: Arthritis, or joint pain, back pain, neck pain, cancer pain near a tumor, headaches,
including migraines. Testicular pain (orchialgia), lasting pain in scar tissue, muscular pain all over (such
as with fibromyalgia), Neurogenic pain, from damage to the nerves or other parts of the nervous system.
 HOW COMMON IS CHRONIC PAIN
Nigeria has been reported to have the highest incidence of sickle cell disease worldwide and
chronic pain is the hallmark of severity of the disease. The second most common cause of CP reported by
doctors was low back pain. This has been earlier reported to be common amongst Nigeria with prevalence
of 17-61%.
Delivering a lecture with the theme: “Chronic Pain – A menace to the aging populace”, Dr. Chigbo
defined chronic pain as “an unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such damage. According to her, chronic pain has been
linked to restricted mobility, opiod dependency, anxiety, depression, and reduced quality of life as it
increases with age, and by the age of 70, pain affects 79 per cent of women and 53 per cent of men. "The
Ibadan Registry estimates more than 1.5 million cases of chronic pain per year in Nigeria. Chronic pain is
pain that is ongoing and usually lasts longer than three months. This type of pain can continue even after
the injury or illness that caused it has healed or gone away. Pain signals remain active in the nervous
system for weeks, months, or years. Some people suffer chronic pain even when there is no past injury or
apparent body damage.
"Chronic pain is linked to conditions including, Headache, Arthritis Cancer, Nerve pain, Back pain,
Fibromyalgia pain. In management of pain, treatment should aim to decrease the intensity of acute pain in
an effort to reduce or prevent permanent changes in the nervous system that may result in chronic pain.
“One of the more long-standing recommendations of chronic pain rehabilitation is to reduce
pain behaviors.”

WHAT CAUSES CHRONIC PAIN

In most cases, we suffer pain because of wear and tear h(degeneration), especially of moving
parts. The spine in the neck and lower back are very susceptible as they are constantly in motion. The
lower spine also bears the weight of the trunk. Chronic pain may originate from bones (arthritis), muscles
(fibromyalgia, myofascial pain syndrome) tendons (tendinitis), and nerves themselves (neuralgias). Some
foods can trigger chronic pain (yes!), as can some medications.
All these causes can occur together in some cases. Chronic pain may also be psychogenic or
psychosomatic.

CHRONIC PAIN IN NIGERIA

Nigeria has a large proportion of people over the age of 35 years, an age when degenerative changes
usually start to manifest pain management services helps sufferers through conditions like herniated discs,
myalgia, spondylosis, radiculopathy, diabetic neuropathy, spinal stenosis, chronic headaches, cancer
pain…and many more. Pain should not limit the contributions that Nigerians can make to their
community, nor should it restrict their enjoyment of the country’s lifestyle.
The shortage of pain doctors across the world, with about 5000 serving a population of over 300
million in the USA, and a similar low ratio in the UK, has prompted investment by governments,
corporations and individuals. Their goal is to ensure that, not just the current able and active workforce,
but the older and retired, all have access to Pain Management Services.

WHAT DOES CHRONIC PAIN FEELS LIKE:

People with chronic pain describe their pain in many different ways, such as:
 Aching.
Burning.
Shooting.
Squeezing.
Stiffness.
Stinging.
Throbbing.
Chronic pain often leads to other symptoms and conditions, including:
Anxiety.
Depression.
Fatigue, or feeling overly tired most of the time.
Insomnia, or trouble falling asleep.

HOW IS CHRONIC PAIN DIAGNOSED

Pain is considered to be chronic if it lasts or comes and goes (recurs) for more than three months.
Pain is usually a symptom, so your healthcare provider needs to determine what’s causing your pain, if
possible. Pain is subjective — only the person experiencing it can identify and describe it — so it can be
difficult for providers to determine the cause.
If you have long-lasting pain, see a doctor. The doctor will want to know:
 Where your pain is.

 How intense it is, on a scale of 0 to 10.

 How often it occurs.

 How much it’s affecting your life and work.

 What makes it worse or better.

 Whether you have a lot of stress or anxiety in your life.

