PSIHOLOGIA DURERII

CATEDRA DE PSIHOLOGIE CLINICA

SI SANATATE MINTALA
PROF.DR.DOINA COSMAN
DEFINITIE

Definitia durerii conform IASP (Internationa

A!!ociation for t"e St#$% of Pain&'
(
)e*+erienta !en,oriaa !i emotionaa ne+ac#ta-
$eterminate !a# reationata c# e,i#ni ti!#are reae ori
+otentiae- !a# $e!cri!a in termeni ce !e refera a
a!tfe $e e,i#ni.

D#rerea +oate fi $e!cri!a +e /a,a ceor 0

com+onente'
(
fi,ioo1ica' mo$ $e tran!mitere- rece+tori im+icati-
+roce!e /ioc"imice- etc
(
com+ortamentaa' com+ortamentee ce e*+rima
$#rerea !i o in!ote!c
(
!#/iecti2a' 1an$#ri- !entimente- re+re,entari e1ate
$e $#rere
CLASIFICARE
Clasificare'
( $#+a mai m#te criterii' caracter- ocai,are- frec2enta- etc
Intre $#rerea ac#ta !i cea cronica e*i!ta $iferente a ni2e# $#ratei-
+rofi##i +!i"oo1ic $iferit- a te"nicior $e contro
Durerea acuta $#rea,a intre 3 !a+t !i 3 #ni !i an*ietatea e!te #n
!entiment a!ociat- intr#cat $#rerea ac#ta are !emnificatia $e +erico
iminent +entr# in$i2i$.
( $#rere !#+erficiaa' te1#mente- m#coa!e- e!te $e !c#rta $#rata- /ine
ocai,ata- are caracter a!c#tit
( $#rere +rof#n$a' m#!c"i- mem/rane- e!te mai 1re# ocai,a/ia- mai
+er!i!tenta !i are caracter $e ar!#ra
Durerea cronica $#rea,a +e!te 3 #ni- e!te ocai,ata a ni2e#
or1aneor interne- are in 1enera caracter +re!iona !i +ro$#ce #n
$i!comfort im+ortant- c# afectare !#/iecti2a- famiiaa- +rofe!ionaa.
Ti+#ri $e $#rere cronica'
( cronica rec#renta- /eni1na $e inten!itate cre!c#ta- re+etata- c# inter2a
i/er- ca in mi1rena
( cronica intracta/ia- con!tanta- $e inten!itate 2aria/ia- ca in $#rerea $e
!+ate
( cronica +ro1re!i2a- in artrita re#mati!maa- cancer
FI4IOLOGIA DURERII

Receptorii $#rero!i (nocice+torii&-

re+re,entati $e terminatiie $en$ritice !#nt
ocai,ati in te1#mente- m#!c"i- fa!cii-
artic#atii- ten$oane- +erio!t- $inti-
m#coa!e- menin1e- 2a!e- or1ane
2i!cerae. Ei +ot fi $e 6 ti+#ri'
(
mecanorece+tori- !tim#ati $e +re!i#ne
(
nocice+tori +oimo$ai- !tim#ati $e +re!i#ne-
iritatii- 2ariatii termice
FI4IOLOGIA DURERII

Fenomenul de sensibilizare periferica !e +ro$#ce +rin

!tim#area re+etata a rece+torior- ceea ce $etermina o
!ca$ere a +ra1##i $e $etectare- !ca$erea +erioa$ei $e
atenta a ra!+#n!##i- cre!terea +er!i!tentei $e!carcarii
im+#!##i- a!tfe incat oc# $in 7#r# e,i#nii $e2ine
$#rero!.

Sen!i/ii,area !e +ro$#ce +rin ei/erarea ocaa $e

"i!tamina- !erotonina- +ro!ta1an$ine- etc !i +ro$#cerea
#n#i +roce! infamator- c# tre,irea nocice+torior
!ientio!i !i recr#tarea ator fi/re ner2oa!e $e ti+# A
/eta- care in mo$ norma n# a# f#nctie nocice+ti2a.

