The Biopsychosocial Components of Pain

Posted on Friday, December the 28th at 7:07pm

By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

Learning More About Pain

In order to understand effective pain management you need to first understand the concept of pain.  Pain is a signal from the body to the brain that tells you that something is wrong.  There are three components of pain—biological, psychological, and social/cultural. 

Pain is not easy to define and in 1979, the International Association for the Study of Pain (IASP) published its first working definition of pain: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

This definition was reaffirmed in 1994 along with an extensive footnote discussion regarding its implications.  The IASP definition acknowledges that, for most people, tissue damage is the gold standard by which pain is understood.  However, the definition also recognizes that pain may occur in the absence of tissue damage and is impacted by emotional (psychological) factors. 

In a footnote explaining the definition, the authors point out that pain is not equivalent to the process by which the signal of tissue damage is passed through the nervous system to the brain (this is called nociception); rather, pain is always a psychological state that cannot be reduced to objective signs.  In other words, pain is always subjective—there is no test or instrument that can measure anyone’s personal experience of pain.

Pain is a total biopsychosocial experience.  You hurt physically.  You psychologically respond to the pain by thinking, feeling, and acting.  You think about the pain and try to figure out what is causing it and why you’re hurting.  You experience emotional reactions to the pain.  You may get angry, frightened, or frustrated by your pain.  You talk about your pain with family, friends, and coworkers who help you to develop a social and cultural context for assigning meaning to your personal pain experience, which leads to taking appropriate action.

The Gate-Control Theory of Pain

A theory of pain that was developed in the early 1960’s was called the gate control theory of pain and it was developed originally by Melzack and Wall.  The gate control theory changed the way in which pain perception was viewed.  The basis of this theory is the idea that physical pain is not a direct result of activation of pain receptor neurons, but rather its perception is modulated by interaction between different neurons.  This theory also proposes that cognitive (thinking) and emotional (feeling) factors influence the perception of pain—that there is much more than just physiological factors involved.

Your brain commonly blocks out sensations that it knows are not dangerous, such as when the feel of tight-fitting shoes that are put on in the morning has all but vanished in a very short time period.  A similar process is at work in processing some moderately painful experiences. 

In the gate control theory, the experience of pain depends on a complex interplay of two systems as they each process pain signals in their own way.  Upon injury, pain messages originate in nerves associated with the damaged tissue and flow along the peripheral nerves to the spinal cord and on up to the brain.

In the gate control theory, before the pain messages can reach the brain they encounter nerve gates in the spinal cord that open or close depending upon a number of factors (including instructions coming down from the brain).  When the gates are opening, pain messages get through more or less easily and pain can be intense.  When the gates close, pain messages are prevented from reaching the brain and pain may not even be experienced.  The gate control theory attempts to explain the experience of pain (including psychological factors) on a physiological level. 

When living with chronic pain it is important to understand the gate control theory of pain.  This provides an excellent foundation to understand what factors can open and close the spinal nerve gates.  An in depth explanation of the gate control theory is beyond the scope of this article.  If you seek additional information please refer to: (a) Melzack, R. and Wall, P.  (1965).  Pain mechanisms: A new theory. Science, 150, 971-979; and (b) Melzack, R. and Wall, P.  (1982).  The challenge of pain. New York: Basic Books.

Successful pain management systematically approaches the treatment of pain at three levels simultaneously—biological, psychological and social.  This means using physical treatments to reduce the intensity of the physical pain.  It also means using psychological treatments to identify and change the thoughts, feelings, and behaviors that are making the pain more intense or distressing and replacing them with positive thinking, as well as feeling and behavior management skills that can reduce the intensity of the pain. 

Therefore, effective pain management must involve not only you, but also the significant people in your life who can help you to develop a social and cultural context in which to experience your pain in a way that reduces any suffering.

The Biological Component of Pain

Biological pain is a signal that something is going wrong with your body.  The biological, or physical, pain sensations are critical to human survival.  Without pain you would have no way of knowing that something was wrong with your body. So without pain you would be unable to take action to correct the problem or deal with the situation that is causing the pain.  There are some unfortunates that are born with a compromised pain system and most of them suffer serious problems as a result.  Imagine that you put your hand on a hot stove and you have no pain receptors in that hand.  Your first indication of a problem would be when you smell burnt flesh.  By then the damage to your hand is very extensive.

The Psychological Component of Pain

Psychological Pain results from the meaning that you assign to a pain signal.  The psychological symptoms include both cognitive (thinking changes) and emotional (uncomfortable feelings) that often lead to suffering.  Most people are not able to differentiate between the physical and psychological symptoms.  All they know is “I hurt.” For effective pain management you need to learn all you can about your pain.

The Social/Cultural Component of Pain

Social and Cultural Pain, results from the social and cultural meaning assigned by other people (or your culture/society as  a whole) to the pain that you are experiencing, and whether or not the pain is recognized as being severe enough to warrant a socially approved sick/injured role.  These three components determine whether the signal from the body to the brain is interpreted as pain or suffering. 

Imagine the following vignette:  Bob is his college’s star football player.  In the previous week’s homecoming game Bob scored the winning touchdown but broke his arm in the process.  This week Bob is sitting on the bench with a cast on his arm that everyone has signed.  This cast and how he earned it are seen as an honorable reason for him to be sitting on the bench instead of out on the field helping his team.  But, in that same game Karl, a big hulking lineman, “tweaked” his back and was also sitting on the bench this week.  Unlike Bob, Karl doesn’t have an observable injury and people keep asking him why he isn’t out on the field helping his team.  Karl is much more apt than Bob to experience shame/guilt, which will probably amplify his pain symptoms.

Your job is not over now that you have learned a little more about the biopsychosocial nature of pain.  Knowledge without action is a dead end street.  The Addiction-Free Pain Management™ System can help people with chronic pain better manage their condition without the cost or risk of an addictive disorder.  Knowledge is power—the more you know the more you can do. Are you are willing to put this into action?