 Whether you’ve had any illnesses or surgeries.

HOW IS CHRONIC PAIN DIAGNOSED

The doctor could physically examine the patient, and conduct test. The following test could be
conducted:
 Blood tests.

 Electromyography to test muscle activity.

 Imaging tests, such as X-rays and MRI.

 Nerve conduction studies to see if your nerves are reacting properly.

 Reflex and balance tests.

 Spinal fluid tests.

  Urine tests.

TREATMENT OF CHRONIC PAIN

To relieve chronic pain, doctors first try to identify and treat the cause. But sometimes they can’t
find the source. If so, they turn to treating, or managing, the pain.
Doctors treat chronic pain in many different ways. The approach depends on many factors,
including:
 The type of pain.

 The cause of the pain, if known

 Your age and overall health.

The best treatment plans use a variety of strategies, including medications, lifestyle changes and
therapies.

MEDICAL TREATMENT FOR CHRONIC PAIN

Your healthcare provider may recommend certain medications to relieve chronic pain, including:
 Anticonvulsants (medications that prevent seizures) for nerve pain.

 Antidepressants such as tricyclic antidepressants.

 Corticosteroid.

 Muscle relaxers.

 Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.

 Topical products (applied to the skin) that contain pain relievers or ingredients that create
soothing heat or cold.

 Opioids (narcotics). Opioids can be addictive, and you can build up a tolerance to them over
time. Because of this, healthcare providers usually try other pain treatment options before
prescribing opioids.

 Sedatives to help with anxiety or insomnia.

 Medical marijuana.

Other medical treatments your healthcare provider may have you try include:
 TRANSCUTANEOUS ELECTRICAL NERVE STIMULATIONS (TENS): This
procedure delivers small shocks through patches on your skin. The electrical impulses can
relieve pain.

 NERVE BLOCKS: For this treatment, your healthcare provider injects an anesthetic near
the site of your pain to reduce feeling in the area. Nerve blocks can also sometimes provide
diagnostic information and locate the source of your pain.
  EPIDURAL STEROID INJECTIONS: This procedure is an injection of anti-
inflammatory medicine — a steroid or corticosteroid — into the space around your spinal
nerves known as the epidural space to treat chronic pain caused by irritation and
inflammation of spinal nerve roots.

SIDE EFFECTS OF TAKING DRUGS FOR CHRONIC PAIN

Every medication has a potential for side effects — some are more serious than others. Be sure to
discuss the possible side effects of your chronic pain medications with your healthcare provider.
Complications from medical treatments for chronic pain can include:
 Acute liver failure from acetaminophen treatment.

 Opioid addiction and/or overdose.

 Mood changes, confusion and respiratory issues from nerve pain medications.

 Spinal cord damage or infection from spinal cord stimulators.

HOW TO COPE WITH CHRONIC PAIN.

Four major lifestyle factors can affect your chronic pain and help minimize it. Doctors sometimes
call them the four pillars of chronic pain. They include:
 STRESS: Stress can play a major role in chronic pain, so it’s important to try to reduce your
stress as much as possible. Everyone has different techniques for managing their stress, but
some techniques include meditation, mindfulness and deep breathing. Try different options
until you find what works best for you.

 EXERCISES: Participating in low-intensity exercises, such as walking or light swimming,

for 30 minutes every day may help reduce your pain. Exercise can also be a stress reliever
for some people, which is important to manage when you have chronic pain.

 DIET: It’s important to eat a healthy diet to boost your overall health. Your healthcare
provider may suggest trying an anti-inflammatory diet by eliminating foods that cause
inflammation, such as red meat and refined carbohydrates.

 SLEEP: Getting enough quality sleep is important for your overall health. A lack of sleep
can cause you to gain weight, which could make your chronic pain worse. Getting quality
sleep is also important for stress management.

Be sure to discuss these four lifestyle pillars with your healthcare provider to determine how
each applies to your type of chronic pain and how you can incorporate changes into your day-to-
day life.