Toate ace!te +roce!e a# ca re,#tat cre!terea

am+it#$inii !emnaeor $#reroa!e $in re1i#nea afectata-
+rec#m !i etic"etarea ca $#rero!i a #nor !tim#i ne#tri-
minori.
FI4IOLOGIA DURERII
Durerea neuropata n# e re,#tat# !tim#arii nocice+torior ci e!te
$atorata mo$ificarii e*cita/iitatii eectrice a ni2e# SNC-
SN+eriferic. Are oc $e fa+t o $e!carcare c2a!icontin#a- anormaa a
+otentia##i $e acti#ne.
Nevralgia e!te #n ti+ $e $#rere rec#renta- /r#!ca- $e inten!itate
cre!c#ta- fara ca#,a a+arenta- +ro$#!a $e !tim#i ne#tri
Cauzalgia e!te $e a!emenea o $#rere rec#renta- inten!a- ti+ ar!#ra-
a carei frec2enta !i inten!itate +ot cre!te in tim+- +oate $i!emina !i
e!te $ecan!ata $e !tim#i minori- ne#tri- ce actionea,a a ni2e#
#nor !e1mente re1enerate ner2o!
Sindromul membrului fantoma e!te o $#rere a+ar#ta intr8#n mem/r#
am+#tat- c# caracter $e cram+a !a# ar!#ra- in cca 98:;< ca,#ri !e
accent#ea,a in tim+ !i e!te $atorata reor1ani,arii corticae- a!tfe
incat im+#!#rie 2enite $e a ate ,one in2ecinate- +ar !a 2ina $e a
mem/r# am+#tat.
TRANSMISIA DURERII
Transmisia $#rerii !e face +rin interme$i# a $o#a ti+#ri $e fi/re'
( A $eta mieini,ate- $e $iametr# mic- c# tran!mi!ie ra+i$a a im+#!##i-
cca =8:;9m>!ec- !+ecifice $#rerii !#+erficiae
( C nemieini,ate- ce a!i1#ra tran!mi!ia enta a $#rerii-;-98:m>!ec- in
!+ecia a $#rerii +rof#n$e
Ner2ii +eriferici contin fi/re $e $iametr# $iferit- +ro2enin$ $in $iferite
!e1mente- ceea ce e*+ica $#rerea referita.
La ni2e# taam#!##i are oc inte1rarea informatiior referitoare a
ti+#- inten!itatea !i ocai,area $#rerii- $#+a care informatia e!te
tran!mi!a +e $e o +arte catre corte*- ariie S:-S6- #n$e e!te
anai,ata in f#nctie $e e*+erienta anterioara- iar +e $e ata +arte
a7#n1e a !i!tem# im/ic- "i+otaam#!- ,one im+icate in
$imen!i#nea emotionaa a $#rerii.
TEORII ALE DURERII
Teoria modelului specific Weddel, 1962- !#!tine ca n# e*i!ta
cai !+ecifice $e +erce+ere a $#rerii- acea!ta reai,an$#8!e +rin
!tim#area inten!a a #nor rece+tori ne!+ecifici
Teoria specificitatii von Trey, 1985- !#!tine $im+otri2a-
e*i!tenta #nor !tim#i !+ecifici +entr# terminatii !+ecifice !i a #nor
cai !+ecifice $e tran!mi!ie
Teoria portii de control Melac!"Wall, 1965 !#!tine e*i!tenta
#n#i mecani!m ne#rona a ni2e# coarneor $or!ae ae ma$#2ei
in !#/!tanta 1eatinoa!a- inf#entat $e acti2itatea fi/reor 1roa!e
nonnocice+ti2e A/eta- care tin$ !a inc"i$a +oarta- cat !i $e fi/ree
!#/tiri A $eta !i C- nocice+ti2e- care tin$ !a $e!c"i$a +oarta.
Mecani!m# re!+ecti2 $e!c"i$e +oarta $aca'
( !tim#ii $#rero!i $e+a!e!c #n an#mit +ra1 a inten!itatii-
( informatia e!te inter+retata centra ca fiin$ $#reroa!a- in f#nctie $e
e*+erienta in$i2i$##i
( e*i!ta o !erie $e reactii emotionae +rec#m an*ietatea- $e+re!ia-
e*citatia- care tin$ !a $e!c"i$a +oarta
Factori +!i"o!ociai ce inf#entea,a
+erce+tia $#rerii

#e$ul' in ci#$a mit##i ca femeie !#nt mai

c#ra7oa!e $ecat /ar/atii- !e +are ca femeie
!#nt mai !en!i/ie a $#rere $atorita
$iferenteor fi,ioo1ice $atorate "ormonior
!e*#ai- a frec2entei mai mari a $#rerior
non+atoo1ice ra+ortate $e femei- +rec#m !i a
#nor $iferente $e or$in 1enetic.

