The psychobiology of chronic pain

Biomedical and psychological perspectives on chronic pain have each advanced our understanding of the development and maintenance of chronic pain syndromes and have led to more effective assessment and treatment approaches. Little attention, however, has been given to the development of a comprehensive model that integrates both biomedical and psychological variables in the etiology, maintenance, and exacerbation of chronic pain. The purpose of this article is to propose a dynamic psychobiological model of chronic pain that emphasizes the interaction among psychological and biomedical variables. The experience of pain is viewed as a complex response that incorporates subjective-psychological, motor-behavioral, and physiological-organic components. Moreover, we postulate that there are varying degrees of synchrony among responses measured on these levels determining the development and etiology of chronic pain syndromes. Specifically, we propose that the development and maintenance of chronic pain is a function of several interacting components: (a) a predisposition to respond with a specific bodily system, (b) external or internal aversive stimulation, (c) maladaptive information processing of and coping with pain-related social and/or physiological stimuli, and (d) operant, respondent, and observational learning processes.