Psychosocial factors and their role in chronic pain: A brief review of development and current status

Stanley I Innes

doi:10.1186/1746-1340-13-6

Abstract

The belief that pain is a direct result of tissue damage has dominated medical thinking since the mid 20th Century. Several schools of psychological thought proffered linear causal models to explain non-physical pain observations such as phantom limb pain and the effects of placebo interventions. Psychological research has focused on identifying those people with acute pain who are at risk of transitioning into chronic and disabling pain, in the hope of producing better outcomes.Several multicausal Cognitive Behavioural models dominate the research landscape in this area. They are gaining wider acceptance and some aspects are being integrated and implemented into a number of health care systems. The most notable of these is the concept of Yellow Flags. The research to validate the veracity of such programs has not yet been established.In this paper I seek to briefly summarize the development of psychological thought, both past and present, then review current cognitive-behavioural models and the available supporting evidence. I conclude by discussing these factors and identifying those that have been shown to be reliable predictors of chronicity and those that may hold promise for the future.

Highlights

There is an increasing interest and acceptance in psychosocial factors and their correlations to the onset and outcomes of acute pain episodes
Historical development The psychological and psychiatric aspects of pain had been infrequently noted by modern writers as early as 1768
The belief that all pain was a direct result of tissue damage was firmly entrenched by the early 20th Century [2]

Summary

Introduction

There is an increasing interest and acceptance in psychosocial factors and their correlations to the onset and outcomes of acute pain episodes. The recent New Zealand Government review into LBP, its subsequent published guidelines, and resultant growing acceptance of the "Yellow Flags" concept is a pertinent example [17-19] Variables such as attitudes, beliefs, mood state, social factors and work appear to interact with pain behaviour, and are cumulatively referred to as psychosocial factors. Several studies have indicated that pain-related fear is one of the most potent predictors of observable performance and is highly correlated to self-reported disability levels in subacute and chronic pain [22,23] These and other factors such as coping strategies [35], sense of control [36], personality type [37], faith and religious beliefs [38], have been reported in literature The most recent literature has implicated such factors as support from supervisors at work and low job control (i.e., inadequate power to make decisions and utilize one's skills) which can create distress, and, when perpetual, may result in ill health [42]

Conclusion

Gamsa A

Skinner BF: Science and Human Behaviour MacMillan

19. Royal College of General Practitioners

24. Wall PD