Psychosocial and Cultural Aspects of Pain
To best conceptualize a pain case, the biopsychosocial model is utilized. This is defined as the integration of pathophysiology, mental health-related events, and context determined historically and situationally that are associated with the individual’s
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Kathleen A. McChesney and Genelle Weits
ain Is a Biopsychosocial P Experience To best conceptualize pain, the traditional biomedical model is insufficient. The model does not take into account psychosocial, cultural, and environmental influences on the pain experience. The biopsychosocial model more accurately accounts for the individual’s complex interactive systemic experience of pain. Unlike the unilateral and deterministic biomedical model, this approach emphasizes that pain is more than a physical symptom resulting from a disease process, tissue injury or pathology. Rather, pain is “...a subjective perception that results from the transduction, transmission, and modulation of sensory input filtered through a person’s genetic composition and prior learning history and modulated further by the person’s
K.A. McChesney, PsyD (*) Department of Surgical Services, Pain Medicine Center, Naval Medical Center, 34800 Bob Wilson Drive, Building 1, 4th Floor, Suite 409, San Diego, CA 92134, USA e-mail: [email protected] G. Weits, PhD (*) Adult Outpatient Mental Health, Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA 92134, USA e-mail: [email protected]
current physiological status, ideosyncratic appraisals, expectations, current mood state, and sociocultural environment” (Turk & Monarch, 2002). This comprehensive model as illustrated in Fig. 31.1 integrates pathophysiology (biological), mental health status (psychological), and environment (social). Etiology is multifaceted, and moderating variables influence perception, interpretation, presentation, and prognosis. Biology, psychology, social and cultural factors influence how pain ins manifested and whether psychological symptoms reflect pain neurophysiology alone, independent psychiatric disorders, or a functional interaction together. paPsychological symptoms do not necessarily constitute pathology. sRather, many psychological symptoms are diretly associated with pain neurophysiology. NOTE: Once pain becomes chronic (> 6 months) sensory input plays a dimished role and affective and cognitive pathways play a more prominent role in the creation of painful perceptions (Apkarian, et. al. 2005 in Williams, 2013). Therefore, physical pathology does not always predict severity of pain or level of disability and pain severity does not adequately determine psychological distress or extent of disability observed. Cognitive appraisals, interpretations, understanding of one’s status and prognosis play a crucial part in the differential versus co-morbid diagnoses and treatment of the individual.
© Springer International Publishing Switzerland 2017 R.J. Yong et al. (eds.), Pain Medicine, DOI 10.1007/978-3-319-43133-8_31
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The Commission on Accreditation Rehabilitation Facilities (CARF) only accredits chronic pain programs that are interdisciplinary in evaluation and treatment and have a psychologist/psychiatrist as part of the core team. Objectives of the psychosocial assessment of a pain patient are to include: 1. Understandin
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