Pain-related behaviors Communication of pain

Abstract

F ordyce8,g made a major contribution to the understanding of chronic pain by focusing attention on the behaviors of chronic pain patients and the role of operant learning factors in the complex pain experience. Two decades later it is fitting to reflect on the subsequent developments. Keefe and Dunsmore focus on a key ingredient of the model: the measurement of pain behaviors, providing an excellent, succinct overview of the evolution of the “pain behavior” construct and the developments in measurement methods for the construct. In responding to the focus article it is therefore reasonable to consider how well these developments have taken advantage of the behavioral conceptualization. What were the potential gains from behavioral approaches made possible by Fordyce’s contribution? Attractions of a behaviorist approach are that observations might avoid difficulties arising from self-report of subjective states, factors controlling behaviors might be readily recognized, and identification of aspects of the complex pain phenomenon as behaviors would permit linkage to the well-developed theory and technology of behavior modification. Implicit in the last is the need to recognize adaptive and maladaptive behaviors so that appropriate strategies for increasing or decreasing response frequency can be implemented. It is legitimate to ask, therefore, have measures of pain behaviors lived up to the behaviorist promise?