Hi, this is James Fricton. And welcome back to the course on Prevention of Chronic Pain: A Human Systems Approach. I'm presenting from the University of Minnesota, here shown on the Mississippi River. And today, this module is focused on the social realm, when people are the risk of chronic pain. And the module has six parts. The social cycles that we fall our, find ourselves in. Neuropasticity and the mechanisms at social risk. We'll talk about abuse, conflict, and social stressors. That leave a lifetime of inner conflict and pain. Talk a little bit about Post-traumatic stress disorders and chronic pain. The effects of assault, rape, and war on chronic pain. And disability, secondary gain, socioeconomics of pain is important. And then, finally, we'll end up with talking about social support and positive relationships and how they can have an impact in preventing pain. But social relationships are complex processes. Each of these factors, I can only give you a brief overview of the evidence and the concepts related to them. But each one are, are very complicated processes. And I find that they are probably the most, difficult problem to deal with, with regard to chronic pain patients. So, I'm hoping, though, by the end of this module, you will be able to understand this social risk and protective factors. And the cybernetic cycles that they are involved in. Hope that you can discuss the mechanisms of neuropasticity and how they effect social risk of chronic pain. I'd like you to be able to identify the risk factors of abuse, conflict, and social stressors and how they play a role in chronic pain. I'd like you to be able to explain PTSD as caused by trauma, assault, rape. And how it has an effect on chronic pain. And then, I'd like you to review disabilities, secondary gain, socioeconomics and their impact on recovery from pain conditions. And finally, the last one, I really would like you to be able to identify and use strategies of social support and positive relationships to prevent chronic pain. So, let's go ahead to the first part, the cycles of the social lives we live in. There are many different contributing factors to the social realm. The protective factors includes those things such as protective relationships, creating harmony and peace in your life. Helping others, socioeconomic stability and receiving social support will all protect you from chronic pain, and if you have an injury, this is what you need to maximize. On the other hand, there's a lot of factors that create risk of chronic pain after an injury. Of course, of course, assault and rape are, are serious problems that will contribute to chronic pain. Conflict and war between people abuse and social stressors are also serious problems that can contribute to chronic pain over time. And disability and socio-economic risk are often misunderstood. Are they protective factors or are they risk factors? And we'll discuss the differences. And secondary gain, along the same lines, and social approval are also confusing concepts. So, we'll discuss each one of those. But first I want to discuss some of the cybernetic cycles, the positive feedback loops that we find ourselves in that often perpetuate chronic pain through this social risk factors. Now, one is the cycle of abuse, conflict, and pain. Verbal abuse or physical abuse, whether it be by a spouse, boss, significant other will create significant stressors. assault, stress, muscle tension, fear all causes pain in the victim. Now, when this pain continues, the victim wants to avoid the pain, and does what the abuser wants, whether it's sex, tasks, more work, obtaining drugs, and many other demands that are put on. And of course, this reinforces further behavior from the abuser. And this perpetuates a cycle over time that includes pain as one of the components. Now, let's talk about another cycle and this is a confusing cycle because lot of people blame chronic pain, blame secondary gain as one of the reasons for chronic pain, but in this case the victim is injured. And complains of significant pain. Of course, because it hurts, they naturally avoid unpleasant tasks, dealing with conflict, missing work, obtaining drugs, obtaining healthcare etc., and others then do the task for them. It's okay to miss work. They get disability. They're given drugs to feel better, opioids particularly. They avoid dealing with conflicts, they avoid exercising, self management and of course, this reinforces the continuation of complaints of pain, to avoid these unpleasant tasks. And this continues over a period of time as a positive feedback loop that's theoretically perpetuates chronic pain. But let's see how it changes when you provide supporting, social support to re, to support recovery. Now same factor. Person has an injury. Complains of significant pain. Of course, they're naturally going to avoid unpleasant tasks or tasks that cause pain. Dealing with conflict, missing school work, obtaining drugs, etc. Then others will, instead of supporting the lack of doing tasks, the others will support the person in recovering. They'll encourage exercises, changing in lifestyle factors developing new healthier routines and this then reduces the pain and decreases the cycle of pain and encourages recovery. Now, another cycle is helping others. In this case, the helper assists others directly to overcome a problem. So, the spouse or family members or healthcare provider will assist others to overcome chronic pain. Well, this recipient directly benefits from the pain, the patient with pain benefits from the help that's provided by the helper. Helper feels good, develops a helper's high even without positive feedback, but when you give positive, if the recipient gives positive feedback, shows appreciation, and others to reciprocate and help others. This will support a positive cycle that will reduce the pain, improve healthy behaviors, and encourage continuing helping. So, there are some of the examples of the cybernetic, positive feedback cycles that can occur with chronic pain and relationships. And there are many others. And I would, suggest that, in your patients, as well as, yourself or others that you know have chronic pain, is to try to identify these cycles. And to support more the recovery and helping others than supporting secondary gain, abuse and other problems. So, thank you.