A biopsychosocial formulation of pain communication.
Open accessAbstract
We present a detailed framework for understanding the numerous and complicated interactions among psychological and social determinants of pain through examination of the process of pain communication. The focus is on an improved understanding of immediate dyadic transactions during painful events in the context of broader social phenomena. Fine-grain consideration of social transactions during pain leads to an appreciation of sociobehavioral events affecting both suffering persons as well as caregivers. Our examination considers knowledge from a variety of perspectives, including clinical health psychology, social and developmental processes, evolutionary psychology, communication studies, and behavioral neuroscience.
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The biosocial model holds that validation soothes, lowers negative affect, and reduces tension in highly emotional interactions.
“According to the biosocial model[12; 13], validation has a soothing effect, reduces negative affect, and “takes the steam” out of interactions with high emotional arousal.[6]”
From Validating pain communication: current state of the science (2015) · cites this paper as [6]
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Self-citationAgreement Between Child and Parent Reports of Pain
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Self-citationUsing fMRI to dissociate sensory encoding from cognitive evaluation of heat pain intensity
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Cited by
Sorted by citations
Updating the definition of pain
Williams, A. C. D. C., & Craig, K. D. (2016) · Pain · doi:10.1097/j.pain.0000000000000613 · Cited by 754 · see citing works
Self-citationExtreme Rituals Promote Prosociality
Xygalatas, D., Mitkidis, P., Fischer, R., Reddish, P., Skewes, J., Geertz, A. W., Roepstorff, A., & Bulbulia, J. (2013) · Psychological Science · doi:10.1177/0956797612472910 · Cited by 442 · see citing works
“The number of piercings did not predict how much participants donated, which suggests that effects were driven by subjective experiences of pain (Hadjistavropoulos et al., 2011).”
BackgroundHarris, J., Ramelet, A., van Dijk, M., Pokorná, P., Wielenga, J. M., Tume, L. N., Tibboel, D., & Ista, E. (2016) · Intensive Care Medicine · doi:10.1007/s00134-016-4344-1 · Cited by 429 · see citing works
“Therefore, standardized assessment tools have been proposed and validated so as to limit avoidable variability in assessment [12].”
Family and parent influences on pediatric chronic pain: a developmental perspective
Palermo, T. M., Valrie, C. R., & Karlson, C. W. (2014) · American Psychologist · doi:10.1037/a0035216 · Cited by 426 · see citing works
“Thus, as posited in frameworks for understanding psychological and social determinants of pain through pain communication, young children’s pain cannot be understood outside the context of the primary caregiver (Hadjistavropoulos et al., 2011).”
BackgroundMcMurtry, C. M., Riddell, R. P., Taddio, A., Racine, N. M., Asmundson, G. J. G., Noel, M. E., Chambers, C. T., & Shah, V. S. (2015) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000272 · Cited by 355 · see citing works
Brain-to-brain coupling during handholding is associated with pain reduction
Goldstein, P., Weissman-Fogel, I., Dumas, G., & Shamay-Tsoory, S. G. (2018) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1703643115 · Cited by 311 · see citing works
Bastian, B., Jetten, J., & Ferris, L. (2014) · Psychology Science · doi:10.1177/0956797614545886 · Cited by 175 · see citing works
“Evolved responses to pain serve to generate social support (e.g., Hadjistavropoulos et al., 2011); when shared, however, pain may promote higher-order effects such as bonding and group formation.”
BackgroundThe Assessment of Pain in Older People: UK National Guidelines
Schofield, P. (2017) · Age and Ageing · doi:10.1093/ageing/afx192 · Cited by 241 · see citing works
“We need not only to understand how the communication process works between vulnerable groups and their caregivers (professional or family), but also to realise that pain is more than mere biology; it is also a biopsychological (subjective) and social force [18].”
