INTRODUCTION TO HEALTH PSYCHOLOGY ABPG 2103

FACULTY OF SOCIAL SCIENCE

SEMESTER JANUARY / 2016

ABPG 2103

INTRODUCTION TO HEALTH PSYCHOLOGY

NAME : ANITHA D/O MAGANTERAN

MATRICULATION NO : 901008146038001
IDENTITY CARD NO. : 901008146038
TELEPHONE NO. : 01126759585
E-MAIL : nitha_5858@yahoo.com
LEARNING CENTRE : NEGERI SEMBILAN LEARNING
CENTRE
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CONTENT

NO TOPIC PAGE

1.0 INTRODUCTION 2

MECHANISM OF PAIN & PAIN

2.0 3
THRESHOLD

DIFFERENCE IN PERCEPTION OF
3.0 6
PAIN AMONG INDIVIDUALS

FACTORS AFFECTING DIFFERENCE

4.0 9
IN SYMPTOMS REPORTING

5.0 CONCLUSION 12

6.0 REFERENCES 14

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1.0 INTRODUCTION
Health psychology is a discipline that focuses on two main concepts known as
health and illness. According to Cherry (2015), health and illness are developed through
the interaction of biology, psychology, behaviour and social factors. Health psychology
plays a crucial role in improving the quality of people’s life by addressing a wide range
of health issues. One of the most common aspect concerned by health psychologists are
pain-related health problems such as analgesia, causalgia, neuralgia and phantom limb
pain (Eccleston, 2012).
Goldberg & McGee (2011) estimated that almost 20% of adult are diagnosed
with chronic pain every year. According to them, people seem to view the pain as a
symptom of a disease rather than as a disease itself. Consequently, less awareness about
pain leads to persistence of the problem for those who experience it until it reaches a
severe stage. Pain is a very complex individual experience which can only be described
by the person who experiences it. Psychologist reasonably agreed that pain is an
unpleasant feeling in body which also serves as a cue to protect the body from damaging
situations (Moseley, 2016).
According to Robinson (2015), pain can be mild, moderate or severe. The
intensity of pain is determined by pain threshold level of each individual. Hundley (2013)
found that each individual have different pain threshold level which contribute to
significant difference in degree of pain experienced.
Barnet (2006) pointed out few demographic factors such as age, gender, culture
and personality trait which explains why different individual perceives pain differently.
Difference in perception greatly affects the symptoms representation of an individual.
Guillot & Collet (2010) described about two major factor which are psychological factors
and cognitive factors that influences the people’s pain experience. Both factors have a
profound effect on difference in evaluation and presentation of pain symptoms by
individuals.
Uncontrolled pain can have an adverse effect on one’s health system by
reducing the ability of immune system to respond pain (Swift, 2015). Hence, it is
important to understand the concept of pain and how it interacts with individuals so that it
can be managed properly in future.

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2.0 MECHANISM OF PAIN & PAIN THRESHOLD

2.1 WHAT IS PAIN?

Pain is an inevitable part of the human experience. According to The

International Association for the Study of Pain, pain is defined as “an unpleasant sensory
and emotional experience associated with actual or potential tissue damage, or described
in terms of such damage"(2012). Nordqvist (2016) describes pain as a discomfort,
distress and agony sensation that hurts an individual.

According to Meyer (2016), pain is not a disease but it is a physical symptom

which is reported through individual experience. Klein (2015) described pain as a signal
to protect the body from any damaging situations. The sensations of pain are contributed
by many factors such as injury, illness and disease (Meyer, 2016). Figure 2.1 shows the
mechanism of pain which involves 2 major processes known as perception of pain stimuli
by brain and psychological response towards it. Most pain resolves once the painful
stimulus is removed and the body is healed.

Figure 2.1: The mechanism of pain in human body system. Source:

http://www.mydr.com.au/pain/pain-and-how-you-sense-it

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Robinson (2015) classified pain into acute pain and chronic pain. According to
D’arcy (2011), acute pain is a short term pain which starts suddenly and may be treatable
through analgesic medications. For example, broken bones, burns, cuts and labor pains
are mild pain which can be stopped once the underlying causes are treated. However,
long term persistence of this pain will eventually leads to chronic pain.

