Biological, Psychological And Social Factors Influence Individual Pain Differences

Main Category: Pain / Anesthetics
Article Date: 08 May 2009 - 1:00 PDT

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Why would two patients undergoing the same surgery report vastly different levels of post-operative pain and are genetic factors mainly responsible? A leading pain researcher in a plenary address at the American Pain Society (APS) Annual Scientific Conference believes this discrepancy is more understandable if clinicians acknowledge that pain is a variable personal experience that is influenced by genetics but also involves multiple interactive biopsychosocial processes.

Roger B. Fillingim, PhD, professor, University of Florida College of Dentistry, told his APS audience that individual differences in pain responses have been a longstanding research concern, however, both scientists and clinicians often dismiss pain variability as a nuisance and refer to those whose pain responses differ from the norm as outliers. Today renewed interest in the issue has been spurred by the genetic revolution.

"Though genetic influences are a significant force that determines someone's response to pain, both genetic and nongenetic variables interact to influence the pain experience," said Fillingim.

He said individualized differences in pain responses should be studied within the context of a broader biopsychosocial perspective. "Characteristics such as age, sex, race and ethnicity, and personality all have been associated with pain responses, as well as situational variables like mood, stress and cognitive processes."

Fillingim explained that in the biopsychosocial model of pain response, individual differences are determined by the complex interaction of biological, psychological and sociocultural factors, and not by linking pain with clinical pathology. "Abundant evidence shows that pain and tissue damage are poorly related and there are significant differences among individual patients in their perception of pain that extend beyond pathology," he said.

In evaluating arthritis patients, for example, Fillingim said tender and swollen joints and radiographic measures are relatively poor predictors of pain and function. However, psychosocial factors consistently account for significant variance in pain reports in these patients.

Fillingim advised clinicians that knowing the social and psychological situations of their patients can be helpful in gauging responses to pain and to morphine and other pain medications. "It's true that one size does not fit all, so we can't assume everyone is average when it comes to managing pain. Psychological, social and cultural factors, as well as life experiences, all play a role in pain responses. "The best course for clinicians is to get to know your patients better from a holistic perspective and gain a more complete understanding of their life situations and how they might influence pain responses. Don't just rely on clinical symptoms and clinical pathology to predict responses to pain and pain management treatments."

About the American Pain Society

Based in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organization. APS has enjoyed solid growth since its early days and today has approximately 3,200 members. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and more.

Source: American Pain Society

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