BackgroundPediatric fear-avoidance model of chronic pain: Foundation, application and future directions
Asmundson, G. J., Noel, M., Petter, M., & Parkerson, H. A. (2012) · Pain Research and Management · doi:10.1155/2012/908061 · Cited by 237 · see citing works
Pain in persons who are marginalized by social conditions
Craig, K. D., Holmes, C., Hudspith, M., Moor, G., Moosa-Mitha, M., Varcoe, C., & Wallace, B. B. (2019) · Pain · doi:10.1097/j.pain.0000000000001719 · Cited by 205 · see citing works
Self-citationPain, decisions, and actions: a motivational perspective
Wiech, K., & Tracey, I. (2013) · Frontiers in Neuroscience · doi:10.3389/fnins.2013.00046 · Cited by 188 · see citing works
“However, such changes are not consistent, as another study examining structural changes in patients with rheumatoid arthritis observed an increase in gray matter content in the basal ganglia, mainly in the NAc and caudate nucleus (Wartolowska et al., 2012).”
BackgroundRacial/ethnic disparities in the assessment and treatment of pain: Psychosocial perspectives.
Tait, R. C., & Chibnall, J. T. (2014) · American Psychologist · doi:10.1037/a0035204 · Cited by 186 · see citing works
Towards a science and practice of resilience in the face of pain
Goubert, L., & Trompetter, H. R. (2017) · European Journal of Pain · doi:10.1002/ejp.1062 · Cited by 177 · see citing works
Self-citationYoshida, W., Seymour, B., Koltzenburg, M., & Dolan, R. J. (2013) · The Journal of Neuroscience · doi:10.1523/jneurosci.4984-12.2013 · Cited by 165 · see citing works
“Socially communicated information is ubiquitous in humans (Tomasello, 1999) and especially important in the context of potential threat (White and Galef, 1998; Olsson and Phelps, 2007) and pain (Langford et al., 2006; Goubert et al., 2011; Hadjistavropoulos et al., 2011) across species.”
BackgroundSocial transfer of pain in mice
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Facial muscle movements encoding pain—a systematic review
Miriam Kunz, A., Meixner, D., & Lautenbacher, S. (2018) · Pain · doi:10.1097/j.pain.0000000000001424 · Cited by 163 · see citing works
Social communication model of pain
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Self-citationInternalized Stigma in People Living With Chronic Pain
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Validating pain communication: current state of the science
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Pain assessment in the critically ill adult: Recent evidence and new trends
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Operant Learning Theory in Pain and Chronic Pain Rehabilitation
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“, 2011), consideration of emotion processes in social contexts is much more recent (Cano & Williams, 2010; Hadjistavropoulos et al., 2011).”
Perceiving one's body shapes empathy
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Pain as a threat to the social self: a motivational account
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Self-citationSocial modulation of and by pain in humans and rodents
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Towards health equity for people experiencing chronic pain and social marginalization
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Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain
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“Access to health care providers and the establishment of a trusting patient-provider partnership have been reported to be an essential component in the effective management of chronic pain (Hadjistavropoulos et al., 2011; Senteio & Veinot, 2014).”
Ruddere, L. D., Goubert, L., Stevens, M., Williams, A. C. D. C., & Crombez, G. (2012) · Pain · doi:10.1016/j.pain.2012.12.018 · Cited by 104 · see citing works
“inclination to help are important, as these responses may underlie pain management decisions and affect the wellbeing of the individual in pain [19].”
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Self-citationEmpathy for Distress in Humans and Rodents
Chen, J. (2017) · Neuroscience Bulletin · doi:10.1007/s12264-017-0135-0 · Cited by 100 · see citing works
“A social communication model of pain proposed recently by Craig attempted to highlight the chronological process of interactions among the pain event, suffering person, and caregiver (physician/nurse/other) in terms of historical and current biological and social determinants imprinted in the brain of a patient [5] (f…”
BackgroundKapos, F. P., Craig, K. D., Anderson, S. R., Bernardes, S. F., Hirsh, A. T., Karos, K., Keogh, E., Losin, E. A. R., McParland, J. L., Moore, D., et al. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104608 · Cited by 99 · see citing works
Self-citationAttentional processing of other’s facial display of pain: An eye tracking study
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Empathy Predicts an Experimental Pain Reduction During Touch
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The Positive Consequences of Pain: A Biopsychosocial Approach
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“Although social support can enhance psychological well-being for persons with chronic pain (Hadjistavropoulos et al., 2011), when it is excessive and becomes solicitous (i.”
