Psychological underpinnings to the development of persistent pain

Other Discussions Pain Science & Rehab Discussion
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Understanding the Etiology of Chronic Pain From a Psychological Perspective

Here is an article by Linton et al discussing the psychological aspects of persistent pain.

I can’t recommend this article enough.

The authors propose 4 tenants to explain the paradox of chronic pain development (see table 1 below).

Table 1: Overview of Various Types of Psychological Processes That May Operate in the Development of Chronic Pain

Predisposing Processes Triggering Processes Protective Processes Catalytic Processes Driving Process
Temperament (eg, trait anxiety, negative affectivity) Exposure to acute aversive events Positive affect Off work Worry and general anxiety
Childhood exposure to adverse, unpredictable environments Acute stress Optimism Interpersonal distress Avoidance
Intolerance of uncertainty Emotional trauma Resilience Work stress Catastrophizing
Helplessness (ie, no sense of control over environment during childhood) Physical trauma Coping strategies to solve problems Poor sleep Inflexible problem solving

To explain why one person may develop persistent pain vs another, the authors present two cases: Lydia and Caroline.

A major premise of the article: “A basic difference between those who become incapacitated and those who do not may be how the pain is dealt with rather than the quality or intensity of the pain itself underscoring the role of psychological processes.”

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I would also add that in the context of chronic pain. I recently cited a paper I did for a research assignment for my psychology class that suggested that parents with chronic pain who catastrophized their pain experience also had more guarded and protected like behavior whenever their adolescent child reported pain. So as it is suggested the predisposed processes have more than just a physical underlying perception.

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I do believe humans illustrate cross section of all four tenets albeit one tenet may be more dominant than others. I related to the contextual cues mainly. All attempts at “managing” the pain were futile but appeared to be all that was available until I was introduced to Barbell Medicine.
Except for the neurosurgeon who told me I was an otherwise healthy individual and to proceed with life as usual, the medical community seemed to always being telling me to come back if such and such didn’t work. Being offered a pill, shot of something, nerve blocks, mechanisms to periodically alter my electrical nerve impulses…ad infinitum… only served to provide context that what I was going through something not normal and increased my fear of “being like this the rest of my life”. I ran around worried about my pain and focused on pain levels.
Now I am beginning to comprehend that my issues are normal for the biological creature I am - degeneration is inevitable, good days / bad days happen to everyone, and that I will live through it and life will go on just like everyone else. I really believe that if I were of the sort to buy into learned helplessness and allowing others to do for me because of my pain I would be one of those who were deemed disabled.
Great article and I do hope more and more clinicians adopt the clinical applications discussed and the research into the biopsychosocial model continues to develop.
Thanks for the read Dr. Ray. This one really hit home for me.

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Yep, this would fall into social and cultural norms/beliefs regarding pain and learned behavioral responses. Would you mind linking the paper?

@1freewoman - glad you found the article useful!

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Yes sir.

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