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

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.

Figure 1

A cognitive-behavioural model of pain related fear [43].