The College Toastmasters Club is offering a 7 session Speechcraft program for UNBC and CNC students. Speechcraft is a program designed to teach public speaking skills. During the program, participants practice impromptu speeches, present three formal speeches and engage in a business meeting to practice parliamentary procedure. Toastmaster Club members advise and evaluate participants and provide instruction in speech preparation and speaking techniques. A new program will start Thursday, January 26th.

Location: CNC College Residence, 2nd Floor. (Free shuttle service from UNBC)

Time: 12:05 – 12:55 (50 minutes)

Dates: Every Thursday, starting Jan 26th and finishing Mar 9

Cost: $20 which includes the Speechcraft manual

No obligation to join Toastmasters

$20 fee can be used towards a College Toastmasters membershipLimited seats are available.

For more information contact: Pete Saar 960-5135 saarp@unbc.ca

A functional perspective on pain A functional perspective on pain behaviourbehaviour

Kenneth M. PrkachinKenneth M. Prkachin

University of Northern British University of Northern British ColumbiaColumbia

Excerpts from two clinical reportsExcerpts from two clinical reports

““Throughout the assessment the client did not Throughout the assessment the client did not display any…behaviours such as…facial display any…behaviours such as…facial grimacing…[This] leads the evaluator to believe grimacing…[This] leads the evaluator to believe that the client’s primary reason for self limiting that the client’s primary reason for self limiting may be due to…fear of re-injury”may be due to…fear of re-injury”

““During today’s clinical assessment, significant During today’s clinical assessment, significant pain magnifying features were observed. Such pain magnifying features were observed. Such a presentation is thought to be due to acquired a presentation is thought to be due to acquired overprotective behaviours”overprotective behaviours”

What is the role of behaviour in the What is the role of behaviour in the pain system?pain system?

Sensory model: simple consequence of a Sensory model: simple consequence of a discrete sensory system (Descartes,1649) discrete sensory system (Descartes,1649) Unitary model: a form of operant Unitary model: a form of operant behaviour, modifiable by its consequences behaviour, modifiable by its consequences (Fordyce, 1978): (Fordyce, 1978): Multidimensional model: different pain Multidimensional model: different pain behaviors are organized in different ways behaviors are organized in different ways and at different levels of the nervous and at different levels of the nervous system (Liebeskind & Paul, 1977) system (Liebeskind & Paul, 1977)

PurposePurpose

Describe properties of pain-related Describe properties of pain-related behavioursbehaviours

Illustrate some of the questions that can Illustrate some of the questions that can be addressed through the study of pain be addressed through the study of pain behavioursbehaviours

Inform the debate on the function of pain Inform the debate on the function of pain behavioursbehaviours

Forms of pain behaviourForms of pain behaviour

Decomposing the facial expression Decomposing the facial expression of painof pain

FACS Cheek RaiseFACS Cheek RaiseAU6, Orbit AU6, Orbit squeeze 1squeeze 1

Facial actions elicited by four pain modalitiesFacial actions elicited by four pain modalities

Pain expressionPain expression

How well does expression encode pain?How well does expression encode pain?

How good are people at inferring How good are people at inferring pain from facial behaviour?pain from facial behaviour?

Pain affect scale (Heft et al)Pain affect scale (Heft et al)

Slightly unpleasant 2.64 Very unpleasant 11.55

Slightly annoying 3.07 Miserable 12.85

Annoying 5.06 Very distressing 15.72

Unpleasant 5.42 Slightly intolerable 16.81

Slightly distressing 5.93 Very miserable 18.93

Slightly miserable 7.21 Intolerable 32.82

Very annoying 9.46 Very intolerable 43.49

Distressing 10.49

How good are people at inferring How good are people at inferring pain from facial behaviour?pain from facial behaviour?

Type of test Self-report- expression

Judge- expression

Active .95 .02

Passive .49 .52

Source: Prkachin, Berzins & Mercer (1994) Pain, 58, 253-259

Perceiving pain in others: effects of Perceiving pain in others: effects of experienceexperience

Enhanced underestimation among health-care Enhanced underestimation among health-care providersproviders

Type of test

Active Passive0

5

10

15

Controls

Professionals

Patients

Source: Prkachin, Solomon, Hwang & Mercer (2001). Pain Research and Management, 6, 105-112.

