The DOI matches its Crossref record; 54 of the 57 references it cites were found in a registry or an index; none of the 54 sources its claims cite is checked for support yet.
Impact of Psychological Factors in the Experience of Pain
Abstract
This article reviews the role of psychological factors in the development of persistent pain and disability, with a focus on how basic psychological processes have been incorporated into theoretical models that have implications for physical therapy. To this end, the key psychological factors associated with the experience of pain are summarized, and an overview of how they have been integrated into the major models of pain and disability in the scientific literature is presented. Pain has clear emotional and behavioral consequences that influence the development of persistent problems and the outcome of treatment. Yet, these psychological factors are not routinely assessed in physical therapy clinics, nor are they sufficiently utilized to enhance treatment. Based on a review of the scientific evidence, a set of 10 principles that have likely implications for clinical practice is offered. Because psychological processes have an influence on both the experience of pain and the treatment outcome, the integration of psychological principles into physical therapy treatment would seem to have potential to enhance outcomes.
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In the paper
“there is considerable evidence that individuals with a psychiatric history, with depressed mood, with major life adversity, or reporting high levels of stress are at greater risk of transitioning to chronic and disabling LBP.24,32,59,60”
§ Impact of Psychological Factors in the Experience of Pain > Stress-diathesis model.
What the sources say
- Not checked yetcites [24] 2000, A review of psychological risk factors in back and neck pain, Spine (Phila Pa 1976) source
- Not checked yetcites [32] 2002, A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain, Spine (Phila Pa 1976) source
- Not checked yetcites [59] 2002, Determinants of occupational disability following a low back injury: a critical review of the literature, J Occup Rehabil source
- Not checked yetcites [60] 2004
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“Three pain beliefs that have been shown to put patients at greatest risk of a poor prognosis are pain catastrophizing (an exaggerated, negative interpretation of pain), fear avoidance (a belief that all activity should be avoided to reduce”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
What the sources say
- Not checked yetcites [6] the “ Decade of the Flags” Working Group, 2011, Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal, Phys Ther source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Several attitudes and beliefs have been found to be related to the development of persistent pain and disability.14,15”
§ Impact of Psychological Factors in the Experience of Pain > Beliefs and attitudes.
What the sources say
- Not checked yetcites [14] 2010, How important are back pain beliefs and expectations for satisfactory recovery from back pain?, Best Pract Res Clin Rheumatol source
- Not checked yetcites [15] 2008, Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial, Pain source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“Indeed, the paradox is that attempting to suppress thoughts about pain actually increases the pain experience.12”
§ Impact of Psychological Factors in the Experience of Pain > Interpretation
What the sources say
- Not checked yetcites [12] 2008
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Although many acute low back pain (LBP) problems resolve, a minority of people (ϳ10%) directly develop a persistent problem that disables them for a long period of time.4,5”
§ Impact of Psychological Factors in the Experience of Pain > Abstract
What the sources say
- Not checked yetcites [4] 2002
- Not checked yetcites [5] 1998
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, certain beliefs that set the stage for activity restrictions are tied to the development of long-term pain and disability.”
§ Impact of Psychological Factors in the Experience of Pain > Beliefs and attitudes.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“when asked to specify which psychologi-cal factors are of importance, most therapists listed some evidencebased factors but also a host of nonevidence-based factors. 2”
§ Impact of Psychological Factors in the Experience of Pain > Abstract
What the sources say
- Not checked yetcites [2] 2004, Do physical therapists recognise established risk factors: Swedish physical therapists' evaluation in comparison to guidelines, Physiotherapy source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“an average of 52% of patients with pain fulfill the criteria for depression.27”
§ Impact of Psychological Factors in the Experience of Pain > Emotions and their regulation.
What the sources say
- Not checked yetcites [27] 2003, Depression and pain comorbidity: a literature review, Arch Intern Med source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“What might be quite a normal and appropriate response in the acute phase paradoxically may be a poor method of coping with persistent pain.”
§ Impact of Psychological Factors in the Experience of Pain > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes? Based: unclear- Rests on an assumption: Psychological processes are highly intertwined and operate together as a system.
In the paper
“People with persistent pain typically have significantly higher rates of anxiety disorders than do those without persistent pain.25”
§ Impact of Psychological Factors in the Experience of Pain > Emotions and their regulation.
What the sources say
- Not checked yetcites [25] 2001, Making sense of hypochondriasis: a cognitive model of health anxiety
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 21
- Probably not a substantial claim. 14
None of the sources cited for this claim have been checked yet.
