Pain Management and

Polyvagal Theory
JESSICA FLETCHER, MM, MT-BC
What is Pain?

u Pain is an uncomfortable feeling that indicates a problem in the body

u Can be steady, throbbing, stabbing, aching, pinching, etc.
u Can be mild to debilitating

u Can cause other physical symptoms:

u Nausea, dizziness, weakness, drowsiness
u Can cause emotional symptoms:
u Anger, depression, mood swings, irritability
u Acute (severe and short)
u Chronic (mild or severe, lasts a long time, requires ongoing treatment)
Pain Statistics

u Affects more Americans than heart disease, cancer, and diabetes

combined
u Most common reason Americans access the health care system
u Leading cause of disability/major part of healthcare costs
u Can accompany or complicate other diseases (e.g. depression, Post
Traumatic Stress, Traumatic Brain Injury)
u Pain perception in infants/children can be especially concerning due to
their lowered ability to describe the type, degree, and location of pain
u Pain may need to be treated differently in men and women and from
person to person
Pain Scales:
How does pain
affect us?
How is pain treated?

u Assessment needs to be comprehensive and attempt to

identify the variables contributing to the pain
u Treatment methods should be multidimensional and
address as many categories (sensory, cognitive, affective,
sociocultural, spiritual, etc.)
u Individualized to meet the unique needs of the patient
u Coping should be emphasized within treatment
Gate Control Theory of Pain

u Pain management theory

u Pain impulses are sent to the brain through nerve receptors
u Travels through spinal cord and through the dorsal horns to the brain
u Dorsal Horn Functions as a “gate”, allowing certain sensory impulses
to enter the brain
u Only a certain amount of sensory stimuli can enter the brain at one
time
u Thus, music or other pleasing stimuli can divert attention away from
pain/stress
Polyvagal Theory

u Stephen W. Porges (2007)

u Focus on the vagal nerve—10th cranial nerve, which accounts
for most parasympathetic nervous system responses
u This theory shows the connection that occurs between
autonomic functions of the nervous system and physical
behavior
u “Primary emotions are related to autonomic function”
u The theory proposes that the vagal system is linked to social
communication, mobilization, and immobilization
 Polyvagal Theory

u The polyvagal theory links the evolution of the

autonomic nervous system to:
u Affective experience
u Emotional expression
u Facial gestures
u Vocal communication
u Contingent social behavior
u Thus, the theory provides a plausible
explanation of several social, emotional, and
communication behaviors and disorders
Polyvagal Theory

u Primary emotions are related to autonomic function

u Withdrawal of the vagal tone results in the behaviors of
fight or flight OR “freezing”
u An increase in vagal tone would bring about social
engagement behaviors
u The theory also points out a connection between nature,
your environment, and neuroception, which prompts
you to trigger adaptive/defensive strategies
Situation One: 25 year old
female is on the med/surg
unit for undiagnosed
abdominal pain. She states
her pain is at a “8”, has
facial grimacing and
bracing. The nurse states
that the patient has been
“crying a lot” due to pain
and “feeling overwhelmed
due to hospitalization and
lack of a diagnosis”.
Situation Two: You have
received a home referral for
a 62 year old male with
chronic headaches. His
family states they will “try
anything” because “pain
medication doesn’t seem to
help anymore”. This had led
the client to spend most of
his time at home, is isolated,
and often curled up, with
muscles tensed, in response
to the pain.
References

u Clair, A. A., & Memmott, J. (2008). Therapeutic Uses of Music with Older Adults(2nd
ed.). Kalamazoo, MI: Wordsetters.
u Dileo, C. (Ed.). (1999). Music therapy and medicine: theoretical and clinical
applications (pp. 181-188). Silver Spring, MD: American Music Therapy
Association.
u Hanson-Abromeit, D., & Colwell, C. M. (2010). Intensive car unit (ICU). In Gerweck.
J.A. & Tan, X. (Eds.), Effective clinical practice in music therapy: Medical music
therapy for adults in hospital settings (pp. 97-160). Silver Spring, MD: American
Music Therapy Association
u Pain Management. (2013, March 29). Retrieved September 24, 2017, from
https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=57
u Tzachi Slonim (2014) The Polyvagal Theory: Neuropsychological Foundations of
Emotions, Attachment, Communication, & Self-Regulation, International Journal of
Group Psychotherapy, 64:4, 593-600, DOI: 10.1521/ijgp.2014.64.4.593
u What is Pain/Types of Pain Treated. (n.d.). Retrieved from
http://www.hopkinsmedicine.org/pain/blaustein_pain_center/patient_care/what_
is_pain.html