Toward a model of the pathogenesis of chronic pain.
There is widespread agreement that chronic pain develops from, and is maintained by, a combination of neurobiological, psychological, and social factors. Nevertheless, few comprehensive models have been proposed that present specific testable predictions about how these factors interact. We propose a vulnerability-diathesis-stress model of the pathogenesis of chronic pain. This model is based on diathesis-stress models of psychopathology and on the results of recent research on psychosocial aspects of chronic pain. The goals of research on chronic pain are to understand its pathogenesis, improve its treatment, and prevent its development. To achieve these goals, prospective studies of the development and maintenance of chronic pain are needed. The vulnerability-diathesis-stress model can serve as a basis for designing and analyzing studies of the interaction among biological, psychological, and social risk factors for chronic pain.
Dworkin
R H
RH
Departments of Anesthesiology and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. dwrkn@troi.cc.rochester.edu
Hetzel
R D
RD
Banks
S M
SM
D002908:Chronic Disease; D003865:Major Depressive Disorder / Q000209:etiology*; D004198:Disease Susceptibility; D006801:Humans; D008016:Life Change Events; D010146:Pain / Q000523:psychology*; D010554:Personality Disorders / Q000523:psychology; D011582:Psychological Theory; D012307:Risk Factors; D013315:Stress, Psychological / Q000523:psychology