In the paper
“Recent studies of patients with chronic pain have suggested that pain-related acceptance leads to less emotional distress and higher physical functioning.46 -48”
§ Impact of Psychological Factors in the Experience of Pain > Examples of Treatment Intervention Strategies
What the sources say
- Not checked yetcites [46] 2003, Coping or acceptance: what to do about chronic pain?, Pain source
- Not checked yetcites [47] 1998, Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain, Pain source
- Not checked yetcites [48] 1999, Behavioral dimensions of adjustment in persons with chronic pain: pain-related anxiety and acceptance, Pain source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If pain is considered a “threat,” then the threat value of the (noxious) stimulus helps to steer awareness: the greater the threat, the more attention given.”
§ Impact of Psychological Factors in the Experience of Pain > Attention
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Attention to a noxious stimulus is a prerequisite for pain perception.
None of the sources cited for this claim have been checked yet.
In the paper
“Indeed, negative affect is strongly associated with poor treatment outcome, as well as the development of disability from LBP. 12,24”
§ Impact of Psychological Factors in the Experience of Pain > Emotions and their regulation.
What the sources say
- Not checked yetcites [12] 2008
- Not checked yetcites [24] 2000, A review of psychological risk factors in back and neck pain, Spine (Phila Pa 1976) source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“we emphasize how psychological factors may contribute not only to the experience of acute pain but also to the development of chronic pain and disability over time.”
§ Impact of Psychological Factors in the Experience of Pain > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Psychological processes are highly intertwined and operate together as a system.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Yet, these psychological factors are not routinely assessed in physical therapy clinics, nor are they sufficiently utilized to enhance treatment.”
§ Impact of Psychological Factors in the Experience of Pain > Abstract
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes? Based: unclearIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The presence of depression in a pain condition is associated with higher levels of pain intensity and is a potent risk factor for disability.27,29”
§ Impact of Psychological Factors in the Experience of Pain > Emotions and their regulation.
What the sources say
- Not checked yetcites [27] 2003, Depression and pain comorbidity: a literature review, Arch Intern Med source
- Not checked yetcites [29] Depression and pain: what is the link?, Scand J Pain
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“many of the factors listed by clinicians were difficult for them to address (eg, economic, drug abuse, or marital issues) in the clinic and did not match the evidence-based factors included in that article. 2”
§ Impact of Psychological Factors in the Experience of Pain > Abstract
What the sources say
- Not checked yetcites [2] 2004, Do physical therapists recognise established risk factors: Swedish physical therapists' evaluation in comparison to guidelines, Physiotherapy source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“although 63% of physical therapists in a primary care setting were aware of the importance of psychological factors, only 47% reported knowledge of utilizing them clinically.3”
§ Impact of Psychological Factors in the Experience of Pain > Abstract
What the sources say
- Not checked yetcites [3] 2005, Do evidence-based guidelines have an impact in primary care: a cross-sectional study of Swedish physicians and physiotherapists, Spine (Phila Pa 1976) source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Not surprisingly, pain catastrophizing is associated with a variety of problems that hinder recovery, making treatment more difficult and increasing the risk of developing persistent pain and disability.6,9,22”
§ Impact of Psychological Factors in the Experience of Pain > Cognitions
What the sources say
- Not checked yetcites [6] the “ Decade of the Flags” Working Group, 2011, Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal, Phys Ther source
- Not checked yetcites [9] 2007, The fear-avoidance model of musculoskeletal pain: current state of scientific evidence, J Behav Med source
- Not checked yetcites [22] 2006, Reducing sickness absence from work due to low back pain: how well do intervention strategies match modifiable risk factors?, J Occup Rehabil source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“A majority of physical therapists are aware of the importance of psychological factors and attempt to utilize this awareness in their practice.2,3”
§ Impact of Psychological Factors in the Experience of Pain > Abstract
What the sources say
- Not checked yetcites [2] 2004, Do physical therapists recognise established risk factors: Swedish physical therapists' evaluation in comparison to guidelines, Physiotherapy source
- Not checked yetcites [3] 2005, Do evidence-based guidelines have an impact in primary care: a cross-sectional study of Swedish physicians and physiotherapists, Spine (Phila Pa 1976) source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“To date, there has been broad recognition of the importance of a biopsychosocial view of pain, but a lack of clarity in how the psychological factors actually fit in, not least in clinical situations.”
§ Impact of Psychological Factors in the Experience of Pain > Abstract
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“For example, Fordyce 36 suggested that although resting or taking analgesics may be a good coping strategy in the acute phase, these behaviors might actually facilitate the development of long-term problems.”
§ Impact of Psychological Factors in the Experience of Pain > Pain Behavior
What the sources say
- Not checked yetcites [36] 1976
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When multiple attempts to get rid of pain fail, worries are further reinforced, and patients are stuck in an endless loop of increasing worries and failed problem-solving attempts to alleviate pain.”
§ Impact of Psychological Factors in the Experience of Pain > Examples of Treatment Intervention Strategies
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Fear of pain develops as a result of a cognitive interpretation of pain as threatening (pain catastrophizing), and this fear affects attention processes (hypervigilance) and leads to avoidance behaviors, followed by disability, disuse, and depression.”
