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Human pain perception is now known to be mediated by the complex and dynamic interaction of biological and psychosocial systems. Research with both clinical and nonclinical populations has identified an array of factors which can influence pain, amongst which gender has become the focus of increased interest in recent years. However, although females generally seem to have lower experimental pain thresholds, report higher levels of pain and demonstrate lower pain tolerance than males, the pain research literature is characterised by conflicting findings regarding the direction, magnitude and robustness of such gender effects. Furthermore, gender differences may not occur equally with all types of noxious stimuli. Investigating the impact of gender on pain is greatly complicated by the fact that gender in itself comprises both biological and psychological components. Gender-differentiated pain responses are therefore likely to involve physiological mechanisms such as the effects of gonadal hormones, as well as psychosocial determinants such as emotional responses and ways of coping. In this thesis, a series of controlled experiments was conducted to investigate the effects of gender and cognitive coping on cold pressor pain perception in healthy, pain-free individuals. The cold pressor paradigm was selected because relatively few previous studies have directly examined gender differences in this type of experimentally-induced pain. In light of potential fluctuations in female pain sensitivity as a function of hormonal status, cold pressor responses and the effectiveness of cognitive coping were also investigated in different phases of the menstrual cycle. Gender differences in pain responses were evident here, but such differences occurred inconsistently across the series of experiments. Cognitive coping was found to have very limited impact overall, and no effects of menstrual phase were found on pain responses or on coping. These findings are discussed within a biopsychosocial framework of pain perception.

This study seeks to examine the relationship between personality variables and pain perception ability. Specifically this thesis hypothesises that the Intuitive psychological type (rooted in Jung's theories of psychological type) will be effective at detecting faking of physical pain. Additionally, this thesis hypothesises that those scoring highly on Openness to Experience, as well as those rating as extraverts and those who rate high in emotional intelligence, will be more accurate at pain-faking detection than individuals who do not demonstrate these personality traits. It is also hypothesised that participants rating high in Machiavellianism will be accurate in detecting pain deception. In addition, it is speculated that a gender factor will exist in the ability to detect pain deception. In the first study, the Myers-Briggs Type Indicator (MBTI; Myers & McCaulley, 1985) and the NEO Five Factor Inventory (NEO-FFI; Costa & McCrae, 1992b) are used to measure participants' intuition level and openness to experience (as well as extraversion), respectively. In the second study, the Mayer Salovey Caruso Emotional Intelligence Test (MSCEIT; Mayer, Salovey & Caruso, 2002) and the Psychopathic Personality Inventory (PPI; Lilienfeld & Widows, 2005) are used to measure emotional intelligence and various psychopathy-related traits (including Machiavellianism), respectively. The stimuli presented are videotapes of facial expressions of pain, in which individuals display either genuine or faked physical pain. The first study's findings support the hypotheses that Intuitive and Open individuals are accurate at pain judgment, with Intuitive and Open females in particular displaying relationships with accuracy. Additionally, males categorised as 'Thinker' types, as well as those low in neuroticism predicted accuracy in pain judgment. However, the hypothesis that extraverted individuals would be more accurate at detection was largely unsupported. In the second study, the hypotheses that overall emotional intelligence and overall psychopathy would predict accuracy were generally unsupported. It was discovered, however, that particular subscales of the emotional intelligence measure such as the 'Changes' task were predictors of accuracy in pain judgment. The Machiavellianism subscale of the psychopathy measure was indeed a predictor of accuracy for male participants. In addition, other subscales of the psychopathy measure that predicted accuracy included Blame Externalisation, which had an inverse relationship with accuracy, as well as 'Fearlessness' in female participants. The significance of the study findings are discussed in terms of application to the realm of deception detection, as well as its relevance to the medical field in particular.

Research has suggested that people are motivated to achieve their hopes for the future (hoped-for self) while trying to move away from that which they fear becoming (feared-for self). In chronic pain populations, however, these hopes and fears become heavily dependent on the presence of pain. Research has suggested that there is a relationship between psychological distress and persistent attempts to remove pain in order to move away from one’s feared self (Wells, 2010). However, little is known about the relationship between the hoped-for self and persistent attempts at pain removal. The purpose of this research is to replicate the research of Wells (2010), adding to this work by exploring the relationship between persistent problem solving and the hoped-for self. An additional aim of the research was to further explore the use of a relatively new measure of scenario-based problem solving, the MEPS for Pain. Sixty chronic pain patients were recruited from one pain clinic in Leeds. Participants completed measures of pain disability (PDI), pain acceptance (CPAQ), pain intensity (VAS), feared self interview, hoped self interview and previously used measures of problem solving attitudes (PaSol) and scenario-based problem solving (MEPS for Pain). Participants also completed the MEPS for Pain-PPS a new measure of personal problem solving. Assimilative problem solving attitudes were significantly negatively correlated with feared-for self proximity but not enmeshment when using the PaSol, and did not correlate with any of the MEPS for Pain problem solving scales. Assimilative problem attitudes were significantly correlated with hoped-for self proximity and enmeshment when using the PaSol, but did not correlate with any of the MEPS for Pain problem solving scales. Assimilative problem solving as measured by the MEPS for Pain-PPS was correlated with hoped-for self enmeshment, but not with hoped-for self proximity or feared-for self proximity or enmeshment. The results suggest a relationship between feared-for and hoped-for self variables and problem solving attitudes as measure by the PaSol, however show no relationship with chronic pain patients scenario-based problem solving attempts. The implications of these findings are explored, limitations highlighted and areas of future research suggested.

