Handbook of Health Psychology

By Andrew Baum; Tracey A. Revenson et al. | Go to book overview

dorsal horn. The inhibitory system utilizes several neurotransmitters including serotonin, enkephalin, norepinephrine gamma aminobutyric acid (GABA), and somatostatin. The periaqueductal grey receives neuronal fibers from cortex, hypothalamus, and the limbic system, probably explaining the interaction of cognitive and emotional elements with pain perception and inhibition. Given the same noxious stimuli, the pain perception between two people may vary according to the phenomenon of attention or inhibition, both of which are probably modulated by various descending neurons. Emotion, attention, and motivation may all influence pain perception, probably through a complex network of reticular, limbic, and cortical fibers.


From the patient's point of view, the pain complaint connotes distress and is a plea for assistance. The subjective experience includes an urge to escape from the cause or, if that is not possible, to obtain relief. It is the overwhelming desire to terminate it that gives pain its power. Pain can produce fear, and if it persists, depression, and ultimately it can take away the will to live.

It has become abundantly clear that no isomorphic relation exists between tissue damage and pain report. The more recent conceptualizations discussed view pain as a perceptual process resulting from the nociceptive input and modulation on a number of different levels in the CNS and not as directly proportional to nociceptive input.

Pain is a subjective, perceptual experience, and one characteristic differentiating it from pure sensation is its affective quality. Thus, pain appears to have two defining properties: bodily sensation and an aversive affect (Fernandez & Turk, 1992; Melzack & Casey, 1968). Quintessentially, pain is experienced at a physical levels and an affective level. As underscored by the International Association for the Study of Pain (Merskey, 1986), “it [pain] is unquestionably a sensation in a part or parts of the body but it is also always unpleasant and therefore also an emotional experience” (p. S217).

In this chapter, conceptual models were presented to explain the subjective experience of pain. Current state of knowledge suggests that pain must be viewed as a complex phenomenon that incorporates physical, psychosocial, and behavioral factors. Failure to incorporate each of these factors will lead to an incomplete understanding. The range of psychological variables that have been identified as being of central importance in pain along with current understanding of the physiological basis of pain were reviewed. Several integrative models were described that try to incorporate the available research and clinical information. Pain has become a vigorous research area and the virtual explosion of informan tion will surely lead to refinements in understanding of pain and advances in clinical management.


Abram, S. E. (1993). Advances in chronic pain management since gate control. Regional Anesthesia, 18, 66–81.

American Psychiatric Association. (1994). Diagnostic and statistical manual (4th ed.). Washington, DC: American Psychiatric Association.

Amtz, A., & Schmidt, A.J.M. (1989). Perceived control and the experience of pain. In A. Steptoe & A. Appels (Eds.), Stress, personal control and health (pp. 131–162). Brussles-Luxembourg: Wiley.

Averill, J. R. (1973). Personal control over aversive stimuli and its relationship to stress. Psychological Bulletin, 80, 286–303.

Bandura, A. (1969). Principles of behavior modification. New York: Holt, Rinehart, & Winston.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change. Psychological Review, 84, 191–215.

Bandura, A. (1978). The self-system in reciprocal determinism. American Psych&gist, 33, 344–359.

Bandura, A., O'Leary, A., Taylor, C. B., Gauthier, J., & Gossard, D. (1987). Perceived self-efficacy and pain control: Opioid nonopioid mechanisms. Juumal of Personality and Social Psychology, 53, 563–571.

Bandura, A., Taylor, C. B., Williams, S. L., Mefford, I. N., & Barchas, J. D. (1985). Catecholamine secretion as a function of perceived coping self-efficacy. Journal of Consulting and Clinical Psychology, 53, 406–414.

Barber, T., & Hahn, K. W. (1962). Physiological and subjective responses to pain producing stimulation under hypnotically-suggested and waking-imagined “analgesia.” Journal of Abnormal and Social Psychology, 65, 411–418.

Beecher, H. K. (1959). Measurement of subjective responses: Quantitative effects of drugs. New York: Oxford University Press.

Beutler, L, E., Engle, D., Oro'-Beutler, M. E., Daldrup, R., & Meredith, K. (1986). Inability to express intense affect: A common link between depression and Pain? Jolcrnal of Consulting and Clinical Psychology, 54, 752–759.

Biedermann, H. J., McGhie, A., Monga, T. N., Bt Shanks, G. L. (1987). Perceived and actual control in EMG treatment of back pain. Behaviour research and Therapy, 25, 137–147.

Blanchard, E. B. (1987). Long-term effects of behaviorai treatment of chronic headache. Behavior Therapy, 18, 375–385.

Blumer, D., & Heilbronn, M. (1981). The pain-prone patients: A clinical and psychological profile. Psychosomatics, 22, 395–402.

Blumer, D., & Heilbronn, M. (1982). Chronic pain as a variant of depressive disease: The pain-prone disorder. Journal of Nervouss and Mental Disease, 170, 381–406.

Block, A. R., Kremer, E. F., & Gaylor, M. (1980). Behavioral treatment of chronic pain: Variables affecting treatment efficacy. Pain, 8, 367–375.

Bonica, J. J. (1979). Caner pain: Importance of the problem. In J. J. Bonica & V. Ventafridda (Eds.), Advances in pain research and therapy (Vol. 2, pp. 1–12). New York: Raven.

Bonica, J. J. (1986) the management of lain (2nd ed.). Philadelphia: Lea & Febiger.

Borgeat, F., Hade, B., Elie, R., & Larouche L. M. (1984). Effects of voluntary muscle tension increases in tension headache. Headache, 24, 199–202.

Brewer, W. (1974). There is no convincing evidence for operant or cfassical conditioning in aduh humus. In W, Weimer & D. Palermo (Eds.), Cognition and the symbolic prucesses (pp. 115–138). New York: Halstead.

Brown, G. K., & Nicassio, P. M. (1987). Development of a questionnaire for the assessment of active and passive coping strategies in chronic pain patients. Pain, 31, 53–62.

Brown, G. K., Nicassio, P. M., & Wallston, K. A. (1989). Pain coping strategies and depression in rheumatoid arthritis. Journal of Cunslting and Clinical Psychology, 57, 652–657.


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