Do pain behaviours predict disability?Do pain behaviours predict disability?

Multivariate prediction of disability—low Multivariate prediction of disability—low back studyback study

Goal: identify set of predictors of poor Goal: identify set of predictors of poor outcomes in first episode, low-back injured outcomes in first episode, low-back injured workersworkers

Comprehensive set of predictors in four Comprehensive set of predictors in four domains: physical, psychosocial, domains: physical, psychosocial, occupational, pain behaviouroccupational, pain behaviour

Multivariate prediction of disabilityMultivariate prediction of disability—low back study—low back study

148 first-episode, subabute low-back pain 148 first-episode, subabute low-back pain patientspatients

Physical exam, psychological tests, workplace Physical exam, psychological tests, workplace assessmentassessment

Measurement of pain behaviour in physical Measurement of pain behaviour in physical exam: guarding, rubbing, words, sounds, facial exam: guarding, rubbing, words, sounds, facial expressionexpression

Follow up at 3 months: return-to-work, time lost, Follow up at 3 months: return-to-work, time lost, rehabilitation costs, self-reported disabilityrehabilitation costs, self-reported disability

Relationships between pain Relationships between pain behaviours and disability outcomesbehaviours and disability outcomes

Measures of disabilityMeasures of disability

(Lack of) return to work(Lack of) return to workDays lostDays lostRehabilitation costsRehabilitation costsSelf-reportSelf-report– Quality of life (SF-36)Quality of life (SF-36)– Von Korff disability measureVon Korff disability measure– Western Ontario-McMaster Osteoarthritis index Western Ontario-McMaster Osteoarthritis index

(WOMAC)(WOMAC)– Roland-MorrisRoland-Morris– Pain Disability IndexPain Disability Index

Relationships between pain Relationships between pain behaviours and disability outcomesbehaviours and disability outcomes

Pain Pain behaviourbehaviour

RTWRTW Days Days lostlost

CostsCosts Self Self reported reported disabilitydisability

GuardingGuarding ++ ++ ++ ++

SoundsSounds -- 00 00 00

WordsWords 00 ++ ++ 00

Facial Facial expressionexpression

00 00 00 00

Multivariate model (best predictors)Multivariate model (best predictors)

VariableVariable No RTWNo RTW Days lostDays lost CostsCosts DisabilityDisability

Job threatenedJob threatened -- -- -- --

Problem worseProblem worse ++ ++ ++ ++

Injury intensityInjury intensity 00 00 00 00

Timed walkTimed walk 00 ++ ++ ++

R leg sciaticaR leg sciatica ++ 00 00 ++

Waddell signsWaddell signs 00 00 00 00

GuardingGuarding ++ ++ ++ ++

ConclusionConclusion

A pain behaviour (facial expression) appears to A pain behaviour (facial expression) appears to be a read-out of painful experience, adapted for be a read-out of painful experience, adapted for communicative purposes. It is not arbitrary and communicative purposes. It is not arbitrary and is unlikely to reflect operant forcesis unlikely to reflect operant forces

A pain behaviour (guarding) appears to be a A pain behaviour (guarding) appears to be a marker of some process that contributes to marker of some process that contributes to disability. Though correlated with other pain disability. Though correlated with other pain behaviours it has different propertiesbehaviours it has different properties

Pain behaviour is not unitaryPain behaviour is not unitary

New directionsNew directions

Toward automated analysisToward automated analysis

Viewing facial expressions of pain engages Viewing facial expressions of pain engages cortical areas involved in the direct experience of cortical areas involved in the direct experience of painpain((Botvinick, Jha, Bylsma, Fabian, Solomon & Prkachin, (In press), Botvinick, Jha, Bylsma, Fabian, Solomon & Prkachin, (In press),

NeNeuroimage)uroimage)..

Direct experience (thermal pain)Direct experience (thermal pain)

Vicarious experience (pain expression)Vicarious experience (pain expression)

fMRIfMRI

Areas jointly activated by 1Areas jointly activated by 1stst person person and 3and 3rdrd person pain person pain