In the last couple posts we’ve explored the four dimensions of the biopsychosocial approach to pain. The upshot of the story is that tissue damage alone cannot reveal pain to us and in fact an approach is required that attends to a range of behavioural, psychological and social factors – as well as the physical.


For example, increased disability is associated with beliefs that pain is a sign of damage, so activity should be avoided when one has pain, and that pain is permanent (Balderson, Lin & Von Korff, 2004). Similarly, depressed pain patients are unmotivated to comply with treatment recommendations (Von Korff & Simon, 1996) and anxious patients may fear day-to-day activities will exacerbate their pain. (Vlaeyen, Kole-Snijders, Rotteveel, Ruesink, & Heuts, 1995) In sum, people’s affective and cognitive responses to pain have the potential to negatively affect the course of their pain condition.


An individual’s beliefs about pain, emotional experience, and pain behavior are interrelated. For instance, behavioral experience can show patients they are capable of participating in their regular, daily activities, and reduce thoughts of helplessness and negative emotions. (Vlaeyen et al., 2002) Additionally, some cognitive coping strategies (e.g., problem solving, goal setting) can increase an individual’s self-efficacy regarding the control of emotional and behavioral responses. (Samwel, Evers, Crul, & Kraaimaat, 2006; Turner & Romano, 2001)


In a one-year follow-up study on the effects of a personal construct group-learning program on patients with chronic musculoskeletal pain, researchers Eldri Steen and Liv Haugli (2001) found that lack of control and inefficient coping with internal and external demands contribute to pain and pain behavior. Taking into account the four dimensions of pain experience (nociception, pain perception, suffering, and pain behavior), the biopsychosocial approach to managing chronic pain is an improvement to the biomedical approach.