Psychosocial stress and chronic pain: a threshold model of biological lock-in

Key Points

1. Chronic pain reflects positive feedback driven neuroimmune activation and lock-in.

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BACKGROUND & OBJECTIVE

Meta-analysis show that psychological interventions work poorly once chronic pain is established (1). Using Social Safety Theory (2) and dynamical systems principles, a threshold model for the emergence and persistence of chronic pain states via biological lock-in was proposed. This paper aimed to investigate the paradox between psychosocial stress driving the emergence of chronic pain.

Psychosocial stress was defined as exposure to socially threatening experiences (social adversity, chronic life stressors, trauma) and the coordinated biological responses these experiences elicit (activation of stress-responsive neuroendocrine and immune systems) (2).

The authors’ objective was to propose that a biological phase transition occurs involving a qualitative reorganisation of the nociceptive apparatus, that is difficult to reverse solely with psychological interventions. Once this biological threshold is crossed and pain becomes persistent, it is proposed that a self -sustaining pathological state is established.

Using Social Safety Theory and dynamical systems principles, a threshold model for the emergence and persistence of chronic pain states via biological lock in was proposed.

If post threshold locked-in nociceptive apparatus function is present, psychological interventions can only be adjunctive for coping and quality of life.

METHODS

The authors performed an extensive literature review, developing their threshold model of biological lock-in & suggestions for interventions.

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