Psychological, Neuropsychological, and Medical Considerations in Assessment and Management of Pain

Abstract

Pain is a common yet challenging problem, particularly following traumatic injuries to the head or neck. It is a complex, multidimensional subjective experience with no clear or objective measures; yet it can have a significantly disabling effect across a wide range of functions. Persisting misconceptions owing to mind-body dualism have hampered advances in its understanding and treatment. In this article, a conceptualization of pain informed by recent research and derived from a more useful biopsychosocial model guides discussion of relevant medical, psychological, and neuropsychological considerations. This pain process model explains chronicity in terms of hyperresponsiveness and dysregulation of inhibitory or excitatory pain modulation mechanisms. Related neurocognitive effects of chronic pain are examined and recommendations for minimizing its confounding effects in neuropsychological evaluations are offered. A biopsychosocial assessment model is presented to guide understanding of the myriad of factors that contribute to chronicity. A brief survey of general classes and samples of the more useful pain assessment instruments is included. Finally, this model offers a rational means of organizing and planning individually tailored pain interventions, and some of the most useful pharmacologic, physical, and behavioral strategies are reviewed.

The hippocampus and TNF: Common links between chronic pain and depression

“…Interestingly, with increasing severity of pain or depression, the pain/depression association becomes stronger; but, it is not clear whether pain causes depression or depression amplifies the pain (Bair et al, 2003). There are five hypotheses that have been put forth to explain the comorbidity of chronic pain and depression: 1 -the 'antecedent hypothesis' states that depression precedes the development of chronic pain; 2 -the 'consequence hypothesis' in which depression is a consequence of chronic pain symptoms; 3 -the 'scar hypothesis' states that previous episodes of depression occurring before the onset of chronic pain predispose the patient to depression after the onset of chronic pain; 4 -the 'cognitive mediation' hypothesis suggests that psychological factors, such as poor coping strategies mediate the reciprocal interaction between chronic pain and depression; and 5 -the 'independent hypothesis' in which the diseases remain distinct diseases without any interaction although they share some pathogenic mechanisms (Blackburn-Munro and Blackburn-Munro, 2001;Maletic et al, 2007;Martelli et al, 2004). Therefore, while it is well-documented that chronic pain can trigger depressive symptoms and that depression manifests as both physical and emotional pain, there is still a lack of agreement on a definitive hypothesis to explain the comorbidity of chronic pain and depression.…”

“…Important goals in pain management are to avoid chronicity and to reduce the functional disability of the patient; this would require that the treatment prevent development of central sensitization by minimizing physical as well as cognitive and emotional distress caused by pain (Martelli et al, 2004).…”

Relationship Between Performance Validity Testing, Disability Status, and Somatic Complaints in Patients With Fibromyalgia

“…However, the fibromyalgia patients still reported more difficulty with subjective complaints such as pain and fatigue. While some researchers have suggested that PVTs be a routine part of evaluations with persons with chronic pain (Martelli, Zasler, Bender, & Nicholson, 2004) others have urged caution in applying the methodology of identifying cognitive malingering to the problem of malingering in patients with pain.…”

Opioid use determines success of videothoracoscopic splanchnicectomy in chronic pancreatic pain patients

“…It was proved that it can lead to constipation and pruritus [19,20] and can influence the cognitive functions of the patients [21] and their interpersonal and social relations [22]. In the context of significant influence of social support (biopsychosocial theory) on the pain reduction [23], the action of these two factors seems to be contrary. Moreover, the immunosuppressive effect of opioids was described, which can have an additional impact on the treatment of CPS in cancer patients [24].…”