What is Pain Behavior?
Definition
Any thoughts, verbalization & non-verbal behaviors that communicate that something is wrong
Central sensitization is a pathophysiological process in which the central nervous system undergoes changes that alter its processing of pain and other sensory stimuli1. This process can make the nervous system more sensitive to stimuli, leading to an increased response to pain2.
Pain behavior, in this context, refers to the set of verbal and nonverbal expressions that accompany the experience of pain. These behaviors can range from verbal reports to nonverbal expressions like facial grimacing, and they can provide valuable information about a person’s pain experience3.
Verbal pain behaviors include:
- Vocal complaints: Words expressing discomfort or pain, such as “ouch,” “that hurts,” or other exclamations of protest4.
- Descriptions of the pain: For example, a person might say, “I feel pain in my shoulder that is quite strong”3.
Nonverbal pain behaviors include:
- Facial expressions: Grimacing, furrowed brow, holding eyes tightly shut, pursed lips5.
- Body language: Clenching fists or blankets, rigid body, unusual breathing patterns5.
- Other indicators: Moaning, yelling, crying, jaw tightening, grinding teeth6.
It’s important to note that these behaviors can vary greatly among individuals and may be influenced by a variety of factors, including cultural background, personal beliefs about pain, and previous pain experiences. Therefore, understanding and interpreting these behaviors requires a comprehensive and individualized approach.
Sure, here are some more examples of verbal and non-verbal pain behaviors:
Verbal Pain Behaviors:
- Requests for help: Asking for medication, assistance, or comfort1.
- Pain ratings: Providing a numerical or descriptive rating of pain intensity2.
- Descriptions of the type of pain: Using words like “sharp,” “dull,” “throbbing,” or “burning” to describe the pain2.
- Expressions of distress or discomfort: Statements like “I can’t stand this anymore” or “This is really bothering me”1.
Non-Verbal Pain Behaviors:
- Changes in activity levels: Decreased mobility, reluctance to move, changes in sleep patterns3.
- Changes in interpersonal interactions: Withdrawal from social activities, irritability1.
- Physiological signs: Changes in heart rate, blood pressure, or sweating2.
- Protective behaviors: Guarding the painful area, limping, or favoring one side of the body3.
Remember, these behaviors can vary greatly among individuals and may be influenced by a variety of factors, including cultural background, personal beliefs about pain, and previous pain experiences. Therefore, understanding and interpreting these behaviors requires a comprehensive and individualized approach.
Examples
- Pain adjustment movements
- Cracking body parts (knuckle, neck)
- Withdrawal
- Excessive Sleep / Napping
- Talking about illnesses
- Complaining
- “I can’t” responses
- Missing activities / school / absences
- Tics
- Spells
- Grumbling / groaning
- Attitude
- Vomiting / Talking about nausea
Why do pain behaviors exist?
- Feel better!
- Get assistance
- Reduce demands / expectations
- Protect from additional injury / provide protection
Pain
All pain is produced in the brain, and can produce it as much as it wants. Including pain to help adapt to the environment… like stay home…
What is the harm?
- Deconditioning
- Increase emphasis on pain # Grey Areas… Example: Hot Bath
- Focus on motivation (Relax or treat a pain?)
- Focus on frequency and duration (Excessive or “normal”?)
- Focus on attitude (Like to have or have to have?)
Diaphragmatic breathing
Diaphragmatic breathing is NOT a pain behavior, it’s a coping skill
Good question... hurt or are you injured?
Are you
Responding to Pain
Parent Instinct
- Help / Assist
- TLC
- Ask about pain
- Rest
- Do things for them
- Give them a pass from doing most things
Schools can be set up to be Pillow-Fluffing with extra care and nurse offices
Stricter schools could be Punitive and Shaming in their approach
When not actually hurt Pillow-Fluffing - Feels good but in the long run makes symptoms worse
Unintended Consequences
- Drawing attention to pain
- Creating central sensitization
- Side-effects from pain / [PRC - Prescribing Cascade](PRC - Prescribing Cascade “wikilink”)
- Deconditioning ## Punitive Response
- Angry / Invalidating
- Shame / Guilt
- Lose support
- Anger leads to Fight or Flight response
- Increase of pain to prove they are in pain
- Escalate # Warm Neutrality
- Neutral / Non-Responsive to the pain
- When seeing limping, ignore
- Don’t react to symptoms of pain
- Don’t draw attention to it
- Attention amplifies pain
- Coaching
- Deep Breathing
- Distracting
- Redirect
- Ignore
- Walk-away
- “Tell me when you have this figured out”
- “You have the tools to handle this”
- Consequence
- Never with anger
- Not punitive
- Based on an existing agreement
- Firm, no exceptions
- 1 reminder is appropriate
- Last resort, not a starting point
Consequences are NOT Punishment - [PRC - Consequences vs Punishment](PRC - Consequences vs Punishment “wikilink”)
How is Consequence NOT a Punishment?
The distinction between a consequence and a punishment lies in their purpose, the behavior they aim to influence, and the manner in which they are implemented.
Consequences are the natural or logical outcomes that follow a behavior. They are intended to help individuals learn from their actions and understand the impact of their choices. Consequences are not necessarily negative; they can be positive as well. They are directly related to the behavior and are reasonable and respectful. For example, if a child refuses to eat their dinner, a natural consequence might be that they feel hungry later. Punishments, on the other hand, are negative outcomes that are imposed in response to undesirable behavior. The primary goal of punishment is to deter or suppress the behavior. Punishments are often unrelated to the behavior and can be arbitrary or harsh. For example, if a child refuses to eat their dinner, a punishment might be that they are not allowed to watch TV for a week.
In summary, while both consequences and punishments are responses to behavior, consequences are learning opportunities that are directly related to the behavior, while punishments are negative impositions intended to suppress the behavior. It’s important to note that the effectiveness of consequences and punishments can vary greatly depending on the context and the individual involved. Always consider the individual’s needs, the situation, and the potential impacts when deciding between consequences and punishments.
Are you happy? You are only as happy as your most miserable child
Warm Neutrality Applies to Many Areas
- Fighting kid’s battles in school
- Emailing teachers asking for accommodations
- Not following through on consequences
- Any other action that potentially shows that the kid can’t do things on their own
Feeling Better is their responsibility
- No consequences for:
- Eating
- Going to bed on-time
- Breathing
- Taking care of Self
- Consequences on results:
- Pain Behaviors
- Chores
- Punctuality
- Respect
Follow Through
It is essential to follow through on the consequences… it’s just 24 hours, but then it will have the desired effect