§ Impact of Psychological Factors in the Experience of Pain > Psychological Models of Chronic Pain
What the sources say
- Not checked yetcites [37][38][39]
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Both negative affectivity (a tendency to see the cup as “half empty” rather than “half full”) and threatening types of illness information can help to fuel catastrophic thoughts about pain.”
§ Impact of Psychological Factors in the Experience of Pain > Psychological Models of Chronic Pain
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Thus, worrying about pain and its implications is part of a natural-born problem-solving strategy, but one that, at least in the case of chronic pain, can have negative long-term”
§ Impact of Psychological Factors in the Experience of Pain > Examples of Treatment Intervention Strategies
What the sources say
- Not checked yetcites [49] 2007, Worry and chronic pain: a misdirected problem solving model, Pain source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“This model explains why persistent pain repeatedly interrupts attention, fuels worries about negative consequences, produces hypervigilance to pain, and produces repeated efforts to alleviate pain, even when there is no belief that a solution exists.8,50,51”
§ Impact of Psychological Factors in the Experience of Pain > Examples of Treatment Intervention Strategies
What the sources say
- Not checked yetcites [8] 1999, Pain demands attention: a cognitive-affective model of the interruptive function of pain, Psychol Bull source
- Not checked yetcites [50] 2006, Worrying about chronic pain: an examination of worry and problem solving in adults who identify as chronic pain sufferers, Pain source
- Not checked yetcites [51] 2001, Worry and chronic pain patients: a description and analysis of individual differences, Eur J Pain source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“A tenet of this model is that active coping promotes a sense of con-fidence, or “self-efficacy,” for dealing with pain that is associated with improved function and wellbeing.52,53”
§ Impact of Psychological Factors in the Experience of Pain > Psychological Models of Health and Pain
What the sources say
- Not checked yetcites [52] 2011, Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain, Eur J Pain source
- Not checked yetcites [53] 2010, Impact of the interaction between self-efficacy, symptoms and catastrophising on disability, quality of life and health with chronic pain patients, Disabil Rehabil source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Over time, fear of pain results in musculoskeletal deconditioning, reduced pain tolerance, and fewer attempts to overcome functional limitations.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effective strategies for coping with persistent, recurrent, or chronic pain are very different from those for managing acute pain”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“pain that persists beyond a few weeks can lead to emotional and behavioral consequences that are deleterious to pain recovery and functional rehabilitation.”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Persistent pain naturally leads to emotional and behavioral consequences for the majority of individuals.”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Catastrophic thinking about pain is an important marker for the development of long-term pain problems as well as for poor treatment outcome.”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Personal acceptance and commitment to selfmanage pain problems are associated with better pain outcomes.”
§ Impact of Psychological Factors in the Experience of Pain > Implementation 8
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“With proper instruction and support, psychological interventions can improve pain management outcomes.”
§ Impact of Psychological Factors in the Experience of Pain > 10
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Psychosocial aspects of the workplace may represent barriers for returning to work while pain problems linger.”
§ Impact of Psychological Factors in the Experience of Pain > 9
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Clients who are depressed or have a history of depression may have more difficulty dealing with pain.”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Personal expectations about the course of pain recovery and treatment benefits are associated with pain outcomes.”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Individuals hold very different attitudes and beliefs about the origins of pain, the seriousness of pain, and how to react to pain.”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
In the paper
“Instead, a reframing of the problem toward more-functional goals and away from pain relief (or biomedical explanations of pain) may help to redirect problem-solving efforts that are more likely to be successful.49”
§ Impact of Psychological Factors in the Experience of Pain > Examples of Treatment Intervention Strategies
What the sources say
- Not checked yetcites [49] 2007, Worry and chronic pain: a misdirected problem solving model, Pain source
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Persistent pain problems can lead to hypervigilance and avoidance, but simple distraction techniques are not enough to counter these behaviors.”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Psychological theories and models about pain have provided a better understanding of cognitive, emotional, and behavioral manifestations of pain”
§ Impact of Psychological Factors in the Experience of Pain > Conclusions and Implications: Guiding Principles
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
The paper relies on this without support.
Psychological processes are highly intertwined and operate together as a system.
“A basic theme is that the psychological processes are highly intertwined and function together as a system.”
The paper relies on this without support.
Attention to a noxious stimulus is a prerequisite for pain perception.
“An obvious prerequisite for pain perception is that our attention is directed toward the noxious stimulus.”
The paper relies on this without support.
Pain is a subjective experience shaped by previous experience.
“pain is a subjective experience, and although it is certainly related to physiological processes, how individuals react to a new episode of pain is shaped and influenced by previous experience.”
