The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness, to the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.KEY WORDS: biopsychosocial; chronic pain; neuroscience of pain; pain and cognition; pain and emotion Biopsychosocial Approach to Chronic Pain 3The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions During the past decade, there has been an explosion of research on chronic pain, with significant advances in understanding its etiology, assessment and treatment (Gatchel, 2004; Turk & Monarch, 2002). This research has important health care implications Epidemiological research has shown that chronic pain (loosely defined as prolonged and persistant pain of at least 3-months duration) and chronic recurrent pain (recurrent episodes of pain interspersed with pain free periods extending over months or years) affects 10% -20% of adults in the general population (Blyth et al., 2001; Gureje, Von Korff, Simon & Gater, 1998; Vehaak, Kerssens, Dekker, Sorbi & Bensing, 1998). For example, in a large-scale epidemiological study, Von Korff, Crane, Lane et al. (2005) estimated a 19% prevalence for chronic spinal pain (neck and back) in the U.S. in the previous year, and a 29% lifetime rate. The American Academy of Pain Management (2003) asserted that approximately 57% of all adult Americans reported experiencing recurrent or chronic pain in the past year. About 62% of those individuals reporting being in pain for more than 1 year, and 40% noted that they were constantly in pain. Indeed, as Gatchel (2004) has summarized that pain is a pervasive medical problem: it affects over 50 million Americans and costs more than $70 billion annually in health care costs and lost productivity; it accounts for more than 80% of all physician visits. Moreover, chronic pain is often associated with major comorbid psychiatric disorders and emotional suffering.As the above factors attest, the prevalence and cost of chronic pain is a major physical and mental health care problem in the United States. Moreover, individuals 50 years of age and older are twice as likely to have been diagnosed with chronic pain (Gatchel, 2004;. Currently, there are approximately 35 million Americans aged 65 years or older, accounting for 12.4% of t...

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The present study attempted to replicate the robustness of a two-factor model of the Tampa Scale for Kinesiophobia (TSK) in chronic low back pain (CLBP) patients and fibromyalgia patients, by means of confirmatory factor analysis. Construct and predictive validity of the TSK subscales were also examined. Results clearly indicated that a two-factor model fitted best in both pain samples. These two factors were labelled somatic focus, which reflects the belief in underlying and serious medical problems, and activity avoidance, which reflects the belief that activity may result in (re)injury or increased pain. Construct validity of the TSK and its subscales was supported by moderate correlation coefficients with self-report measures of pain-related fear, pain catastrophising, and disability, predominantly in patients with CLBP. Predictive validity was supported by moderate correlation coefficients with performance on physical performance tests (i.e., lifting tasks, bicycle task) mainly in CLBP patients. Implications of the results are discussed and directions for future research are provided.

This study was the first to identify the joint contribution of somatic and psychologic factors to chronic pain, functional limitations, and quality of life 6 months after surgical interventions. It replicates previous findings that intense acute postoperative pain is a risk factor for long-term adverse outcome and also identified additional risk factors, namely, long duration of the operation, ASA status, and preoperative fear of surgery.

We conclude that despite an acute pain protocol, postoperative pain treatment was unsatisfactory, especially after intermediate and major surgical procedures on an extremity or on the spine.