The establishment, maintenance, and adaptation of high- and low-impact chronic pain: a framework for biopsychosocial pain research

Eccleston, Christopher, Begley, Emma, Birkinshaw, Hollie, Choy, Ernest ORCID: https://orcid.org/0000-0003-4459-8609, Crombez, Geert, Fisher, Emma, Gibby, Anna, Gooberman-Hill, Rachael, Grieve, Sharon, Guest, Amber, Jordan, Abbie, Lilywhite, Amanda, Macfarlane, Gary J., McCabe, Candida, McBeth, John, Pickering, Anthony E., Pincus, Tamar, Sallis, Hannah M., Stone, Samantha, Van der Windt, Danielle, Vitali, Diego, Wainwright, Elaine, Wilkinson, Colin, de C Williams, Amanda C., Zeyen, Anica and Keogh, Edmund 2023. The establishment, maintenance, and adaptation of high- and low-impact chronic pain: a framework for biopsychosocial pain research. PAIN 164 (10) , pp. 2143-2147. 10.1097/j.pain.0000000000002951

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Abstract

We present a framework for the study of states of chronic pain and transitions between those states. We capture in the framework the dynamic nature of pain: people live with pain that changes over time. First, we offer definitions of both acute and chronic pain and explore the contextual considerations related to the common use of this temporal dichotomy. Second, we promote the importance of incorporating the impact pain has on a person's life. Finally, we discuss the challenges and opportunities inherent in implementing this common approach. Our goal is to produce a framework for the study of the development, maintenance, and resolution of chronic pain. Whether a single brief event or a constant feature of life, pain interrupts to prioritise protection, interferes with activity, reduces quality of life, and can alter identity.44 Protection is achieved by escape from harm, avoidance of perceived danger, withdrawal for respite and repair, and communication of incapacity and environmental risk; longer-term protection is achieved by learning the cues for pain and injury.53 From this perspective, pain is most usefully considered a need state, fundamentally a motivational drive to protect.49 This approach centres our attention on the consequences of pain for the person in their context, on its duration and its impact.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Lippincott, Williams & Wilkins
ISSN:	0304-3959
Date of First Compliant Deposit:	18 August 2023
Date of Acceptance:	14 April 2023
Last Modified:	05 Oct 2023 17:55
URI:	https://orca.cardiff.ac.uk/id/eprint/161923

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