THERAPIES THAT CAN HELP WITH CHRONIC PAIN

Certain therapies may help people manage chronic pain, including:
 COGNITIVE-BEHAVIOURAL THERAPY: (CBT): This counseling method helps you
think differently about pain and teaches you ways to cope.
  COUNSELLING: Talk therapy can help you manage chronic pain, especially psychogenic
pain.

 OCCUPATIONAL THERAPY: Occupational therapy teaches you how to do everyday

tasks differently to lessen pain or avoid injury.

 PHYSICAL THERAPY: Physical therapy involves exercises that stretch and strengthen
your body, which can help reduce your pain.

ALTERNATIVE TREATMENT FOR CHRONIC PAIN

Alternative treatments that have been shown to relieve chronic pain over time include:
 Acupuncture, which uses small needles placed in the body.

 Aromatherapy, which uses aromatic plants and essential oils.

 Biofeedback, which teaches you how to tweak the way your body works, influencing such
things as heart rate, breathing and muscle tension.

 Hypnotherapy, or hypnosis.

 Mindfulness training, which teaches you how to calm yourself.

 Music, art or pet therapy.

 Reiki or Healing Touch, with a therapist using touch to change energy fields in your body.

 Relaxation techniques, such as massage, meditation and guided imagery.

CURE FOR CHRONIC PAIN

Currently, there is no cure for chronic pain, other than to identify and treat its cause. For example,
treating arthritis can sometimes stop joint pain.Many people with chronic pain don’t know its cause and
can’t find a cure. They use a combination of medications, therapies and lifestyle changes to lessen pain.

RISK FACTORS FOR CHRONIC PAIN

Since many conditions or injuries can cause chronic pain, there are several risk factors for
experiencing it. Some risk factors include:
 YOUR GENETICS: Some chronic pain causes, like migraines, run in the family (are
genetic).

 HAVING OBESITY: Having obesity can worsen certain health conditions that cause pain,
such as arthritis since there’s extra pressure on your joints.

 YOUR AGE: Older people are more likely to experience chronic pain from arthritis and
neuropathy.

 HAVING A PREVIOUS INJURY: If you’ve had a traumatic injury, you’re more likely to
develop chronic pain in the future.
  HAVING A LABOUR-INTENSIVE JOB: If you have a physically strenuous job, you’re
at greater risk for developing chronic pain.

 EXPERIENCING STRESS: Studies have shown that chronic pain is connected to both
frequent stress and post-traumatic stress disorder.

 SMOKING: If you smoke, you’re at greater risk for developing medical conditions that lead
to a need for chronic pain treatment.

HOW CHRONIC PAIN CAN BE PREVENTED

Unfortunately, nothing has been proven to prevent chronic pain in general. You may be able to
prevent certain conditions that lead to chronic pain. For example, you can quit smoking to lower your risk
of lung cancer.

WHAT ARE THE PROGNOSIS (OUTLOOK) FOR PEOPLE WITH CHRONIC PAIN?
Chronic pain usually doesn’t go away, but you can manage it with a combination of strategies that
work for you. Current chronic pain treatments can reduce a person’s pain score by about 30%.
Researchers continue to study pain disorders. Advances in neuroscience and a better understanding of the
human body should lead to more effective treatments. If you have chronic pain and depression and/or
anxiety, it’s important to seek treatment for your mental health. Untreated depression and anxiety can
make the pain worse and further lower the quality of life.

COMPLICATIONS OF CHRONIC PAIN

Complications of chronic pain can include:
 Decreased quality of life.

 Depression.

 Anxiety.

 Substance abuse disorders.

 Worsening of existing chronic disease.

 An increased risk of suicidal ideation and/or suicide.

The complications of chronic pain are serious. Because of this, it’s essential to seek medical care if
you’re experiencing chronic pain. There are many options for pain treatment and management. While it
may take a while to find the right combination of therapies that work for you, it’s worth undertaking.

HOW TO COPE WITH CHRONIC PAIN.

Besides taking medications, getting therapy and making lifestyle changes, take good care of
yourself. The following actions can help you cope with your chronic pain and improve your overall
health:
 Avoid smoking.
  Don’t try to do too much. Create a daily schedule that includes a few priorities and time for
rest and self-care.