Chronic pain is an excruciating, episodic or continuous pain that lasts longer

despite the fact that an injury has healed. Some of the chronic pains include recurring
migraines, low back pain, cancer pain, arthritis pain and pain caused by nerve damages.
Chronic pains are progressive symptoms and can have a profound effect on an individual
when it goes untreated (Robinson, 2015). According to Margoles & Weiner (1998),
chronic pain contributes a great impact on both physiological and psychological
development of an individual. Some of the physiological effects are limited body
movement, weakened immune system, tensed muscle and changes in appetite.

2.2 PAIN THRESHOLD

Dellwo (2015) defined pain threshold as the point at which an unpleasant

stimulus activates the pain receptor and produces the sensation of pain produced by
stimuli’s such as pressure and heat. According to White, Duncan & Baumle (2010), pain
threshold intensity is the minimum intensity of pain at which an individual starts to
perceive pain and feels discomfort. Pain threshold of an individual can be measured
through the subjective experience of an individual (Lautenbacher & Fillingim, 2004).

Figure 2.2 shows the pain threshold graph of an individual when pressure is
applied over time. Based on the graph, pain is not felt by an individual until he reaches a
certain point at which he starts perceiving the pain stimuli. This point is known as the
threshold intensity of an individual at which the pressure applied begins to evoke pain
and hurt the individual. As the intensity of pressure increases, the pain intensity also
increases beyond the pain threshold until the individual acts to stop the pain (Meyer,
2016)

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Figure 2.2: Pain threshold of an individual. Source:

http://www.pemft.net/pemf-therapy-for-pain-relief.html

According to Backstrom (1998), the pain threshold level of each individual

may vary according to their ethnicity, gender and age. Horn (1997) stated that an
individual may have either low or high pain threshold. Individuals with high pain
threshold are able to sustain a high amount of damage before they can feel the pain.
Meanwhile, those with low pain threshold can quickly detect a small amount of pain and
cannot withstand a relatively high damage to the body.

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3.0 DIFFERENCE IN PERCEPTION OF PAIN AMONG INDIVIDUALS

According to Gould (2006), pain has a different meaning for different

individuals and undergoes a complex modulation by a variety of psychological, social
and demographic aspects. Barnet (2006) describes a few factors that are related to the
difference in each individual’s pain perception such as age, gender, culture and
personality traits.

3.1 AGE

People at different age experience different intensity of pain. According to

McGuire, Yarbro & Ferrell (1995), the perception of pain decreases as the age increases.
A study conducted by Oxford University proves that babies are more sensitive to pain
compared to older children and adults. This is because they have a very low pain
threshold which makes them more sensitive to pain compared to older children (Spencer,
2015).

According to Ranger (2008) perceptions of pain in older children are influenced

by cognitive development. As children develop cognitive maturity, they gain the capacity
to experience and remember pain which in turn cause them to exhibit to less visible
physical cues of pain.

Paul & William (2009) believed that perception of pain in adulthood is

inconsistent. According to Hallingbye e.t.all (2011), most of the adults experience less
pain but have high tolerance compared to the young one. However, Jansen (2008)
recognised that the tendency of pain perception diminished once an individual reach the
elderly stage. This is due to the influence of cognitive impairment in which they have
difficulty in remembering the experience of pain (Jansen, 2008).

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3.2 GENDER

According to U.S National Institute of Health (2006), gender has a great

influence on sensitivity and perception of pain. A few postoperative pain studies outlined
that women tend to report higher pain intensity and have a lower pain tolerance compared
to men (Joint Commission Resources, 2003). Based on an article by Marcus (2009), the
difference in pain perception between male and female is due to the presence of lower
threshold in female compared to male. Hence, female has higher tendency to perceive
more pain compared to male under same pain stimuli conditions.

Apart from that, the presence of state anxiety also greatly influences the
difference in perception of pain in both male and female. According to Marchand,
Saravane & Gaumond (2014), the higher the anxiety level, the higher the perception of
pain in an individual. Acton (2013) pointed out that men do feel more anxiety compared
to women. However, despite having a lower state of anxiety, female perceive more pain
than male due to the fact that they have higher trait anxiety in general (Virginia, 2002).
Meanwhile, the less perception of pain in men is related to the greater release of cortisol
in men compared to women. When an anxiety causes pain in men, it activates descending
inhibitory mechanism which causes them to perceive less pain compared to women
(Marchand, Saravane & Gaumond, 2014).