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Self-citationOn the interpersonal dynamics of sexuality
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“Hence, the inferred experience of the partner entails thoughts, feelings, or motives that eventually translate into behavioral responses directed toward the patient (Hadjistavropoulos et al., 2011).”
BackgroundPain, aging and dementia: towards a biopsychosocial model
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“With such high prevalence rates, the specificity of these symptoms for pain must necessarily be low, and their responsiveness to pain management may signal a nonspecific sedative effect of analgesics (Hayes et al., 2007) rather than pain relief per se.”
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The faces of pain: A cluster analysis of individual differences in facial activity patterns of pain
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Pain Catastrophizing: Controversies, Misconceptions and Future Directions
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Self-citationSensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review
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“Given that pain response behavior includes facial expressions, possibly intended to request support or empathy [237], computer vision techniques have been used for facial recognition of pain [238].”
MethodWhat is pain: Are cognitive and social features core components?
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“This association often continues to adulthood, consequently with a risk of extension of both somatic pain and psychosocial burdens [7, 8].”
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The Interaction Between Pain and Social Behavior in Humans and Rodents
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Self-citationWe Discount the Pain of Others When Pain Has No Medical Explanation
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Self-citationVervoort, T., Trost, Z., & Van Ryckeghem, D. M. L. (2013) · Pain · doi:10.1016/j.pain.2013.05.052 · Cited by 64 · see citing works
Self-citationParental Distress and Catastrophic Thoughts About Child Pain
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“Engel’s (1980) biopsychosocial model of health and recent findings underscore the centrality of relationships, social networks, and other interpersonal factors to pain adaptation (Hadjistavropoulos et al., 2011).”
BackgroundCorrelates and consequences of the disclosure of pain-related distress to one’s spouse
Caño, A., Leong, L. E. M., Williams, A. M., May, D. K., & Lutz, J. R. (2012) · Pain · doi:10.1016/j.pain.2012.08.015 · Cited by 65 · see citing works
Self-citationTheoretical Considerations for Chronic Pain Rehabilitation
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Is the folk concept of pain polyeidic?
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“…often report finding patients with intractable pain – those who have exhausted the usual clinical routes for investigating and treating somatic causes for their pain – both problematic and frustrating (Levinson et al 1993, Matthias et al 2010, Upshur et al 2010, Hadjistavropoulos et al 2011).”
BackgroundKeogh, E. (2014) · Pain · doi:10.1016/j.pain.2014.06.024 · Cited by 63 · see citing works
Do patient perceptions of provider communication relate to experiences of physical pain?
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The Continuing Evolution of Biopsychosocial Interventions for Chronic Pain
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“Although the social and interpersonal contexts within which patients with chronic pain live rarely receive explicit attention in treatment manuals (Hadjistavropoulos et al., 2011), we would argue that these elements are a critical component inherent in the therapeutic process of CBT as it unfolds.”
BackgroundThe costs and benefits of sexual communal motivation for couples coping with vulvodynia.
Muise, A., Bergeron, S., Impett, E. A., & Rosen, N. O. (2017) · Health Psychology · doi:10.1037/hea0000470 · Cited by 58 · see citing works
“This work contributes to a growing body of research demonstrating the role of interpersonal factors in chronic pain (Hadjistavropoulos et al., 2011).”
Scott, W., Yu, L., Patel, S. J., & McCracken, L. M. (2019) · Journal of Pain · doi:10.1016/j.jpain.2019.03.011 · Cited by 58 · see citing works
Creating Mandalas for the Management of Acute Pain Symptoms in Pediatric Patients
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“This discomfort may be expressed as pain behaviors like verbalized fear, crying, fidgeting, and physical resistance (Hadjistavropoulos et al., 2011).”
BackgroundGan, X., Zhou, X., Li, J., Jiao, G., Jiang, X., Biswal, B. B., Yao, S., Klugah‐Brown, B., & Becker, B. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104553 · Cited by 57 · see citing works
“…the facial expression of disgust as social signal represents a more indirect and context depended signal which requires further interpretation by the observer (for similar reasoning with respect to other facial expression domains see e.g., Hadjistavropoulos et al., 2011; Zhou et al., 2020).”
