The role of psychosocial processes in the development and maintenance of chronic pain
Open accessAbstract
Unlabelled The recently proposed Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION)-American Pain Society (APS) Pain Taxonomy (AAPT) provides an evidence-based, multidimensional, chronic pain classification system. Psychosocial factors play a crucial role within several dimensions of the taxonomy. In this article, we discuss the evaluation of psychosocial factors that influence the diagnosis and trajectory of chronic pain disorders. We review studies in individuals with a variety of persistent pain conditions, and describe evidence that psychosocial variables play key roles in conferring risk for the development of pain, in shaping long-term pain-related adjustment, and in modulating pain treatment outcomes. We consider "general" psychosocial variables such as negative affect, childhood trauma, and social support, as well as "pain-specific" psychosocial variables that include pain-related catastrophizing, self-efficacy for managing pain, and pain-related coping. Collectively, the complexity and profound variability in chronic pain highlights the need to better understand the multidimensional array of interacting forces that determine the trajectory of chronic pain conditions.Perspective The AAPT is an evidence-based chronic pain classification system in which psychosocial concepts and processes are essential in understanding the development of chronic pain and its effects. In this article we review psychosocial processes that influence the onset, exacerbation, and maintenance of chronic pain disorders.
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Anxiety and depression could exacerbate pain intensity, facilitate the transition from acute to chronic pain, or have a causal effect on pain onset, especially anxiety.
“Evidence suggests that anxiety and depression could exacerbate pain intensity, facilitate the transition of the acute to CP,10 or even have a causal effect on the onset of pain, especially in the case of anxiety.”
From Psychological interventions for depression and anxiety: a systematic review and meta-analysis of Iranian chronic pain trials. (2020) · cites this paper as [10]
The General Psychosocial Factors section says premorbid psychological dysfunction is a risk factor for later chronic pain and that higher distress predicts transition from acute to chronic musculoskeletal pain. The Biopsychosocial Model section also links anxiety and depression with worse pain outcomes after joint replacement. These passages do not establish a causal effect on pain onset or identify anxiety as a particularly strong cause. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFor the majority of patients who walk through the door of an outpatient orthopaedic clinic, providers lack a more robust psychologically informed model to understand individual differences in motivation, learning, cognition, affect, communication, coping-style, resilience, social orientation, and health-related behaviours.
“For the majority of patients who walk through the door of an outpatient orthopaedic clinic, providers lack a more robust psychologically informed model to understand individual differences in motivation, learning, cognition, affect, communication, coping-style, resilience, social orientation, and health-related behaviours (Boselie & Vlaeyen, 2017;Edwards et al., 2016;Wideman et al., 2013).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Edwards et al., 2016
The Biopsychosocial Model of Pain section (page not provided) says the model is nearly universally accepted in principle but not necessarily in practice, and criticizes its vagueness about how psychosocial factors interact. This supports a need for a more useful psychologically informed framework, but the paper does not establish that providers lack one for the majority of patients attending outpatient orthopaedic clinics. (LLM, conf=0.83)
Experimental — accuracy not yet measuredPain is a biopsychosocial phenomenon.
“Our skepticism about the generalizability of the American and European trials to a Middle Eastern population such as Iranian community is based on the fact that pain is a biopsychosocial phenomenon.10,22,23”
From Psychological interventions for depression and anxiety: a systematic review and meta-analysis of Iranian chronic pain trials. (2020) · cites this paper as [10]
Psychosocial variables are more predictive of long-term disability than physical measures in some cases.
“Evidence in some cases demonstrates that psychosocial variables are more predictive of long-term disability than physical measures (Edwards et al., 2016;Piva et al., 2009).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Edwards et al., 2016
Yellow flags represent a narrow set of cognitive and affective responses to pain.
“However, yellow flags represent a narrow set of cognitive and affective responses to pain (Crofford, 2015;Edwards et al., 2016).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Edwards et al., 2016
In the References (page unavailable), the only mention of “yellow flags” is in the title of a cited work, which identifies them as psychological risk factors. The paper discusses cognitive and affective processes elsewhere, but the passages found do not say that yellow flags represent a narrow set of those responses (searched: “yellow flags” and related terms). (LLM, conf=0.72)
Experimental — accuracy not yet measured
Having a supportive partner is associated with reduced symptom burden including less pain, improved quality of life, and fewer distress symptoms in patients with chronic lymphocytic leukemia, metastatic breast cancer, and colorectal cancer.
