After reading this chapter, you should be able to:
• understand the basic physiology underlying the experience of pain
• describe the biopsychosocial perspective of pain
• understand the problems that arise when acute pain becomes chronic/persistent
• understand the psychological theory associated with the psychosocial management of chronic pain
• have a basic understanding of current evidence-based psychosocial approaches for the management of chronic pain
• know what is needed in the field of pain management, from a health psychology perspective, to optimise treatment and public healthcare resources.
Pain is a highly complex, universal phenomenon that at some point in our lives nearly all of us have experienced. At its core, pain is adaptive and is as essential to our everyday existence as being able to see, hear, touch, taste and smell; the reason is that pain entails a ‘withdrawal’ function designed to prevent and/or minimise harm to our body. Rare individuals who are born with a congenital insensitivity to pain experience an abnormal number of injuries, such as cuts, burns and infections, due to their inability to perceive and respond appropriately to painful stimuli, and they usually die young. Such individuals do not know how to avoid activities that cause harm, and are unable to report when they are feeling ill (Melzack & Wall, 1982).
Most often, especially when we are young and relatively healthy, pain naturally diminishes as the source (i.e. the injury of whatever form) heals. However, in some cases, pain persists beyond the normal or expected healing time, and pain becomes chronic. Chronic pain is pain that extends for at least 3 to 6 months (depending on the classification system used), and it affects hundreds of millions of individuals worldwide (Task Force on Taxonomy, IASP, 1994). It is not only associated with critically high financial costs, but also carries with it a tremendous emotional, social and psychological burden. Health psychologists have an important role in helping to effectively rehabilitate individuals with acute pain following injury.