Psychological factors are an integral component of the experience of pain.
Psychological factors influence chronic pain treatment outcomes and should be addressed as a component of pain management.
Effective treatments for chronic pain include biofeedback, relaxation, cognitive behavioral therapy, acceptance and commitment therapy, self-management, and mindfulness-based stress reduction.
Psychological factors powerfully influence postsurgical pain intensity, medication use, and surgical outcomes.
Addressing psychological factors prior to surgery may enhance surgical response, pain resolution, and opioid cessation. Studies are needed to assess the efficacy of presurgical psychological ‘prehabilitation’ treatments.
Psychological factors profoundly influence the experience of pain. Fundamentally and teleologically, pain is a warning that motivates behavior to escape actual or potential harm. In the case of acute injury, pain serves an adaptive function in that it reinforces protective behaviors that help to protect the organism against further bodily damage. However, in the surgical or chronic pain contexts, the experience of pain is often more complex because of the multitude of biopsychosocial, behavioral, and environmental factors at play within each individual. These factors shape an individual’s patterns of cognition, emotion, and behavior to varying degrees of magnitude and valence, thereby impacting pain intensity, pain duration and pain treatment needs.
To date, the pain psychology literature and research has focused primarily on patients with chronic pain, although the perioperative pain psychology literature has been growing in recent years. The purpose of this chapter is to provide a high-level overview of pain psychology in surgical and chronic pain patients, including correlates and predictors of outcomes. This chapter also reviews prominent evidence-based psychological treatments for pain and emerging trends in the field of pain psychology relevant to both contexts. Finally, we provide practical information for resourcing the treatments discussed.
PSYCHOLOGY AS AN INTEGRAL COMPONENT OF PAIN
Pain has been historically viewed as exclusively a negative sensory experience, thereby defining pain as something that occurs in the body and linearly related to the stimulus intensity. However, the contemporary definition of pain encompasses the sensory and emotional experience,1 thereby establishing psychology as an integral component of the pain experience. Considering that the primary function of pain is to serve as a “harm alarm,” it follows that anxiety, fear, and dread may be among the emotions commonly elicited by pain across different contexts and settings. Various emotions, in turn, modulate pain;2 in this way, pain and emotion appear to share a mutually influential relationship. The subjective nature of pain is such that two people receiving the same noxious stimulus can have two entirely different pain experiences, with one person rating it far more painful than the other person. What accounts for the individual differences in pain intensity ratings? Some of the individual factors that influence sensory perception, pain modulation, and the experience of pain include genetics, sex/gender,3,4 age,5 medical and psychological comorbidities,6...