 Eat a healthy diet.

 Exercise regularly.

 Get enough sleep.

 Manage your stress.

 Join a support group for chronic pain to learn from other people with similar conditions.

 Limit alcohol, which can cause more problems with sleep and pain.

 Try to think positively.

QUESTIONS TO ASK ABOUT CHRONIC PAIN(PATIENT-DOCTOR RELATIONSHIP

BASED)
If you have chronic pain, it may be helpful to ask your doctor the following questions:
 What’s causing my pain?

 Will it go away? If no, why not?

 What kinds of medications can I take? What are their side effects?

 Should I try physical or psychological therapy?

 Is it safe to exercise?

 What else can I do to relieve my chronic pain?

 Should I call you if it gets worse?

Application of Models of Health Psychology in beliefs and Decision Making of

Patients

The Health Belief Model and Hypertension

The Health Belief Model (HBM) was developed initially by Rosenstock (1966) and further by
Becker and colleagues throughout the 1970s and 1980s in order to predict preventive health
behaviours and also the behavioural response to treatment in acutely and chronically ill patients.
However, over recent years, the health belief model has been used to predict a wide variety of
health-related behaviours. A recent study on 'The effect of education based on health belief
model on promoting preventive behaviors of hypertensive disease in staff of the Iran University
of Medical Sciences' shows that education based on the health belief model effectively promotes
hypertension preventive behaviors in University staff. Therefore, by enhancing the knowledge
level, perceived susceptibility, perceived severity, perceived benefits, and staff self-efficacy, it is
possible to affect their behavior positively. Another study on the use of HBM to analyze the
factors that influence hypertension prevention behavior, found that there is a positive relationship
between various dimensions of the HBM and hypertension prevention behavior. So it can be
concluded that the HBM is still relevant and feasible to use in predicting hypertension prevention
behavior.

Components of the Health Belief Model.

The HBM predicts that behaviour is a result of a set of core beliefs, which have been redefined
over the years. The original core beliefs are the individual’s perception of:
susceptibility to illness (e.g. ‘my chances of having hypertension is high’)
 The severity of the illness (e.g., ‘hypertension is a serious illness’)
 The costs involved in carrying out the behaviour (e.g., ‘engaging in exercise may make
me miserable’)
 The costs involved in carrying out the behaviour (e.g. ‘engaging in exercise may make
me miserable’)
 The benefits involved in carrying out the behaviour (e.g., ‘early detection and treatment
of hypertension will save my life’)
 Cues to action, which may be internal (e.g., the evidence of hypertension in family
history).
The HBM suggests that these core beliefs should be used to predict the likelihood that a
behaviour will occur. In response to criticisms, the HBM has been revised originally to add the
construct ‘health motivation’ to reflect an individual’s readiness to be concerned about health
matters (e.g. ‘I am concerned that hypertension may cost my life’). More recently, Becker and
Rosenstock (1987) have also suggested that perceived control (e.g. ‘I am confident that I can
control hypertension’) should be added to the model.

Support and Criticism of the Health Belief Model

Research also provides support for individual components of the model. Norman and Fitter
(1989) examined health screening behaviour and found that perceived barriers are the greatest
predictors of clinic attendance. Several studies have examined breast self-examination behaviour
and report that barriers (Lashley 1987; Wyper 1990) and perceived susceptibility (Wyper 1990)
are the best predictors of healthy behaviour.
Although there is much contradiction in the literature surrounding the HBM, such as the
criticism of Leventhal et al. (1985) who argued that health-related behaviour is due to the
perception of symptoms rather than the individual factors as suggested by the HBM; research
has used aspects of this model to predict screening for hypertension, screening for cervical
cancer, genetic screening, exercise behaviour, decreased alcohol use, changes in diet and
smoking cessation.

