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The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain
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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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Noncancer pain conditions and risk of suicide
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Small sample mediation testing: Misplaced confidence in bootstrapped confidence intervals.
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Rethinking the fear avoidance model: toward a multidimensional framework of pain-related disability
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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”
The role of depression and catastrophizing in musculoskeletal pain
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Self-citationPatient-physician discordance in assessments of global disease severity in rheumatoid arthritis
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Psychosocial approaches to pain management: an organizational framework
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Self-citationPain-related catastrophizing as a risk factor for suicidal ideation in chronic pain
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A prospective sequential analysis of the fear-avoidance model of pain
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Self-citationDisuse and physical deconditioning in the first year after the onset of back pain
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Protective Factors for Adults From Low-Childhood Socioeconomic Circumstances
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Pain and post traumatic stress disorder - review of clinical and experimental evidence
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Self-citationChronic Pain and Mortality: A Systematic Review
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Self-citationSymptoms of depression and stress mediate the effect of pain on disability
Hall, A. M., Kamper, S. J., Maher, C. G., Latimer, J., Ferreira, M. L., & Nicholas, M. K. (2011) · Pain · doi:10.1016/j.pain.2011.01.014 · Cited by 149
McCracken, L. M., & Vowles, K. E. (2006) · Current Pain and Headache Reports · doi:10.1007/s11916-006-0018-y · Cited by 148
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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…”
Wright, L. J., Zautra, A. J., & Going, S. (2008) · Annals of Behavioral Medicine · doi:10.1007/s12160-008-9048-5 · Cited by 141
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
Hassett, A. L., Aquino, J. K., & Ilgen, M. A. (2014) · Current Pain and Headache Reports · doi:10.1007/s11916-014-0436-1 · Cited by 140
Chronic pain and PTSD: evolving views on their comorbidity
Brennstuhl, M.-J., Tarquinio, C., & Montel, S. (2015) · Perspectives in Psychiatric Care · doi:10.1111/ppc.12093 · Cited by 140
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“In samples of obese patients with knee osteoarthritis, catastrophizing was associated with poorer weight management, with more frequent binge eating, with reduced physical capacity, and with reduced weightrelated quality of life.(210) In prospective studies in patients with acute LBP, those with high levels of negativ…”
Toward a Biopsychomotor Conceptualization of Pain
Sullivan, M. J. L. (2008) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e318164bb15 · Cited by 135
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Self-citationPredictors of poor outcome in patients with neck pain treated by physical therapy
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Arola, H., Nicholls, E. E., Mallen, C. D., & Thomas, E. (2010) · European Journal of Pain · doi:10.1016/j.ejpain.2010.02.012 · Cited by 132
Effects of psychological distress and perceptions of illness on recovery from total knee replacement
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Measuring expectations in orthopaedic surgery: a systematic review
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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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“Multiple randomized controlled trials have shown that pain patients with high pretreatment catastrophizing scores report less benefit from topical analgesics,(150) cortisone,(149) oral analgesics,(199) painrelieving surgeries,(238) and psychosocial treatments such as CBT.(53,232)”
Dowd, H., Hogan, M. J., McGuire, B. E., Davis, M. C., Sarma, K. M., Fish, R. A., & Zautra, A. J. (2015) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000201 · Cited by 121
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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Buenaver, L. F., Edwards, R. R., & Haythornthwaite, J. A. (2007) · Pain · doi:10.1016/j.pain.2006.08.018 · Cited by 113
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Psychological approaches to understanding and treating arthritis pain
Keefe, F. J., & Somers, T. J. (2010) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2010.22 · Cited by 112
Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse
Edwards, R. R., Wasan, A. D., Michna, E., Greenbaum, S., Ross, E. L., & Jamison, R. N. (2011) · Journal of Pain · doi:10.1016/j.jpain.2011.02.357 · Cited by 110
Self-citationRaphael, K. G., & Widom, C. S. (2010) · Pain · doi:10.1016/j.pain.2010.10.014 · Cited by 108
Hasenbring, M. I., Chehadi, O., Titze, C., & Kreddig, N. (2014) · Pain Management · doi:10.2217/pmt.14.36 · Cited by 106
Schreiber, K. L., Kehlet, H., Belfer, I., & Edwards, R. R. (2014) · Pain Management · doi:10.2217/pmt.14.33 · Cited by 106
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Wideman, T. H., & Sullivan, M. J. L. (2011) · Pain · doi:10.1016/j.pain.2010.10.044 · Cited by 102
Self-citationWeiner, B. K. (2008) · Spine · doi:10.1097/brs.0b013e3181604572 · Cited by 100
What should be the core outcomes in chronic pain clinical trials?