3.3 CULTURE

Based on an article by Shipton (2013), a recent study reported that the perception
and experience of pain by each individual varies across time and are influenced by
cultural factors. Moore & Woodrow (2004) classified individuals involved in culturally-
based perception of pain into two categories known as stoic and emotive.

According to Tung & Li (2014), stoic patient mostly comes from Northern
European and Asian background. They tend to endure pain without showing any
emotions and expressing it. In contrast, emotive patients who come from Hispanic,
Middle Eastern and Mediterranean tend to be expressive about their pain and expect
others to react for them. For instance, Jarrett (2011) pointed that white Caucasian people
are less sensitive to perception of pain compared to African or Asian descent. One of the
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possible reasons for this could that people from different ethnic group is more likely to be
susceptible to their own cultural influences. Consequently, a person’s beliefs and
upbringing in their own culture can affect the way their body responds to pain
experiences. In addition, differences in coping style and attitude towards pain experiences
also may contribute to ethnic differences in perception of pain (Block, Fernandez &
Kremer, 2013).

3.4 PERSONALITY TRAITS

According to Satterthwaite, Tollison & Tollison (2002), inter-individual

differences is one of the factors that influence the difference in pain experience.
Mostofsky & Lomranz (2013) relates the perception of pain to the meaning attributed
towards the stimulus, type of personality and level of neuroticism.

Some studies suggested that neuroticism is a vulnerability factor which lowers

the threshold at which the intensity of perceived pain is increased (Block, Fernandez &
Kremer, 2013). According to Lee (2008), neuroticism affect sensory mechanism of
nociceptive processes as well as influence the way people cognitively perceive the pain
experiences. Hence, people with high neuroticism tend to develop pain-related emotional
disturbances which increase the intensity of pain.

On the other hand, people with personality such as extraversion tend to perceive
less pain as they use more active coping strategies in managing pains compared to those
inclined towards introversion personality (Drenth, 2007).

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4.0 FACTORS AFFECTING DIFFERENCE IN SYMPTOMS REPORTING

Representation of pain symptoms is the primary criterion for diagnosis of

certain disease. However, the symptom presentation for pain varies according to each
individual. The most common factors that influence the pain reporting by each individual
are psychological factors and cognitive factors (Guillot & Collet, 2010).

4.1 PSYCHOLOGICAL FACTORS

According to Main, Sullivan & Watson (2008), psychological distress is the

primary domain that causes one to draw attention to pain sensations which in turn
increases the amount of pain perceived. Dr. Bushnell (2008) stated that the intensity of
pain experienced by an individual is influenced by an altered state of positive and
negative affect. Negative affect states are associated with the presence of negative
emotions such as anxiety, anger and depression which causes pain modulation in an
individual. Godsoe (2008) reported that individual with higher negative affect have an
increased perception of pain which causes them to report more pain symptoms. This
phenomenon is might be due to the fact that an illness cognitive schema was more
strongly activated in individuals with higher negative compared to those with positive
affect (Borkum, 2012). Hence, they might experience high intensity of pain for a
prolonged duration compared to normal individuals. For example, clinical studies has
proven that depressed cardiac patient have a prolonged duration of angina attack
compared to non-depressed patients (Dr Bushnell, 2008).

On the other hand, personality trait and behaviour are other features that greatly
influence the pain symptom reporting by individuals. According to Borkum (2013),
evidence shows that people with neuroticism tend to report more frequent and higher pain
levels. Neuroticism is the presence of long-term negative personality state such as
depression, panic disorder, aggression and anxiety in an individual (Nordqvist, 2014).
Brannon, Feist & Updegraff (2013) explained that the high symptom reporting in
individual with neuroticism might be due to presence of environmental stress which
induces strong and frequent negative emotional reactions.

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In contrast, Finn & Leornard (2015) identified that patient with optimism tend
to have fewer pain symptoms compared to those with neuroticism. Friedman (2016)
supported the view by stating that optimistic individual have positive mental health
characterized by hope and perception of a pain in an optimal way. Hence, an optimistic
thinking style directly contributes to less pain sensitivity and few symptoms reporting by
an individual.

