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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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“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]
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“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
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“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]
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“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
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“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
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“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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Metadata
- 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
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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