The Theory of Reasoned Action (TRA) and Planned Behaviour and Chronic
Pain

Physical pain often translates into psychological pain (White, Lefort, Amsel, & Jeans, 1997).
Whatever the physiological symptoms, the chronic pain patient may feel like an individual
trapped within the walls of a malfunctioning body. The emotional consequences of living in pain
may include hopelessness, anxiety, fear, and depression (Wade, Prince, Hammer, Schwartz, &
Hart, 1990). Accordingly, it is theorized that depressed mood may result in a decreased level of
pain tolerance (Weisenberg, Krendler Schachat & Werboff, 1975). Thus, while pain may cause
negative emotion, negative emotion may in turn perpetuate pain. The causal effect of each on the
other is one of the foremost mysteries of the chronic pain experience. The Theory of Planned
Behaviour (TPB) (see Figure 2.6) was developed by Ajzen and colleagues (Ajzen 1985; Ajzen
and Madden 1986; Ajzen 1988) and represented a progression from the TRA.The TRA is an
important model as it placed the individual within the social context and in addition suggested a
role for value which was in contrast to the traditional more rational approach to behaviour.The
TPB also states that perceived behavioural control can have a direct effect on behaviour without
the mediating effect of behavioural intentions.

Components of the Theory of Planned Behaviour

The Theory of Planned Behaviour emphasizes behavioural intentions as the outcome of a
combination of several beliefs. The theory proposes that intentions should be conceptualized as
‘plans of action in pursuit of behavioural goals’ (Ajzen and Madden 1986) and are as a result of
the following beliefs:
 Attitude towards a behaviour, which is composed of either a positive or negative
evaluation of a particular behaviour and beliefs about the outcome of the behaviour
(e.g.,‘CBTis good for me and it will improve my health’).

 Subjective norm, which is composed of the perception of social norms and pressures to
perform a behaviour and an evaluation of whether the individual is motivated to comply
with this pressure (e.g., ‘people who are important to me will approve if I’m consistent
with CBT and I want their approval’).

 Perceived behavioural control, which is composed of a belief that the individual can
carry out a particular behaviour based upon a consideration of internal control factors
 (e.g.,‘I have the skills to modify and self-regulate aspects of the pain problem) and
external control factors (e.g., ‘I won’t be discouraged or depressed by my current
limitation).

Support and Criticism for Theory of Planned Behaviour

A further study evaluated the TPB in relation to weight loss (Schifter and Ajzen 1985). The
results showed that weight loss was predicted by the components of the model; in particular, goal
attainment (weight loss) was linked to perceived behavioural control.
However, Schwarzer (1992) has criticized the TPB for its omission of a temporal element and
argues that the TPB does not describe either the order of the different beliefs or any direction of
causality. However, in contrast to the HBM and the PMT, the model attempts to address the
problem of social and environmental factors (in the form of normative beliefs). In addition, it
includes a role for past behaviour within the measure of perceived behavioural control.

CONCLUSION
Integration of the Models in Practice
A variety of cognitive –behavioral methods have been used to treat hypertension. These include
biofeedback, progressive muscle relaxation, hypnosis and meditation, all which of based on the
understanding of the Nervous System of the Human body, have been found to reduce blood
pressure via the induction of a low state of arousal. Also, theories of chronic pain have been
found to have evolved from several schools of thought based upon psychological theories,
empirical research and clinical observation. Seeing them that treatment approaches are based
upon these models, they need not be applied exclusively according to one particular model. The
cognitive behavioural model, which in itself combines two major models, is used successfully in
hypertension and pain management programmes (Harding and Williams, 1995). It is argued that
any patient therapist interaction involves a psychological discourse which is based upon a
number of variables including the patient’s beliefs and expectations, personality, family
circumstances and behaviours, in addition to biomechanical dysfunction. The most effective use
of the different models is to combine them into a multi-modal strategy using the appropriate
components of each model. If pain and its treatment can be described accurately only in terms of
a combination of different factors from different models, then effective treatment will also
necessarily be multi-modal. It is important for patients to understand possible explanations for a
disorder as well as possible forms of treatment so that they can help the therapists to define what
would be the most effective protocol for them, given their needs, beliefs and expectations.
Additionally, whether patients are given to understand that it is the environment which is
maintaining their pain, or that they are maintaining it, the control of the pain is always given to
the patients, not to the environment, even when a behavioural model is emphasized.
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