A Framework for Conceptualization and Assessment of Affective Disturbance in Pain
Southern Methodist University
Timothy S. Clark
Baylor Center for Pain Management
Psychologist in Private Practice-- Dallas, Texas
Though pain is commonly described in terms of its physical properties (such as location, depth, and sensation), it also encompasses an emotional quality, all pain being intrinsically aversive. The Aristotelian position placed pain outside the senses and among the passions of the soul. In recent times, pain has continued to be equated with affect ( Szasz, 1957). Von Frey ( 1895), on the other hand, considered affect as a secondary reaction to pain. Beecher ( 1957) was inclined to place affect under the reactive component of pain. Today, there is little dispute about the co-occurrence of affect and pain, and the International Association for the Study of Pain has formalized this into a definition of pain as always sensory and emotional. These dual defining features are depicted in Fig. 7.1 ( Fernandez, 1997). As shown, the boundaries between these two components are not rigid but fluid, thus reflecting reciprocal determinism; sensation influences affect and vice versa, and not necessarily in a proportional fashion. Furthermore, they function like parts of a whole: Reducing one has the capacity to reduce the whole directly or else indirectly through its effect on the countercomponent.
Surprisingly, little research has appeared on the affective as compared to the sensory aspects of pain. Yet, it is the affective component that is proximally responsible for help-seeking behavior and other attempts at adaptation ( Chapman, 1993). Besides, an adequate explanation of pain depends on an adequate theory of human emotions, said Buytendyck (as cited in Price, 1988). For an adequate theory of human emotions, we turn