Caes, L., Vervoort, T., Trost, Z., & Goubert, L. (2012) · Pain · doi:10.1016/j.pain.2011.12.007 · Cited by 56 · see citing works
Self-citationReicherts, P., Gerdes, A. B. M., Pauli, P., & Wieser, M. J. (2013) · Pain · doi:10.1016/j.pain.2013.02.012 · Cited by 56 · see citing works
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“An early study [28] for the discrimination between PCPs and non-PCPs in flexion exercises used the forward flexion/extension lumbar paraspinal muscle activation ratio, the mean lumbar paraspinal muscle activation, and the amount of flexion to achieve an accuracy of 0.86.”
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Cognitive styles and processes in paediatric pain
Goubert, L., & Simons, L. E. (2013) · Oxford Textbook of Paediatric Pain · doi:10.1093/med/9780199642656.003.0010 · Cited by 56 · see citing works
Self-citationEffects of Alzheimer Disease on the Facial Expression of Pain
Beach, P. A., Huck, J. T., Miranda, M. M., Foley, K. T., & Bozoki, A. (2015) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000302 · Cited by 55 · see citing works
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Hunter, P. V., Hadjistavropoulos, T., Smythe, W. E., Malloy, D. C., Kaasalainen, S., & Williams, J. L. (2013) · Journal of Aging Studies · doi:10.1016/j.jaging.2013.05.003 · Cited by 50 · see citing works
“Pain management in dementia is complex and undertreatment is associated with a number of factors, including the challenges associated with changes in communication as dementia progresses (Hadjistavropoulos, Hunter, & Dever Fitzgerald, 2009) and the variety of influences on caregiver decisions about when and how to int…”
BackgroundSelf-citationThe effects of emotion regulation strategies on the pain experience
Hampton, A. J. D., Hadjistavropoulos, T., Gagnon, M. M., Williams, J. L., & Clark, D. A. (2015) · Pain · doi:10.1097/j.pain.0000000000000126 · Cited by 48 · see citing works
Self-citationChang, J. E., Versloot, J., Fashler, S. R., McCrystal, K. N., & Craig, K. D. (2014) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000103 · Cited by 48 · see citing works
Self-citationRosen, N. O., Bois, K., Mayrand, M., Vannier, S. A., & Bergeron, S. (2016) · Archives of Sexual Behavior · doi:10.1007/s10508-016-0739-x · Cited by 48 · see citing works
“…of thesemodels, researchershavefound that factors suchasspouse’sbehavioral responses topain, verbal andnonverbal communication, and spousal support, influencethedevelopmentandmaintenanceof chronic pain and its associatednegativeconsequences (Cano& Williams, 2010; Hadjistavropoulos et al., 2011).”
Mediating Pain: Navigating Endometriosis on Social Media
Holowka, E. M. (2022) · Frontiers in Pain Research · doi:10.3389/fpain.2022.889990 · Cited by 47 · see citing works
Exploring the concept of pain of Australian children with and without pain: qualitative study
Pate, J. W., Noblet, T., Hush, J. M., Hancock, M. J., Sandells, R., Pounder, M., & Pacey, V. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-033199 · Cited by 47 · see citing works
“52 53 Because a child’s concept of pain is not always overtly communicated by the child, particularly the ‘hidden’ emotional components which affect communication, 54 using vignettes and drawings in pain science education or assessments may be particularly beneficial in clinical practice.”
Empathic Contagious Pain and Consolation in Laboratory Rodents: Species and Sex Comparisons
Du, R., Luo, W.-J., Geng, K.-W., Li, C.-L., Yang, Y., He, T., Chen, J., & Chen, J. (2020) · Neuroscience Bulletin · doi:10.1007/s12264-020-00465-y · Cited by 46 · see citing works
“3 Introduction Increasing lines of evidence from both clinical and basic research implicate an important role of social communication in modulation of pain [1-3].”
BackgroundNew Developments in the Psychological Management of Chronic Pain
Morley, S., & Williams, A. C. D. C. (2015) · The Canadian Journal of Psychiatry · doi:10.1177/070674371506000403 · Cited by 46 · see citing works
Self-citationEEVEE: the Empathy-Enhancing Virtual Evolving Environment
Jackson, P. L., Michon, P., Geslin, E., Carignan, M., & Beaudoin, D. (2015) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2015.00112 · Cited by 45 · see citing works
“The added value of EEVEE for research on pain communication (Hadjistavropoulos et al., 2011) is immense.”
