[2Y2T3S] [PT10110] [4] Psychosocial Adaptation to Pain

Multidimensional dynamic interaction among physiological, psychological, and social factors that reciprocally influence each other

• Resulting in chronic and complex pain syndromes

Biopsychosocial model of pain

This model understands how pain works, assesses the patient, and treats them wholistically

Biopsychosocial model of pain

Three factors considered in the biopsychosocial model of pain that constitute pain experience

1. Biological factors

2. Psychological factors

3. Social factors

BIOPSYCHOSOCIAL MODEL OF PAIN

Four components under biological factors

1. Genetics

2. Physiology

3. Neurochemistry

4. Tissue health

BIOPSYCHOSOCIAL MODEL OF PAIN

Seven components under psychological factors

1. Perceived control

2. Self-efficacy

3. Catastrophic thinking

4. Hypervigilance

5. Depression

6. Anxiety

7. Anger

BIOPSYCHOSOCIAL MODEL OF PAIN

Six components under social factors

1. Socioeconomic status

2. Social

3. Skepticism

4. Operant

5. Social learning

6. Social support

Pain model that describes the influence of avoidance and confrontation in pain experiences

Fear avoidance model of pain

FEAR AVOIDANCE MODEL (FAM) OF PAIN

Leads to eventual reduction of fear

Confrontation

FEAR AVOIDANCE MODEL (FAM) OF PAIN

Leads to maintenance or amplification of fear

Avoidance

FEAR AVOIDANCE MODEL (FAM) OF PAIN

This direction can develop acute pain into chronic pain

Avoidance

FEAR AVOIDANCE MODEL (FAM) OF PAIN

This direction can lead to recovery from pain

Confrontation

Four effects of risk/vulnerability factors that can increase pain

1. Distress

2. Trauma

3. Fear

4. Catastrophizing

Four examples of resilience/protective factors that increase the chance of pain resolution

1. Social support

2. Active coping

3. Acceptance

4. Self-efficacy

Comprised of negative cognitive emotional processes (i.e. helplessness, pessimism, rumination about pain, and magnification of pain reports)

Catastrophizing

CATASTROPHIZING

This positively correlates with…

Negative affect

CATASTROPHIZING

Recommended treatment?

Cognitive behavioral therapy (+ adequate pain control)

Refers to an individual’s belief that his or her own ability to perform a certain behavior to achieve a desired outcome

Self-efficacy

Advantages of adjusting the expectations of the patient (3)

1. Increased feelings of control

2. Use of more active coping strategies

3. Better functional outcomes

One of the core mechanisms of underlying placebo mechanism

Expectations

Premorbid psychological dysfunction represents a risk for future development of chronic pain conditions

Distress

Higher presurgical emotional distress were associated with more post-surgical pain and impairment

Distress

DISTRESS

Improves pain intensity through reducing pain catastrophizing

Dispositional optimism

DISTRESS

These have shown to increase the likelihood of transitioning from acute to chronic musculoskeletal pain (2)

1. Emotional distress

2. Psychosocial stress

Reported to be risk factors for adult development of pain syndromes

Childhood physical, sexual, and psychological abuse

Identified as a risk factor for chronic pain, transition from acute to chronic pain and elevated severity of pain and disability

PTSD

More ______ is associated with better outcome in those with SCI, MS, and acquired amputation

More perceived social support

Strongly related to the development of children’s persistent pain after a major surgery and is significantly related to the child’s disability

Parental catastrophizing

May provide specific pathways by which parental catastrophizing amplifies a child’s pain experience and behavior (2)

1. Parental attention to pain

2. Solicitousness behavior that encourages children to avoid regular activities

Two crucial interpersonal factors for psychotherapy process

1. Stimulating the patient’s expectations that treatment will help

2. Establishing a sound therapeutic relationship