Pain psychology in the 21st century: lessons learned and moving forward

Background and aimsIn the spring of 2019, Professor Steven J. Linton, the founder of the Center for Health and Medical Psychology (CHAMP) at Örebro University, Sweden, formally retired. As a tribute to his scholarly work covering decades of influence and inspiration to the field of pain psychology, the research center organized a topical conference titled “Pain in the 21st century: Where do we come from and where are we going?”, which resulted in this state-of the-art synthesis. The aim of this declaration is to highlight lessons learned but not in the least is meant to inspire and guide our continued journey forward, developing pain psychology into the 21st century.MethodsSeveral collaborators of Professor Linton have summarized and reflected on the current state-of-the-art of pain psychology from the perspective of his input to the field, as well as on developments from the last years of advancements in pain psychology.ResultsThe topics have been divided into six themed sections covering the fear avoidance model, transdiagnostics, secondary prevention, risk- and protective factors, communication and contextual factors. The sections cover a broad spectrum, from basic experimental studies, integrating emotion and motivational theories into current theoretical models, to applied research on the effect of early interventions as well as sophisticated emotion-focused treatment models for pain patients with concurrent emotional ill-health.ConclusionsThere have been major advancements within pain psychology research during the last decades, moving the field towards a more comprehensive picture, taking emotional and motivational aspects into account to understand pain sufferers. Although psychologically informed interventions in general mainly focus on the individual, it has been put forward that pain management is highly influenced by the surrounding environment, including communication with health care providers, and the occupational and social context.ImplicationsProfessor Steven J. Linton has been at the forefront of pain psychology research during the last decades, and inspired by his work this journey will continue into the 21st century, with the ultimate goal of enhancing the understanding and treatment for all people suffering from persistent and disabling pain.

Pain Psychology

Chapter 5 covers the foundations of pain clinical care in the biopsychosocial model, demonstrates how this model is applied in psychological assessment and treatment planning for patients with chronic pain, and introduces the reader to the foundational concepts in pain psychology and the major categories of psychological treatments for pain. The biopsychosocial model is examined and explained in detail with application to the case scenario that opens the chapter. The assessment of patients with chronic pain is described, and the benefits and potential risks of psychological assessment are characterized. Pain psychology concepts, including pain catastrophizing, pain anxiety, and passive coping, are explained. The major treatment paradigms, including psychoeducation, cognitive behavioral therapy (CBT), acceptance commitment therapy, relaxation strategies, mindfulness-based therapies, biofeedback, and treatment responses, are described in detail. An application of CBT is presented, explaining to the reader the process of feeding forward through automatic thoughts, feelings, and behaviors and illustrating how this is changed positively by CBT to reduce the negative impacts of chronic pain on thoughts, feelings, and behaviors, leading ultimately to less pain and less pain interference. Pain psychology is introduced in this chapter in the context of collaborative interprofessional care models.

Neuropathic Pain

Neuropathic pain is a common but complex condition. The pathophysiology and mechanisms are not fully understood. The evaluation should incorporate a detailed history and physical examination with the selective investigations. There is still no standard classification of neuropathic pain; however, it may be classified as central or peripheral or by location and etiology. The common etiologies of neuropathic pain include diabetes mellitus, chemotherapy, alcohol, inflammation, and HIV. Since neuropathic pain is a chronic condition and unlikely to be cured or to disappear, the goal of treatment includes pain control as well as improved physical functions, attenuated psychological distress, and improved quality of life. The team approach by integrating pharmacologic treatment, physical therapy, pain psychology, and complementary medicine would improve the patient’s quality of life and outcome. Key words: classification, diagnosis, etiology, neuropathic pain, treatment