The interaction between these different processes
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The interaction between these different processes
Page 294 Black blue 294 HEALTH PSYCHOLOGY pain experience. For example, in the experimental study described above, James and Hardardottir (2002) illustrated this association using the cold pressor task. Eccleston and Crombez have carried out much work in this area which they review in 1999. They illustrate that patients who attend to their pain experience more pain than those who are distracted. This association explains why patients suffering from back pain who take to their beds and therefore focus on their pain take longer to recover than those who carry on working and engaging with their lives. This association is also reflected in relatively recent changes in the general management approach to back pain problems – bedrest is no longer the main treatment option. In addition, Eccleston and Crombez provide a model of how pain and attention are related (Eccleston 1994; Eccleston and Crombez 1999). They argue that pain interrupts and demands attention and that this interruption depends upon pain-related characteristics such as the threat value of the pain and environmental demands such as emotional arousal. They argue that pain causes a shift in attention towards the pain as a way to encourage escape and action. The result of this shift in attention towards the pain is a reduced ability to focus on other tasks resulting in attentional interference and disruption. This disruption has been shown in a series of experimental studies indicating that patients with high pain perform less well on difficult tasks which involve the greatest demand of their limited resources (e.g. Eccleston 1994; Crombez et. al. 1998a; 1999). Behavioural processes Pain behaviour and secondary gains The way in which an individual responds to the pain can itself increase or decrease the pain perception. In particular, research has looked at pain behaviours which have been defined by Turk et al. (1985) as facial or audible expression (e.g. clenched teeth and moaning), distorted posture or movement (e.g. limping, protecting the pain area), negative affect (e.g. irritability, depression) or avoidance of activity (e.g. not going to work, lying down). It has been suggested that pain behaviours are reinforced through attention, the acknowledgment they receive and through secondary gains, such as not having to go to work. Positively reinforcing pain behaviour may increase pain perception. Pain behaviour can also cause a lack of activity and muscle wastage, no social contact and no distraction leading to a sick role, which can also increase pain perception. Williams (2002) provides an evolutionary analysis of facial expressions of pain and argues that if the function of pain is to prioritize escape, recovery and healing, facial expressions are a means to communicate pain and to elicit help from others to achieve these goals. Further she argues that people often assume that individuals have more control over the extent of their pain induced facial expressions than they actually do and are more likely to offer help or sympathy when expressions are mild. Stronger forms of expressions are interpreted as amplified and as indications of malingering. The interaction between these different processes The three process model describes the separate components that influence pain perception. However, these three processes are not discrete but interact and are at times Page 294 Black blue