Research has highlighted that some people will respond to chronic pain with over activity, while others respond with under activity. Previous models have either only been able to explain patterns of under use, for example the Fear Avoidance model (Vlaeyen & Linton, 2000), or patterns of overuse, such as the ergomania model (Van-Houdenhove, 1986).

The present study examined the nature of and relationship between attributions, just world beliefs (JWB) and adjustment in a sample of 62 community pain sufferers. This was exploratory because it accounted for shortcomings of these concepts, meaning they have not been investigated like this in pain. Specifically, it accounted for the scarcity of research distinguishing between cause, responsibility and blame; allowing the self-definition of responsibility, blame and adjustment; examining changes in attributions and adjustment, and considering just world beliefs. The importance of investigating these issues in pain was detailed. The research was conducted in two phases. The first, brief phase piloted a measure to account for these shortcomings. The second phase used the piloted measure to investigate the shortcomings in a series of five aims. Descriptive analyses indicated that most participants made causal attributions for their pain, with around half attributing responsibility and blame. Although similar in the types of attributions made, cause was distinguished from responsibility and blame, which were indistinguishable from each other. Attributions did not change. Additionally, JWB were weakly correlated with pain intensity, and analyses of variance techniques found JWB to interact with pain duration, such that those with 1 month-2.5 years' duration had stronger JWB than those in the 3-9 years' duration. JWB did not interact with attributions or adjustment, but chi-square analyses found attributions interacted with adjustment, such that attributions to the self were adaptive, while attributions to others resulted in poor adjustment to pain. Stepwise multiple regression analyses suggested that these latter attributions predicted pain intensity, as did pain treatments. Additionally, individual differences in attributions, adjustment and pain intensity emerged in chi-square analyses, although none were found on JWB. Full interpretations were made of these findings, and their implications for future research discussed.

It is now widely accepted that the experience of pain is subject to cognitive influences that may determine the severity of subjectively perceived pain. Many of these top-down factors rely on memory-based processes, which in turn are related to prior experience, learned beliefs and behaviours about pain. As such, memory for pain heavily contributes to the physical pain experience. We posit that pain memory is bidirectional in that following each painful event a trace is stored and that these traces in turn may modify future pain perception prospectively. The following body of work explores aspects of what we have termed a memory template for pain. The results of these chapters taken together, examine these bidirectional aspects of short-term memory for pain employing a recall pain task. Specifically, we explore how, after an acute pain event, a short-term mental representation of the initial event persists. We show that during this time, sensory re-experiencing of the painful event is possible. Furthermore, we investigate aspects of recalled pain, namely intensity and vividness. Data suggests that the intensity and the vividness of this mental representation are determined by the intensity of the initial stimulus, as well as the time-to-test delay. We identify regions that characterise short-term memory for pain. Following on from studies in motor and visual imagery, we explore how pain imagery in the form of recall may affect subsequent pain perception. Our results demonstrate that the inclusion of pain-related imagery preceding physical pain events reduces affective qualities of pain. Testing healthy, naïve subjects, we replicate the effect observed in studies using attention management and imagery strategies, which normally require extensive training. Finally, in a cohort of neuropathic pain patients we show significant reductions in white matter connectivity between areas responsible for working and prospective memory. Collectively, these studies emphasise and elucidate the role of short-term memory of pain in physical pain perception. Acting both retrospectively and prospectively, cognitive reinforcement can increase or decrease the subjective feeling of pain, and therefore manipulating how pain is recalled may have therapeutic potential.

This research was executed as three separate studies. Study 1 focused on the perception of pain and the semantic aspects of pain. Study 2 focused on the measurement of acute pain and mood states. Study 3 focused on the psychological treatment of cancer pain. In Study 1 a group of 66 Setswana-speaking adults were required to describe what they saw, what happened, and what would be the outcome with respect to three visually presented pain scenes using The Pain Apperception Test (PAT) A qualitative analysis of their responses shows that pain is experienced as an all encompassing experience affecting all aspects of their lives, such as the physical, emotional, social, and economic. This was found to be true, irrespective of gender and age with the exception of economic issues. A qualitative analysis of their responses to the Pain Eliciting Incidents Questionnaire (PEIQ) reveals that the Setswana pain descriptors are classifiable according to the three dimensions of pain namely, the sensory-discriminative, affective-motivational, and cognitive-evaluative. Sludy 2 applied the Profile of Mood States (POMS) preoperatively to a group of 58 female laparotomy (gynaecological) patients. These patients were also tested post-operatively with the Visual Analogue Scale (VAS) and the Wisconsin Brief Pain Questionnaire (WBPQ) as pain measures. The pain measures were taken at no medication and at the peak of medication. Factor analysis could not confirm the validity of the six POMS scales. These scales also did not show correlations with post-operative pain. Correlations between the pain measures showed acceptable reliability and validity of the VAS and the WBPQ. In Study 3 three groups of 15 cancer patients each, suffering from chronic pain, were treated over a period of two weeks with either cognitive behavioural therapy plus medication, reassurance therapy plus medication, or medication only. Comparison of before and after treatment pain measures showed that both cognitive behavioural therapy and reassurance therapy had a beneficial effect. Follow-up results three months later showed that the beneficial effect of reassurance therapy did not persist. Patients treated with cognitive behavioral therapy still showed the beneficial effects thereof. / Psychology / D. Litt. et Phil. (Psychology)