The Importance of Psychosocial Influences On Chronic Pain

Abstract

SUMMARY Recent experimental and clinical studies into the nature of chronic pain and its development have highlighted the importance of psychosocial factors on the perception of pain and response to it. There have been advances in the understanding of not only the biological substrate, but also the nature and influence of specific psychological and social factors in particular. A range of new explanatory models have stimulated new approaches to treatment directed not only at the reduction of pain and its impact, but also at the identification of early indicators or risk factors for the development of chronicity. The purpose of this paper is to attempt a summary and integration of these diverse research findings and identify the next set of research challenges that might serve as a basis for more clearly focused and targeted approaches to multifaceted pain management and perhaps c ontribute to reduction in the burden of chronic pain.*Arthritis Care UK National Primary Care Centre, Keele University, North Staffordshire, ST5 5BG, UK; profcmain@gmail.com Complete cures for chronic pain are often unachievable, so we need to help the patient develop more realistic expectations, with a focus on the impact of pain in terms of function and emotional wellbeing.In meeting this challenge adoption of an evidence-based biopsychosocial framework is required.For most patients, identifying the relevant psychosocial factors will increase the range of therapeutic options and maximize the opportunity to assist the patient to gain/regain control of their symptoms and their impact.Many chronic patients have been ill-served by their encounters with healthcare professionals. The first objective of treatment therefore must be to identify and address possible iatrogenic confusion and distress, and offer appropriate reassurance as a precursor to exploring treatment options.Restructuring clinical assessment specifically to begin with a careful elicitation of the patient's understanding, expectations, beliefs and concerns offers a framework within which to facilitate self-disclosure, identify need for reassurance and embark on the planning of effective interventions.In chronic pain patients, it is important to recognize that many psychosocial factors, which may be perceived as obstacles to recovery, may in fact by repositioned as opportunities to develop more effective interventions. Practice PointsThe importance of psychosocial influences on chronic pain MANAGEMENT PERSPECTIVEChris J Main* Any attempt to treat chronic pain necessitates consideration not only of the nature of chronic pain but also why and how it persists. The gate control theory of pain [1] has spawned a plethora of investigations into peripheral and central pain mechanisms. New techniques such as imaging [2] have supported sophisticated and wide-ranging investigations of its neurobiological substrate [3] holding the promise of further enhancing our understanding of fundamental pain mechanisms. However the experience of pain is ultimately perceptual and the nature a...

Heterogeneity in patterns of pain development after nerve injury in rats and the influence of sex

“…While this has been reported by others in preclinical models where 29–40% rats did not develop neuropathic syndrome after sciatic or spinal nerve injury ( Cui et al, 2000 , Dean et al, 2017 , Gemes et al, 2009 , Kupers et al, 1992 ), such distinctions have rarely been previously described after nerve trauma, likely due to grouping of all data ( Decosterd and Woolf, 2000 , DeLeo and Rutkowski, 2000 , Dominguez et al, 2009 , Kupers et al, 1992 , LaCroix-Fralish et al, 2005 , Roytta et al, 1999 ). The reasons for variability in, or lack of, development of pain behavior is currently not known but have been attributed to biological, psychosocial, environmental, and genetic factors in humans that are largely absent or controlled in animal studies ( Bushnell et al, 2015 , Main, 2013 , Mogil, 2012 , Paller et al, 2009 ). The variations identified in the present study are unlikely to be due to genetic variation as all the rats were of the same strain, although epigenetic difference may be present, and pharmacologic and anatomic differences in analgesic mechanisms have been noted for identical strains obtained from different vendors ( Clark et al, 1992 ) The observation of individual differences raises the possibility that there are subtypes of temporal patterns of response to injury that are dictated by underlying differences in pathogenic mechanisms.…”

Masticatory sensory-motor changes after an experimental chewing test influenced by pain catastrophizing and neck-pain-related disability in patients with headache attributed to temporomandibular disorders

“…This finding shows the interaction between sensory-type variables with psychological variables, which should be considered a crucial issue when assessing or designing therapeutic interventions. In patients with chronic pain, it is essential to recognize psychosocial factors that may be perceived as obstacles to recovery [ 108 ]. Achieving a reduction of pain catastrophizing is the best predictor of successful rehabilitation in pain conditions [ 109 ].…”

Individual differences in pain: understanding the mosaic that makes pain personal

“…traumatic experiences, developmental influences, personality). On average, compared to individuals without pain, people with chronic pain conditions report increased psychological distress, greater life stress, and more non-pain somatic symptoms [22; 61; 84]. Moreover, when assessed in pain-free individuals, these psychosocial variables represent premorbid risk factors for future development of chronic pain [8; 58].…”