In the last post, we started an introduction to the biopsychosocial approach to pain, seeing, in its first dimension, how there was no 1:1 relation between correlation between tissue damage and pain experience.


The second dimension is pain perception: a complex, subjective experience that involves sensory input filtered through an individual’s genetic composition, prior learning, psychological status, and sociocultural influences. The distinction between nociception and pain perception can be likened to the distinction between disease (objective biological event involving the disruption of specific body structures) and illness (subjective experience of disease.)


The third dimension is suffering: emotional (e.g. anxiety, anger) and cognitive (e.g. thoughts of helplessness) responses to pain perception. It is important to assess an individual’s emotional reactions to and cognitions about pain; they can influence recovery.”(Loeser, 1982, pp. 109-142) Suffering is an affective response generated in higher nervous centres by pain or by other affective states such as depression, isolation, fear or anxiety. The limbic lobes of the brain are critically involved in suffering. This means that suffering is contextual by nature.


Loeser’s fourth dimension is “pain behavior”: the things a person says or does, or does not do, that suggest that tissue damage has occurred. Pain behaviors are closely linked to the expression of suffering. For example, it can be seen in expressions like moaning, limping, and avoidance of certain activities. “Pain behaviors are a subset of illness behaviors and they always reflect more than tissue damage.” (Loeser, 1982)


My next post will explore some of the implications of these insights.