Do Pain-Related Support Preferences Moderate Relationships Between Chronic Pain Patients' Reports of Support Received and Psychosocial Functioning?

Understanding the Psychological, Physiological, and Genetic Factors Affecting Precision Pain Medicine: A Narrative Review

PURPOSE

Precision pain medicine focuses on employing methods to assess each patient individually, identify their risk profile for disproportionate pain and/or the development of chronic pain, and optimize therapeutic strategies to target specific pathological processes underlying chronic pain. This review aims to provide a concise summary of the current body of knowledge regarding psychological, physiological, and genetic determinants of chronic pain related to precision pain medicine.

METHODS

Following the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, we employed PubMed/Medline to identify relevant articles using primary database search terms to query articles such as: precision medicine, non-modifiable factors, pain, anesthesiology, quantitative sensory testing, genetics, pain medicine, and psychological.

RESULTS

Precision pain medicine provides an opportunity to identify populations at risk, develop personalized treatment strategies, and reduce side effects and cost through elimination of ineffective treatment strategies. As in other complex chronic health conditions, there are two broad categories that contribute to chronic pain risk: modifiable and non-modifiable patient factors. This review focuses on three primary determinants of health, representing both modifiable and non-modifiable factors, that may contribute to a patient's profile for risk of developing pain and most effective management strategies: psychological, physiological, and genetic factors.

CONCLUSION

Consideration of these three domains is already being integrated into patient care in other specialties, but by understanding the role they play in development and maintenance of chronic pain, we can begin to implement both precision and personalized treatment regimens.

Interpretations of partners' responses to pain behaviours: Perspectives of patients and partners

OBJECTIVES

Partner's responses to pain behaviours play a pivotal role in the patient's adjustment. This study aims to further our knowledge regarding patients' and partners' interpretation of partners' responses to pain behaviours, and the possible discrepancies between patients' and partners' perceptions. Further, this study examines patients' preferred responses to pain behaviours and possible discrepancies between received and preferred responses to pain behaviours.

DESIGN

A qualitative research design based on a semi-structured in-depth interview.

METHODS

Patients with chronic low back pain and their partners (n = 54) were recruited through purposive sampling and interviewed. Data were analysed based on an inductive analytic approach.

RESULTS

Patients as well as partners indicated a number of different interpretations of partners' responses to pain behaviours, including invalidation, relieving pain, validation, encouragement, caregiving exhaustion, and expressing resentment. Patients and partners revealed similarities in the interpretation of response categories that they associated with validation, invalidation, and expressing resentment. Discrepancies between patients and partners indicated that partners interpreted some responses as caused by caregiving exhaustion while patients did not. Patients perceived partner responses that included the active involvement of the partner (e.g., encouraging pain talk) more positively than responses that showed less active involvement of the partner.

CONCLUSION

Patients and partners are likely to make various interpretations of a certain partner response to pain behaviours. Our findings underscore that patients' interpretation about a certain behaviour might determine whether that behaviour is rated as desirable or aversive.

Evaluating psychosocial contributions to chronic pain outcomes

The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.