Pain is a condition that currently affects millions of people. In Spain, the percentage of the population suffering from pain is around 23.4%, making it one of the most impactful issues today. Furthermore, it has become one of the main causes of suffering and distress due to the fact that this condition is accompanied by other factors of different natures. Thus, a pathology that until very recently was considered to be of organic nature, is now considered to be a problem of psychological or social nature due to the expansion of its repercussions.
In this sense, there has been a notable evolution in the conception of pain, moving from simplistic approaches to current multidimensional models, becoming a complex issue due to various neurological advances and, especially, the research by Melzack and Wall with the so-called „Gate Control Theory”. As a consequence, the number of research studies regarding the role of psychological factors in the pain process has increased. Within this field, Lazarus’ stress model has been incorporated, which delves into the evaluation and coping of the individual in the face of a potentially threatening event. According to this theory, the experience of pain could cause greater or lesser disability depending on how it is evaluated and coped with.
What is pain? The definition of this condition has evolved over time, generating new forms of study and treatment. The initial definitions emphasized the physical or organic nature of this pathology, considering it as a physical sensation that arises as a direct consequence of tissue damage. From this perspective, if there is pain, there must be a wound or damage to justify it. However, later on, the International Association for the Study of Pain (IASP) described it as a „sensory and emotional experience associated with actual or potential tissue damage”. As a result, psychology starts to have greater relevance in the study and treatment of this condition. Furthermore, by highlighting the mention of „potential damage”, cases where there is a sensation of pain without actual injury are included; therefore, a possible perception of pain is discussed in which no organic cause is detected. Currently, pain is considered a multidimensional phenomenon composed of perceptual and affective experiences that are conditioned by various interactive factors (organic, psychological, social, cultural, etc.).
Along these lines, it is from the 1980s onwards when pain begins to be understood as a complex subjective experience that requires a biopsychosocial intervention, that is, it is considered as the result of the interaction of factors of different natures. These factors can produce, maintain, and/or worsen the existing condition by acting as modulators that influence the individual’s subjective internal experience, nociceptive stimulation, and responses. Furthermore, it has been found that psychological factors play a fundamental role in conditions involving chronic pain, such as fibromyalgia, which is a pathology in itself.
Psychological factors associated with pain: On the other hand, several research studies have observed that cognitive and emotional variables such as anxiety, sadness, or anger can better explain the differences found in terms of pain perception and tolerance than other personality variables. In many cases, pain can generate some degree of disability due to the repercussions it has in different areas of life (work, academic, family, etc.). Feelings of uselessness and alterations in mood are also common, which can lead to a deterioration in interpersonal relationships. Socially, feelings of incomprehension are frequent, even from loved ones. Additionally, the difficulty of establishing a medical diagnosis and an appropriate treatment for these conditions increases the perception of misunderstanding by professionals. This situation, together with mood alterations and interpersonal conflicts, can lead to a continuous feeling of loneliness.
On the other hand, some of the emotional responses most associated with pain are:
Anxiety: Through different research studies, the relationship between anxiety and pain has been demonstrated. Anxiety acts as an amplifier capable of increasing the intensity of perceived sensation and the maintenance of pain. It has also been observed that individuals with chronic pain conditions have higher levels of anxiety and a higher rate of related disorders.
Emotional disturbances: Depression is a pathology that has attracted great interest from pain researchers. In some studies, a higher prevalence of this condition has been observed in people with chronic pain. However, the prevalence has shown great variability in different research, making it difficult to determine the level of comorbidity between both conditions.
Anger: This is one of the most observed emotional responses in chronic pain research. This response is favored by various situations such as the limited available information about the cause of the problem, failures in different treatments, persistent somatic complaints, etc. These situations can generate a continuous sense of frustration and lead to an intense anger response. Anger is one of the emotions that can produce the greatest physiological activation in the body, consequently increasing the perceived level of pain.
In addition to these emotional responses, other factors linked to this condition include:
Previous history: Similar to other pathologies, the individual’s previous history influences the origin and maintenance of chronic pain. In reference to chronic pain, individuals suffering from this condition have a higher percentage of parents who also have a similar pathology compared to those without pain. Furthermore, regarding their past experiences, a higher prevalence of stressful and adverse situations has been found.
Social support: This factor has been considered a modulator of pain. Studies have indicated the presence of less pain and/or disability in individuals who perceive having a greater social support network. Through this support, individuals have the opportunity to share their experiences and feel listened to, as well as receive more information, which could improve their coping strategies.
Coping strategies: These strategies have been linked to variations in parameters involved in pain perception, emotional response, and their consequences (disability, interference, etc.). Likewise, several studies have observed that the strategies used by individuals predict their adjustment to the pain. In this regard, passive coping strategies have been associated with higher intensity and frequency of pain perception, higher levels of stress, and more frequent medical visits. On the other hand, active coping has been associated with a decrease in pain parameters and disability or interference.
To conclude, it is important to highlight that the evolution of the concept of pain has led to changes in the modalities of intervention, where psychological treatment has become an essential element that is part of many multidisciplinary intervention packages. However, despite recognizing the great influence of emotional factors in this pathology, the presence of psychologists remains scarce in some pain treatment units.
