Haverford College

Psychology 240

Psychology of Pain and Pain Inhibition

Fall Semester 2007

Wendy Sternberg, Ph.D.

KINSC S404 (Sharpless Wing)

610-896-1237

wsternbe@haverford.edu

Course overview:  This course is an introduction to the biological and psychological aspects of pain, as a multidimensional bodily sensation, an adaptive solution to threatening stimuli in the environment, and, at times (with alarming frequency), a clinical problem affecting quality and enjoyment of life.  We will take both an historic perspective and modern perspective, whereby we discuss the topic as both a scientific discipline and a phenomenon to be understood and explained by its underlying nervous system substrates and psychological sequelae.  Some understanding of nervous system structure and function will be helpful, but no prior biology background is expected. 

RequirementsYou are required to come to class, pay attention, do the assigned readings, and participate in class discussions.  Although there is no formal grading on these criteria, your successful completion of these requirements will be taken into account (on a purely subjective level on my part) when formulating grades for the semester.  Other objective criteria will also be used (follow links for further details on particular assignments):

*      Midterm exam (in class, October 11th, 2007): 30%

*      Final exam (in class, December 13th, 2007): 30%

*      Oral presentation (dates vary): 20%

*      Term paper (due at the end of Finals period): 20%

The Plan: The course is divided into two main sections—the first section of the course (approximately 2/3 of the semester) is the “basic science” section, where we discuss pain as a sensory process and as a scientific discipline.  After a brief introduction to the field, we will discuss the history of the study of pain, some basic physiology of the pain sensing circuitry in the nervous system, measurement of pain, and the psychological factors that influence pain experience.   We will be visited by a pain scientist who will discuss the latest themes in pain science.  The last third of the course is the “clinical” section, where we will deal with pain as a health problem.  We will be visited by a clinician-researcher who treats and studies patients in pain.  Each day will be dedicated to the study of a different pain condition or treatment.  We will focus on the similarities and differences among the clinical pains that humans experience, and the principles of normal pain processing that may be inferred from the study of pathological conditions.  The schedule of topics is outlined in the table below.

Readings: There is one required books for this course:

*      Melzack R., & Wall, P.D.  The Challenge of Pain: Updated 2nd Edition, Penguin Science: 1996 (indicated in reading list as M & W)

There is also a textbook, located on reserve in the KINSC Science Library, which you might find helpful as you research your paper topic:

 Wall, P.D., Melzack, R., Textbook of Pain: 5 th Edition, Churchill Livingstone: 2006

Other articles and book sections are listed by the author’s last name in the reading list below, and are available on-line through the Blackboard interface.

The schedule of readings for each topic is listed below.  You must do the readings before class. 

Unit 1 Schedule (may be updated or revised, check back frequently)

Date

Topic

Readings

9/4

Introduction to the Course

Taxonomy of Pain

Pain as a Scientific Discipline

Pain as a Societal Issue

  • Livingston, pp. 1-16
  • M & W, Chapter 1, 3
  • http://history.nih.gov/exhibits/pain/
  • Brennan, et al. 2007,  Pain  Management: a fundamental human right.  Pain Medicine, 105, pp. 205-221.

9/6 & 9/11

Pain as a Clinical Problem

The Ethics of Pain

  • Angell, M. The quality of mercy.  N Engl J Med: 306 (1982), pp. 98-99.
  • Scientific American Editorial (2002): A Real Pain, p. 8
  • Weissman, D.E. Progress in pain management: Is the emperor dressed? Journal of Palliative Medicine: 7 (2004) pp. 391-392.
  • Liebeskind, JC (1991).  Animal Rights and Human Responsibilities.  APS Bulletin, pp. 3-7

9/13, 9/18

Nervous System Organization & Function

Theories of Pain Processing

Ascending and Descending Pain Pathways

  • Wall, 2000 Pain: The Science of Suffering, pp. 31-47 (Chapter 3);
  • M & W, pp. 82-107; 122-137

***********************************

  • Melzack, R. & Wall, P.D., Pain Mechanisms: A New Theory.  Science: 150 (1965), 971-979.
  • M&W Ch. 8 & 9
  • Mayer et al.  Analgesia from electrical stimulation of the brainstem of the rat. Science: 174 (1971), pp. 1351-1354

9/20

 

Measuring Pain

Psychology of Pain

  • M&W Ch 2, 12
  • Sullivan et al., Theoretical perspectives on the relation between catastrophizing and pain, Clin J Pain 17 (2001), pp. 52–64.
  • Crombez, G. et al. Self, Identity and Acceptance in Chronic Pain.  In Proceedings of the 10th World Congress on Pain (2003).

9/25

Modulating variables: gender

  • Berkeley, K. Sex differences in pain. Behavioral and Brain Sciences: 20 (1997), pp. 371-380.
  • Fillingim, R.B. Sex, gender, and pain: a biopsychosocial framework. In Sex, Gender and Pain, R.B. Fillingim (Ed.), (2000) IASP Press
  • Robinson et al., Gender role expectations of pain: relationship to sex differences in pain.  Journal of Pain: 2 (2001), pp. 251-257

9/27

Modulating variables: culture/ethnicity

  • Portenoy et al. Population-based survey of pain in the US: differences among white, African American, and Hispanic subjects. Journal of Pain: 5 (2004), pp. 317-328.
  • Rahim-Williams et al. Ethnic identity predicts experimental pain sensitivity in African Americans and Hispanics,  Pain 129 (2008) 177-184.

10/2 & 10/4

Mechanisms of Nociception

Central sensitization

  • Textbook of Pain, Chapter 1

10/9

Visit from Dr. Jeffrey Mogil, PhD, McGill University

  • Mogil, J. S. The genetic mediation of individual differences in sensitivity to pain and its inhibition. Proceedings of the National Academy of Sciences: 96 (1999), pp. 7744-7751.
10/11 Exam 1  

FALL BREAK

10/23

Central sensitization, continued

  • Textbook of Pain, Chapter 1
10/25 Itch
  • McMahon & Koltzenberg (1992).  Itching for an explanation.  Trends in Neurosciences.
  • Andrew, et al. (2003).  Itch: Mechanisms and Mediators.  In Proceedings of the 10th World Congress on Pain.

 

10/30 Opioid analgesia
11/1

Non-opioid analgesics

Anesthesia

  • Topol, EJ Failing the Public Health--Refocoxib, Merck, and the FDA. NEJM (2004), 351: 1707-1709.
  • Fitzgerald, GA, Coxibs and Cardiovascular Disease. NEJM (2004), 351: 1709-1711
  • Travis, J. Comfortably Numb, Science News, (2004)
11/6 NO CLASS  

Unit 2 Schedule


Date

Topic

Readings

11/8 Visit from Dr. John Farrar, MD, PhD, University of Pennsylvania TBA

11/13

Phantom Limbs and the Neuromatrix

  •  M&W 61-70
  • Livingston, Ch 9
  • Melzack, R. Phantom Limb Pain. Scientific American (1997) (this is the article in which Melzack describes his neuromatrix theory and how it applies to phantom limb pain).

11/15

 

Neuropathic Pain (e.g., trigeminal neuralgia, post-herpetic neuralgia, diabetic neuropathy, etc.)

TBA

11/20

 

Headache

TBA

11/22

NO CLASS-Thanksgiving

11/27

 

Arthritis

TBA

11/29


Back Pain

TBA

12/4

Fibromyalgia

TBA

12/6

 

Complex Regional Pain Syndrome

TBA

12/11

 

Non-traditional therapies

 

12/13

Exam 2