“the presence of a supportive partner has been associated with reduced symptom burden (including less pain), improved quality of life, and fewer symptoms of distress in patients with chronic lymphocytic leukemia 92, metastatic breast cancer 93, 94, and other cancer types such as colorectal cancer95, 96.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [94]
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“Other studies of acceptance-oriented interventions have arrived at similar conclusions regarding the importance of acceptance and psychological flexibility as process variables that may serve as treatment targets.(159,243,246) Such findings suggest that, much”
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Pain and post traumatic stress disorder - review of clinical and experimental evidence
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A prospective sequential analysis of the fear-avoidance model of pain
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Self-citationProtective Factors for Adults From Low-Childhood Socioeconomic Circumstances
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“Indeed, some recent work has suggested that mindfulness-based interventionsmayhavegreater effects on pain-related catastrophizing, especially in the context of high levels of pain intensity, than traditional CBT approaches.(49,55) Such findings suggest the possibility of tailoring individual psychosocial interventions…”
Chronic Pain and Mortality: A Systematic Review
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Social and psychological factors influenced the course of arm, neck and shoulder complaints
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The risk of suicide mortality in chronic pain patients
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Chronic pain and PTSD: evolving views on their comorbidity
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Effects of psychological distress and perceptions of illness on recovery from total knee replacement
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Anxiety, Depression, and Pain in Burning Mouth Syndrome: First Chicken or Egg?
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The Mediating Role of Acceptance in Multidisciplinary Cognitive-Behavioral Therapy for Chronic Pain
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“being increasingly used by psychosocial pain researchers.(3,11,214) SEM is a combination of regression analysis and factor analysis and, although many of the same assumptions are made about the data, it handles the inclusion of several mediating factors more readily, it can include latent (unobserved) factors, and it…”
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How do patients with rheumatic disease experience their relationship with their doctors?
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Development of chronic pain following severe accidental injury. Results of a 3-year follow-up study
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Psychological approaches to understanding and treating arthritis pain
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Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse
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What should be the core outcomes in chronic pain clinical trials?
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Acute stress response and recovery after whiplash injuries. A one‐year prospective study
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Parental catastrophizing about their child's chronic pain: are mothers and fathers different?
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Pathways of chronic pain in survivors of intimate partner violence
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“PTSD has been identified as a risk factor for chronic pain,(99,100) for the transition from acute to chronic pain,(122) and for elevated severity of pain and disability in abuse victims.(262,263) A number of studies have evaluated PTSD symptoms as a statistical mediator of the association between trauma and various pa…”
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Determinants of pain treatment response and nonresponse: identification of TMD patient subgroups
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Attachment and pain: Recent findings and future directions
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Summary of Findings from the OPPERA Baseline Case-Control Study: Implications and Future Directions
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Self-citationThe biopsychosocial model in cancer pain
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Patient Characteristics and Variation in Treatment Outcomes
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Specific and general therapeutic mechanisms in cognitive behavioral treatment of chronic pain
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“active pain-coping is an important component of many nonpharmacological treatments.(34,35,52,141,224) Such ‘‘active’’ coping generally includes engaging in positive thinking, making encouraging self-statements, distracting one’s attention from pain, undertaking as much physical activity as possible within pacing guide…”
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The importance of the family environment in pediatric chronic pain
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- Authors
- Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D.
- Affiliations
- Brigham and Women's Hospital (US)
- University of Rochester Medicine (US)
- University of Washington (US)
- University of Pittsburgh (US)
- Corresponding author
- Edwards, Robert R.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 17
- Issue
- 9
- Pages
- T70-T92
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC5012303
- OpenAlex
- W2515541350
- Cited by
- 954
- References
- 266
- Citations by year
- 2026: 97 · 2025: 120 · 2024: 111 · 2023: 159 · 2022: 103 · 2021: 111 · 2020: 94 · 2019: 71 · 2018: 48 · 2017: 29 · 2016: 8 · 2015: 1
- FWCI
- 5.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Food and Drug Administration (U01-FD005936)
- National Institute on Aging (R01AG034982)
- National Institute on Drug Abuse (R21DA041020)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR064367)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic pain, psychosocial factors, pain catastrophizing, pain self-efficacy, pain coping, negative affect, childhood trauma, social support, pain treatment outcomes
- MeSH terms
- Adaptation, Psychological, Avoidance Learning, Fear, Humans, Pain Measurement, Risk Factors, Self Efficacy, Chronic Pain
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