Psychological, cognitive factors and contextual influences in pain and pain-related suffering as revealed by a combined qualitative and quantitative assessment approach

Abstract

Previous psychophysiological research suggests that pain measurement needs to go beyond the assessment of Pain Intensity and Unpleasantness by adding the evaluation of Pain-Related Suffering. Based on this three-dimensional approach, we attempted to elucidate who is more likely to suffer by identifying reasons that may lead individuals to report Pain and Pain-Related Suffering more than others. A sample of 24 healthy participants (age range 18–33) underwent four different sessions involving the evaluation of experimentally induced phasic and tonic pain. We applied two decision tree models to identify variables (selected from psychological questionnaires regarding pain and descriptors from post-session interviews) that provided a qualitative characterization of the degrees of Pain Intensity, Unpleasantness and Suffering and assessed the respective impact of contextual influences. The overall classification accuracy of the decision trees was 75% for Intensity, 77% for Unpleasantness and 78% for Pain-Related Suffering. The reporting of suffering was predominantly associated with fear of pain and active cognitive coping strategies, pain intensity with bodily competence conveying strength and resistance and unpleasantness with the degree of fear of pain and catastrophizing. These results indicate that the appraisal of the three pain dimensions was largely determined by stable psychological constructs. They also suggest that individuals manifesting higher active coping strategies may suffer less despite enhanced pain and those who fear pain may suffer even under low pain. The second decision tree model revealed that suffering did not depend on pain alone, but that the complex rating-related decision making can be shifted by situational factors (context, emotional and cognitive). The impact of coping and fear of pain on individual Pain-Related Suffering may highlight the importance of improving cognitive coping strategies in clinical settings.

Assessment and Brain Training of Patients Experiencing Head and Facial Pain with a Distortion of Orofacial Somatorepresentation: A Narrative Review

“…Normal tactile acuity depends on a competent epicritic sensory system and an adequate central processing of the efferent signals. For example, in chronic neck [40], low back pain [41] and complex regional pain syndrome [42], activity levels are changed in the somatosensory cortex (S1). In comparison with healthy subjects, TMD patients suffering from myofascial pain have a decreased S1 grey-matter volume as defined by structural MRI, which may be expressed in a reduced sensory function [43], supported by the results obtained at the two-point discrimination test, which indicates a decrease in the discriminative threshold [34].…”

Developing a patient-centred tool for pain measurement and evaluation in autosomal dominant polycystic kidney disease

“…In addition, the APAT uses 22 pain descriptors, providing a much wider range of qualitative pain descriptions for patients to use. Therefore, by designing an APAT that allows broader capture of these pain syndromes, we are better positioned to understand the key influences of pain perceptions and experiences [ 23 ]. The APAT was also administered to ADPKD patients covering a spectrum of CKD Stages 1–4, although further validation through administration to larger cohorts is essential.…”

The lived experience of anxiety and the many facets of pain: A qualitative, arts-based approach

“…By examining the role of pain in the lived experiences of youth with anxiety disorders, this study explores the ways in which anxiety and pain are interrelated. In youth experiencing pain, anxiety-related mental states (e.g., fear of pain and catastrophizing) 69 and anxiety-provoking social contexts (e.g., isolation, interpersonal conflict) 21 augment suffering. Yet youths’ narratives reinforced the multidimensional and interrelated nature of pain; for these youth, pain is experienced as much more than physical, also encompassing mental, emotional, and social dimensions.…”