Despite that, personality characteristics such as introversion and extraversion are

also associated with variable psychological responsiveness to pain. Based on an article of
Dubey (2012), introverts are known to react strongly towards pain compared to
extroverts. Starkey (2013) believe that extroverts are less sensitive to pain since they have
higher level of psychological arousal that increases their tolerance towards the pain. As a
result, introverts tend to report more pain symptoms compared to extroverts.

4.2 COGNITIVE FACTORS

According to Marchand, Saravane & Gaumond (2014), the variable pain

symptom reporting is related to catastrophic thinking of an individual. Catastrophic
thinking is one of the cognitive factors that modulate an individual’s response towards
the pain. Individual with higher negative affect is positively associated with pain
catastrophizing (Godsoe, 2008). Quartana, Campbell & Edwards (2009) believes that
pain catastrophizing adverse pain-related outcomes by inducing negative responses to
anticipated or actual pain. For instance, a study conducted on patients with
gastrointestinal cancer shows that patients who engaged with pain catastrophizing
reported much higher level of pain and have greater dramatization behaviour compare to
normal patient (Berger.e.t al, 2007).

On the other hand, there is another cognitive aspect known as sense of control that
influences the variation in reporting pain symptoms. Marchand, Saravane & Gaumond
(2014) defined sense of control as the perceived ability to manage pain or pain-related
events. The ability of an individual to control the pain is associated with the use of more
active coping strategies. Hence, those who possess a low sense of control seem to report

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higher levels of pain symptoms compared to people with high sense of control (Weiner,
Wiley & Sons, 2003).

Despite that, people’s belief, appraisals and expectation about the pain they
suffering also influence the way they respond to it. According to Weiner, Wiley & Sons
(2003), negative belief or expectation that develop in an individual’s thinking may
reinforce pain behaviour and impression about the severity and seriousness of pain. As a
result of the negative cognitive appraisal, psychological distress will start to develop
causing more pain symptoms in individuals.

The extent to which people notice pain symptoms also depends on the amount of
attention provided to the bodily state. The process of cognition serves as cues and
consequences of the following pain behaviour. This can be explained by competition of
cues theory in which the internal (bodily states) and external (environment) cues compete
for attention using the limited capacity to process stimuli (Ayers.e.t al, 2007).

Generally, people who focus their attention towards external cues are less likely
to attend their bodily states. However, once they become less engaging with the external
environmental cues, their awareness on their body condition will increase. As people
focus more internally, they will notice more pain symptoms which are less obvious in
those who focus on external cues (McCalberg & Clauw, 2016).

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5.0 CONCLUSION

Pain is a very individual experience which is measured subjectively. Pain is

generally classified into acute pain and chronic pain. Acute pain is a short term pain
which is treatable while chronic pain is progressive and episodic pain that lasts longer.
Pain threshold refers to the point at which sensation becomes heat. Different people have
different pain threshold. People with low threshold are able to detect pain sensation in
low level of pain while those with high threshold can tolerate well in high level of pain.

The perception of pain is greatly influenced by few factors such as age, gender,
ethnicity & culture and personality traits. The level of perception of pain has a declining
function from an early age of life. Gender differences also affects pain perception in
which female tend to perceive more pain compared to men. From the perspective of
culture, perception of pain is high in African and Asian descent compared to white
Caucasian people. Besides, inter-individual difference also contributes to difference in
pain perception. For instance, people with personality such as introversion, neuroticism
and anxiety disorder tend to perceive more pain compared to normal people.

Apart from that, symptom presentation is highly adaptive, functional and

personal. Even though, people experience the same pain stimuli, they still produce
varying response in reporting symptoms. This condition is influenced by two major
factors known as psychological factor and cognitive factor. One of factor is psychological
distresses that cause difference in pain response is presence of negative affect state such
as depression and anxiety. In addition, personality traits such neuroticism-optimism and
introversion-extraversion also contribute to development of different pain behaviour
which produces variable symptoms reporting. Meanwhile, pain catastrophizing and
different sense of control are the major cognitive factors that cause different symptom
presentations in individuals. In addition to that, one’s believe, appraisal, expectation and
attention towards the pain also biases an individual to produce different symptoms report
than the actual one.

In conclusion, there are multiple factors which have contributed to the individual
difference in perception of pain and symptom presentations. A wide understanding on

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these influences in individual differences might lead to effective pain diagnosis and
treatment in the future.

(2984 WORDS)

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