Pain Worlds: Towards the Integration of a Sociocultural Perspective of Pain in Clinical Physical Therapy

Abstract

The World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) model has been advocated as a model of function to conceptualize physical therapist practice. Among its advances, the WHO-ICF model explicitly recognizes the existence of social factors that may influence patients' and clients' understanding of pain. However, understandings of the historical, social and cultural processes that shape the individual and collective experiences of pain and the therapeutic relationship remain limited. We call for a more intentional and sustained dialogue between clinical practice and sociology to help elucidate the nature, characteristics, complexities and clinical implications of one specific element of the WHO-ICF model, environmental factors. The purpose of this review is to advocate for the continued adoption of a sociological lens to help physical therapists better understand the broader networks of people, ideologies and practices in which people 'in pain' are enmeshed and the historical, geographical and cultural spaces in which they operate. In this review, we discuss existing empirical findings in sociology to introduce the concept of 'pain worlds', which can be applied by physical therapists to help characterize the sociocultural factors identified in the WHO-ICF model. Pain worlds is designed to complement the WHO-ICF model and assist in developing interdisciplinary research agendas that illuminate and examine the role, significance and clinical implications of sociocultural and environmental dimensions of pain. We conclude with a brief set of recommendations for the development of such translational research agendas and call for the integration of pain worlds in clinical practice.

Understanding cultural influences on back pain and back pain research

“…For example, religion can be considered a possible instrument for the handling of pain in some patients who are believers [64], especially those who have spiritual beliefs about the cause of their pain. When we consider other social groups -such as athletes -where a culture exists of disregarding risk of physical harm, and pain and disablement are normalised [65], enforced rest or restricted activities may play an important role. However, many studies on pain management in cultural minorities are flawed as they rely on convenience samples, have small sample sizes, or collect data retrospectively [20,38].…”

Challenges and Opportunities in Developing Tailored Pain Management Strategies for Liver Patients

“…Pharmacogenomic testing examines crucial genes that produce enzymes involved in drug metabolism, providing insights into an individual's potential reaction to particular drugs. One example is the cytochrome P450 family of enzymes, including CYP2D6 and CYP3A4, vital in breaking down certain pain-relieving drugs, such as opioids [ 24 ]. Genetic differences in these enzymes can lead to individuals being classified as poor metabolizers, extensive metabolizers, or ultra-rapid metabolizers.…”

“…Pharmacogenomics aids in understanding an individual's reaction to opioids, thereby contributing to this urgent matter. Genetic differences in opioid receptors, namely the mu-opioid receptor (OPRM1), have an impact on the effectiveness and possible adverse reactions of opioids [ 24 ]. Through the identification of genetic markers linked to heightened sensitivity or reduced response to opioids, healthcare providers can make well-informed choices regarding opioid prescriptions, thereby reducing the chances of overdose or insufficient pain management.…”

“…Healthcare providers can utilize genetic information to tailor the selection of analgesic drugs, doses, and administration methods instead of using a standardized strategy for pain management. Recent research has investigated the application of pharmacogenomic testing to enhance pain management for illnesses such as osteoarthritis and postoperative pain [ 24 ]. Research indicates that integrating pharmacogenomics into pain management regimens not only enhances pain outcomes but also decreases the occurrence of adverse medication reactions.…”