Turk, D. C., & Dworkin, R. H. (2004) · Arthritis Research · doi:10.1186/ar1196 · Cited by 98
Self-citationAvoidance behavior in chronic pain research: a cold case revisited
Volders, S., Boddez, Y., De Peuter, S., Meulders, A., & Vlaeyen, J. W. S. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.11.003 · Cited by 97
Acute stress response and recovery after whiplash injuries. A one‐year prospective study
Kongsted, A., Bendix, T., Qerama, E., Kasch, H., Bach, F. W., Korsholm, L., & Jensen, T. S. (2007) · European Journal of Pain · doi:10.1016/j.ejpain.2007.07.008 · Cited by 97
Parental catastrophizing about their child's chronic pain: are mothers and fathers different?
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Sturgeon, J. A., Zautra, A., & Arewasikporn, A. (2013) · Pain · doi:10.1016/j.pain.2013.10.007 · Cited by 96
Pathways of chronic pain in survivors of intimate partner violence
Wuest, J., Ford-Gilboe, M., Merritt-Gray, M., Wilk, P., Campbell, J. C., Lent, B., Varcoe, C., & Smye, V. (2010) · Journal of Women's Health · doi:10.1089/jwh.2009.1856 · Cited by 94 · cited 1×
“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…”
Vowles, K. E., Sowden, G., & Ashworth, J. (2014) · Behavior Therapy · doi:10.1016/j.beth.2013.12.009 · Cited by 92
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Determinants of pain treatment response and nonresponse: identification of TMD patient subgroups
Litt, M. D., & Porto, F. B. (2013) · The Journal of Pain · doi:10.1016/j.jpain.2013.07.017 · Cited by 86 · cited 2×
“A recent study of patients with persistent orofacial pain, randomized to 6 weeks of either standard care or CBT and followed for 12 months, confirmed the treatment-mediating effects of catastrophizing.(140) Patients with high levels of pretreatment catastrophizing,”
Attachment and pain: Recent findings and future directions
Porter, L. S., Davis, D., & Keefe, F. J. (2007) · Pain · doi:10.1016/j.pain.2007.02.001 · Cited by 86
Summary of Findings from the OPPERA Baseline Case-Control Study: Implications and Future Directions
Fillingim, R. B., Slade, G. D., Diatchenko, L. B., Dubner, R. A., Greenspan, J. D., Knott, C. E., Ohrbach, R. K., & Maixner, W. D. (2011) · Journal of Pain · doi:10.1016/j.jpain.2011.08.009 · Cited by 86
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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
Burns, J. W., Nielson, W. R., Jensen, M. P., Heapy, A., Czlapinski, R., & Kerns, R. D. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0037208 · Cited by 77 · cited 3×
“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
Palermo, T. M., & Holley, A. L. (2013) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2013.428 · Cited by 76
Psychological pain interventions and neurophysiology: Implications for a mechanism-based approach.
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Self-citationPain catastrophizing predicts poor response to topical analgesics in patients with neuropathic pain
Mankovsky, T., Lynch, M. E., Clark, A., Sawynok, J., & Sullivan, M. J. (2012) · Pain Research and Management · doi:10.1155/2012/970423 · Cited by 72
Self-citationCommunal coping model of catastrophizing: conceptual model building
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Theoretical Considerations for Chronic Pain Rehabilitation
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The importance of psychological assessment in chronic pain
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2 of the 266 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Chronic pain: an update on burden, best practices, and new advances
Cohen, S. P., Vase, L., & Hooten, W. M. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00393-7 · Cited by 2,614
Handbook of Religion and Health
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · doi:10.1093/oso/9780190088859.001.0001 · Cited by 1,160
Evaluating psychosocial contributions to chronic pain outcomes
Meints, S. M., & Edwards, R. R. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.01.017 · Cited by 719
Self-citationIndividual differences in pain: understanding the mosaic that makes pain personal
Fillingim, R. B. (2016) · Pain · doi:10.1097/j.pain.0000000000000775 · Cited by 758
Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification
Maixner, W., Fillingim, R. B., Williams, D. A., Smith, S. B., & Slade, G. D. (2016) · The Journal of Pain · doi:10.1016/j.jpain.2016.06.002 · Cited by 558
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.
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