The authors state this as an assumption.
The influence of psychological factors can be portrayed as a sequence from attention through cognitive processing, appraisal, interpretation, and pain behavior.
“In our presentation, we attempt to portray the influence of psychological factors, as illustrated in Figure 1, as a sequence of processes, starting with initial awareness of the noxious stimulus, then cognitive processing, appraisal, and interpretation that leads people to act on their pain (ie, their pain behavior).7”
“Although we present this as a sequence for understanding, we are aware that this is a model, and much more work is needed to fully describe these processes.”
The paper relies on this without support.
Low self-efficacy and the feeling that pain is uncontrollable cause physical and psychological dysfunction.
“The belief that a person is capable of coping with pain is directly related to self-management; low self-efficacy, with feelings that the pain is uncontrollable cause physical and psychological dysfunction.”
The paper relies on this without support.
When low back pain occurs in someone already under significant psychological stress or with limited coping resources, pain may lead to greater functional limitations and emotional distress.
“This model suggests that when LBP befalls an individual who is already under significant psychological stress or whose coping resources are already stretched thin, pain may result in more significant functional limitations and generate higher levels of emotional distress.”
The paper relies on this without support.
Protective psychosocial factors buffer the emotional impact of pain, while distress and emotional dysregulation predispose to pain.
“Protective psychosocial factors buffer the emotional impact of pain, whereas distress and emotional dysregulation predispose to pain”
The paper relies on this without support.
Fluctuating pain reduces perceptions of control and mastery over pain.
“Fluctuating pain reduces perceptions of control and mastery over pain”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Our survey design relied on self-report metrics, which could introduce biases in the reporting of psychological distress and physical pain, given their known association, and can be dependent on the time of survey response.56”
From Mindful attention is inversely associated with pain via mediation by psychological distress in orthopedic patients. (2024) · cites this paper as [56]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Pain beliefs like pain catastrophizing (an exaggerated, negative interpretation of pain), fear of avoidance of work (a belief that all activities should be avoided to reduce pain), and low expectations for recovery put patients at a poor prognosis.[5]”
From Mindfulness influences the psycho-social dimension of chronic pain: A randomized controlled clinical trial in Indian context (2023) · cites this paper as [5]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Despite a range of psychological factors being important in the genesis and persistence of CP syndromes, they are not always routinely assessed in general practice or utilized to enhance treatment outcomes.26”
From Pain and Evil: From Local Nociception to Misery Following Social Harm (2020) · cites this paper as [26]
The cited source says what the claim attributes to it.
In the citing paper
“It is known that psychological processes influence the experience of pain and the treatment outcomes; therefore, there is a chance that integrating psychological approaches into physical therapy could enhance outcomes [45].”
Citations
Cites
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The Pain Catastrophizing Scale: Development and validation.
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995) · Psychological Assessment · doi:10.1037//1040-3590.7.4.524 · Cited by 8,227
Acceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587
(1999) · Cited by 5,934
Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.
Vlaeyen, J. W. S., & Linton, S. J. (2000) · Pain · doi:10.1016/s0304-3959(99)00242-0 · Cited by 4,931
Self-citationDepression and Pain Comorbidity: A Literature Review
Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.20.2433 · Cited by 3,463
Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance
Vlaeyen, J. W. S., Kole-Snijders, A. M. J., Boeren, R. G. B., & van Eek, H. (1995) · Pain · doi:10.1016/0304-3959(94)00279-n · Cited by 2,446
The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence
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Metadata
- Authors
- Linton, S. J., & Shaw, W. S.
- Affiliations
- Örebro University (SE)
- Liberty Mutual Research Institute for Safety (US)
- Corresponding author
- Linton, Steven J.
- Venue
- Physical Therapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-05-01
- Volume
- 91
- Issue
- 5
- Pages
- 700-711
- ISSN
- 0031-9023 (ISSN-L)
- 1538-6724
- OpenAlex
- W2104886205
- Cited by
- 819
- References
- 57
- Citations by year
- 2026: 62 · 2025: 69 · 2024: 91 · 2023: 89 · 2022: 53 · 2021: 77 · 2020: 68 · 2019: 60 · 2018: 52 · 2017: 53 · 2016: 36 · 2015: 32 · 2014: 28 · 2013: 32 · 2012: 8
- FWCI
- 17.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Physical Therapy (publishedVersion)
- PubMed (publishedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- psychological factors, pain experience, chronic pain, disability, pain models, treatment principles
- MeSH terms
- Adaptation, Psychological, Attention, Cognition, Emotions, Persons with Disabilities, Humans, Learning, Models, Psychological, Pain, Pain Measurement, Psychophysiology, Health Behavior, Low Back Pain, Physical Therapy Modalities
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.
A language model drew the claims from the paper on 2026-10-05, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-05 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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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