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Self-citationBuruck, G., Wendsche, J., Melzer, M., Strobel, A., & Dörfel, D. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.00517 · Cited by 44 · see citing works
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Self-citationDurand, H., Birnie, K. A., Noel, M. E., Vervoort, T., Goubert, L., Boerner, K. E., Chambers, C. T., & Caes, L. (2016) · Journal of Pain · doi:10.1016/j.jpain.2016.11.012 · Cited by 44 · see citing works
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“Despite early evidence that the social context in which pain is experienced may be a potentially valuable area for research and treatment [9–11,25], it remains insufficiently studied [4,5].”
BackgroundHelping motivation and well-being of chronic pain couples: a daily diary study
Kindt, S., Vansteenkiste, M., Loeys, T., & Goubert, L. (2016) · Pain · doi:10.1097/j.pain.0000000000000550 · Cited by 41 · see citing works
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“Theoretically, findings support empathy and communication models of pain (Goubert et al., 2005; Hadjistavropoulos et al., 2011) and calls to move beyond intraindividual models of coping to frameworks taking into account the social context of pain (Keefe, Rumble, Scipio, Giordano, & Perri, 2004),…”
BackgroundWalking a fine line: is it possible to remain an empathic physician and have a hardened heart?
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“Indeed, the ability to detect the intensity of another’s pain is most highly correlated with the degree of the facial response of the one in pain (Gu and Han, 2007; Saarela et al., 2007; Han et al., 2009; Hadjistavropoulos et al., 2011).”
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Gagnon, M. M., Moussaoui, D., Gordon, J. L., Alberts, N. M., & Grover, S. R. (2022) · Pain · doi:10.1097/j.pain.0000000000002649 · Cited by 42 · see citing works
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The pain of being misunderstood: Invalidation of pain complaints in chronic low back pain patients
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“On the other hand, empathetic responses may also reinforce the pain (behavior), with studies demonstrating that solicitous partner responses to overt pain behavior can actually increase pain ratings (Hadjistavropoulos et al., 2011; Romano et al., 2000).”
BackgroundI wanted you to know: Breast cancer survivors’ control of workplace communication about cancer.
Robinson, L. M., Kocum, L., Loughlin, C. A., Bryson, L., & Dimoff, J. K. (2015) · Journal of Occupational Health Psychology · doi:10.1037/a0039142 · Cited by 40 · see citing works
- Authors
- Hadjistavropoulos, T., Craig, K. D., Duck, S., Cano, A., Goubert, L., Jackson, P. L., Mogil, J. S., Rainville, P., Sullivan, M. J. L., Williams, A. C. D. C., Vervoort, T., & Fitzgerald, T. D.
- Affiliations
- University of Regina (CA)
- University of British Columbia (CA)
- University of Iowa (US)
- Ghent University (BE)
- Université Laval (CA)
- McGill University (CA)
- Université de Montréal (CA)
- University College London (GB)
- ORCID
- Venue
- Psychological Bulletin
- Published
- 2011-11
- Volume
- 137
- Issue
- 6
- Pages
- 910-939
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- OpenAlex
- W2161506337
- Cited by
- 466
- References
- 365
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 28 · 2023: 28 · 2022: 26 · 2021: 24 · 2020: 37 · 2019: 31 · 2018: 45 · 2017: 36 · 2016: 38 · 2015: 42 · 2014: 30 · 2013: 42 · 2012: 26
- FWCI
- 21.63
- Type
- journal article
- Language
- en
- Open access
- green
- biblio.ugent.be
- Licence
- other-oa
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- Corpus Université Laval (Université Laval) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- pain communication, biopsychosocial model, dyadic interaction, caregiver-patient interaction
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Animals, Brain, Child, Child, Preschool, Communication, Biological Evolution, Facial Expression, Female, Humans, Infant, Infant, Newborn, Interpersonal Relations, Male, Models, Theoretical, Neurosciences, Pain, Pain Measurement, Social Behavior, Caregivers, Mice, Rats, Pain Perception, 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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