A Biopsychosocial Approach to Chronic Pain: Epidemiology, Assessment & Treatment.

Pain is certainly one of the most common reasons for which patients seek medical treatment. The relief of pain is one of the physicians primary tasks, and the expectation of this relief often leads to the patient's idealization of the physician. While current understanding of the scientific basis of acute pain is minimal, that of chronic pain is even less. Chronic pain appears to serve no biological function, yet it remains resistant to treatment. Moreover, this condition seems to inhibit the patient's capacity to function and to enjoy life instead of serving the patient in some protective function. The patient gradually gives in to changes in behavior and affect, which in themselves are undesirable and maladaptive and, in turn, require treatment. Finally, besides the physical and emotional turmoil, chronic pain adds significant economic as well as social stress to the patient, family and society (Kouyanou, Pither, Rabe-Hesketh, & Wessely, 1998).

The present paper will present an overview of the latest advances in the literature related to non-pathological or benign-chronic pain. In other words, for purposes of this paper, chronic pain will refer to pain of a chronic nature for which no organic or tissu pathology is presently identified, eventhough the origins of that pain might have been of organic nature. The first section will present a biopsychosocial definition of chronic pain and will contrast chronic with acute pain. The second section will discuss the different methods that serve the assessment process of chronic pain. The third section will review the latest epidemiological data of chronic pain and will emphasize preventive care methods (primary, secondary and tertiary). The fourth section will present the role of treatment (biopsychosocial approaches) in dealing with chronic pain patients on an individual as well as on a community basis. Finally, the last section will outline some concluding remarks as well as future directions related to chronic pain research.

1. Chronic Pain: Conceptualization

The concept of chronic pain has been recognized and studied since antiquity. Historically, etiology of chronic pain has lied within different mystical, spiritual, and religious structures. Western thinking has been influenced by religious explanations of chronic pain, with pain conceptualized as a punishment inflicted by God for sins committed by the sufferer. In fact, the word pain is derived from the Latin word peona, meaning punishment. It was further believed at that time that the heart was the center of sensation and that pain was the result of increase in the sensitivity to touch, which was carried by the blood to the heart (Todd, 1999). This interpretation of pain was the predominant one in the Western world until it was replaced by Descartes' hypothesizing that the brain was the center of sensation and that pain was transmitted by means of threads running from the skin to the brain. With the identification of specific pain receptors in the periphery of the brain and pathways from the periphery to the brain, Descartes' hypothesis was supported (Todd, 1999).

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Yaniv M. Benzimra, Ph.D.
Consulting Psychologist
Y2 Consulting Psychologists