&arsta inf#entea,a mo$# $e +erce+ere !i

ra+ortare a $#rerii. S8a infirmat mit# conform
car#ia /e/e#!ii n# ar re!imti $#rerea. Ceea ce
$ifera e!te $iferenta $e !trate1ie in +erce+erea
!i contro# $#rerii
Factori +!i"o!ociai ce inf#entea,a
+erce+tia $#rerii

Diferentele etnice in e*+re!ia $#rerii !#nt !#!tin#te $e

1ra$# i$entificarii c#t#rae- +rec#m !i $e contro#
+erce+#t a!#+ra $#rerii- atinii fiin$ mai e*+re!i2i in
e*+rimarea $#rerii $ecat nor$icii- care !#nt mai !toici.

Diferentele personalitatii' intro2ertii !#nt mai reacti2i

a $#rere !i a# #n +re1 mai !ca,#t a !en!i/iitatii
$#reroa!e. De a!emenea cei ce +re,inta con2in1eri
ne1ati2e e1ate $e $iferite e2enimente +otentia
$#reroa!e- +re,inta o !#+rae!timare a $#rerii. a# fo!t
$e!cri!e a!a n#mitee +er!onaitati +re$i!+#!e a
$#rere a acee +er!oane a/#,ate in co+iarie- care a#
$e,2otat #terior o inca+acitate $e e*+rimare 2er/aa a
!entimenteor ne1ati2e !i care re!imt ne2oia $e
+e$ea+!a in e1at#ra c# orice !entiment $e 2ino2atie.
D#rerea ac#ta
experienta trecuta a $#rerii !i !emnificatia $e !emna $e aarma a
ace!teia- a!ociat !i c# a!te+tarie e1ate $e +ro+ria ca+acitate $e
a face fata !it#atiei- ceea ce $etermina +erce+tia act#aa a $#rerii
!i $i!f#nctionaitatii a!ociate
informatia acordata de anturaj- ca$re !anitare referitor a ca#,e-
e2o#tie- +ro1no!tic. At#nci can$ informatia a$ec2ata e1ata $e
$#rata- !co+- mo$# +ractic a #nei inter2entii me$icae $#reroa!e
e!te $ata inaintea efect#arii aceei inter2entii- acea!ta +are mai
+#tin $#reroa!a. Im+ortanta ace!tei informari $e+in$e $e ti+# $e
co+in1 #tii,at $e +er!oana re!+ecti2a- fiin$ a$ec2ata $oar +entr#
in$i2i,ii c# co+in1 centrat +e +ro/ema
distragerea atentiei e!te mai a$ec2ata in$i2i,ior c# co+in1 centrat
+e emotie !i +oate fi #tii,ata c# !#cce! $aca tema a/or$ata e!te
intere!anta +entr# !#/iect !i +re,entata !#ficient $e $etaiat
locul terapeutului, $e caitatie !ae em+atice- $e cam# $e care
$a $o2a$a- $e incre$erea in tratament# +re!cri! !i n# in #tim#
ran$ $e +re!ti1i#
D#rerea cronica

!emnificatia $#rerii cronice n# mai e!te

aceea!i- $e !emna $e aarma- ca !i in cea
ac#ta- in!a in$i2i$# o +erce+e i$entic

$i!+o,itia +!i"ica a in$i2i$##i. S8a o/!er2at ca

an*ietatea- $e+re!ia- o!tiitatea- mania-
inf#entea,a ne1ati2 +roce!area informatiei !i
$etermina centrarea in$i2i$##i +e $#rere.

!ti# co1niti2 re+re,entat +rin aterari ae

e2a#arii +rimare- !ec#n$are ae !it#atiei- c# o
1an$ire ti+ cata!trofi,ant- $etermina e*a1erari-
e*+ectatii ne1ati2e e1ate $e $#rere.
Mana1ement# $#rerii ac#te

Meto$e fi,ice' re+ao! a +at-ma!a7-

ca$#ra- 2entiatie- #mina a$ec2ata-
ac#+#nct#ra- !tim#are tran!c#tanata-
etc

Meto$e farmacoo1ice' antiinfamatoare-

o+ioi,i- ana1e,ice ocae- 1enerae-
anti$e+re!i2e $#+a #timee !t#$ii cinice

Meto$e +!i"oo1ice' rea*are- /iofee$8

/ac?- "i+no,a
Mana1ement# $#rerii cronice

im/#natatirea mo/iitatii +rin intro$#cerea

tre+tata a e*ercitiior fi,ice

cre!terea acti2itatior coti$iene

im/#natatirea $i!+o,itiei +!i"ice +rin

te"nici co1niti2e

re$#cerea tre+tata a me$icatiei !i

inoc#irea ace!teia c# te"nici $e rea*are