Cognitive models of chronic pain

As described in the previous sections of this book, psychological theories work from the perspective that pain, and the disability related to it, are not only influenced by physiological pathology but also by psychological and social factors. Chronic pain is not only a somatic problem. It is influenced by the individual’s attitudes and beliefs about their symptoms and the distress and behavioural responses initiated by their experience of pain. There are a number of psychological theories related to chronic pain, however, behavioural and cognitive-behavioural theories are the most relevant ones which have been discussed in previous chapters. The purpose of the following section is to describe predominately cognitive models to pain processing and to review the evidence concerning the cognitive mechanisms by which psychological factors modulate pain in both clinical and experimental contexts. The experience of pain is never an isolated sensory event and it never occurs without the influence of context and meaning. Pain is influenced by beliefs, attention, expectations and emotions, regardless of whether it occurs during the most controlled laboratory circumstances or during circumstances of physical trauma or emotional distress (Price and Bushnell 2004).