Pain PSYCHOLOGICAL PERSPECTIVES Edited by Thomas Hadjistavropoulos Kenneth D. Craig PAIN Psychological Perspectives PAIN Psychological Perspectives Edited by Thomas Hadjistavropoulos University of Regina Kenneth D. Craig University of British Columbia LAWRENCE ERLBAUM ASSOCIATES, PUBLISHERS 2004 Mahwah, New Jersey London Copyright © 2004 by Lawrence Erlbaum Associates, Inc. All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means, without the prior written permission of the publisher. Lawrence Erlbaum Associates, Inc., Publishers 10 Industrial Avenue Mahwah, New Jersey 07430 Cover design by Sean Sciarrone Library of Congress Cataloging-in-Publication Data Pain : psychological perspectives / edited by Thomas Hadjistavropoulos, Kenneth D. Craig. p. cm. Includes bibliographical references and index. ISBN 0-8058-4299-3 (alk. paper) 1. Pain—Psychological aspects. I. Hadjistavropoulos, Thomas. II. Craig, Kenneth D., 1937– BF515.P29 2003 152.1¢824—dc21 2003052862 CIP Books published by Lawrence Erlbaum Associates are printed on acid-free paper, and their bindings are chosen for strength and durability. Printed in the United States of America 10987654321 We dedicate this volume to those who mean the most to us: Heather, Nicholas, and Dimitri —T. H. Sydney, Kenneth, Alexandra, and Jamie —K. D. C. Contents Contributors ix Preface xi An Introduction to Pain: Psychological Perspectives 1 Thomas Hadjistavropoulos and Kenneth D. Craig 1 The Gate Control Theory: Reaching for the Brain 13 Ronald Melzack and Joel Katz 2 Biopsychosocial Approaches to Pain 35 Gordon J. G. Asmundson and Kristi D. Wright 3 Pain Perception, Affective Mechanisms, and Conscious Experience 59 C. Richard Chapman 4 Social Influences and the Communication of Pain 87 Thomas Hadjistavropoulos, Kenneth D. Craig, and Shannon Fuchs-Lacelle 5 Pain Over the Life Span: A Developmental Perspective 113 Stephen J. Gibson and Christine T. Chambers vii viii CONTENTS 6 Ethnocultural Variations in the Experience of Pain 155 Gary B. Rollman 7 Social Influences on Individual Differences in Responding to Pain 179 Suzanne M. Skevington and Victoria L. Mason 8 Assessment of Chronic Pain Sufferers 209 Dennis C. Turk, Elena S. Monarch, and Arthur D. Williams 9 Psychological Interventions for Acute Pain 245 Stephen Bruehl and Ok Yung Chung 10 Psychological Interventions and Chronic Pain 271 Heather D. Hadjistavropoulos and Amanda C. de C. Williams 11 Psychological Perspectives on Pain: Controversies 303 Kenneth D. Craig and Thomas Hadjistavropoulos 12 Ethics for Psychologists Who Treat, Assess, and/or Study Pain 327 Thomas Hadjistavropoulos Author Index 345 Subject Index 371 Contributors Gordon J. G. Asmundson Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada Stephen Bruehl Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Christine T. Chambers Department of Pediatrics, University of British Columbia, Centre for Community Child Health Research, Vancouver, British Columbia, Can- ada C. Richard Chapman Pain Research Centre, Department of Anesthesiology, Univer- sity of Utah, Salt Lake City, Utah Ok Yung Chung Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Kenneth D. Craig Department of Psychology, University of British Columbia, Van- couver, British Columbia, Canada Amanda C. de C. Williams INPUT Pain Management Unit, St. Thomas’ Hospital, London, United Kingdom Shannon Fuchs-Lacelle Department of Psychology, University of Regina, Regina, Saskatchewan, Canada Steven J. Gibson National Ageing Research Institute, Parkville, Victoria, Australia Heather D. Hadjistavropoulos Department of Psychology, University of Regina, Re- gina, Saskatchewan, Canada ix x CONTRIBUTORS Thomas Hadjistavropoulos Department of Psychology, University of Regina, Re- gina, Saskatchewan, Canada Joel Katz Department of Psychology, York University, Toronto, Ontario, Canada Victoria L. Mason Department of Psychology, University of Bath, Bath, United King- dom Ronald Melzack Department of Psychology, McGill University, Montreal, Qeubec, Canada Elena S. Monarch Department of Anesthesiology, University of Washington, Seat- tle, Washington Gary B. Rollman Department of Psychology, University of Western Ontario, Lon- don, Ontario, Canada Suzanne M. Skevington Department of Psychology, University of Bath, Bath, United Kingdom Dennis C. Turk Department of Anesthesiology, University of Washington, Seattle, Washington Arthur D. Williams Department of Anesthesiology, University of Washington, Seat- tle, Washington Kristi D. Wright Dalhousie University, Halifax, Nova Scotia, Canada Preface This volume offers a state-of-the-art, comprehensive account of the psychol- ogy of pain that encompasses clinical perspectives but also basic social and behavioral science as well as biopsychological contributions to the field. The relatively recent focus on pain as a subjective experience has led to dramatic improvements in our understanding of the complex psychological processes that represent and control pain. There has also been an en- hanced understanding of the ontogenetic, socialization, and contextual de- terminants of pain. Mechanisms responsible for the complex synthesis of sensations, feelings, and thoughts underlying pain behavior have been the target of concerted research and clinical investigation. This volume expli- cates our current understanding of the current theory, research, and prac- tice on these complex psychological processes. We are proud of our list of contributors that includes some of the most influential and productive pain researchers in the world. Although the book is primarily intended for psychologists (practitioners, researchers, and students) managing, investigating, and studying pain, it would also be of interest to a variety of other professionals working in this area (e.g., physicians, nurses, physiotherapists). The book is also suitable as a textbook for graduate and advanced undergraduate courses on the psychology of pain. We owe a debt of gratitude to the many sources of support made avail- able to us. In the first instance, we are most appreciative of the commit- ment, inspiration, and hard work of the people who work with us in the xi xii PREFACE common cause of developing a better understanding of pain and pain con- trol. Our graduate students and project staff continuously offer fresh per- spectives, ideas, and boundless energy, giving us a great hope for the future and confidence in our work today. We also acknowledge many outstanding colleagues who generously exchange ideas with us about important issues relating to the psychology of pain. These ideas are a source of inspiration and make us proud of the many scientific and clinical advances our field has achieved. Work on this project was supported, in part, by a Canadian Institutes of Health Research Investigator Award to Thomas Hadjistavropoulos and by a Canadian Institutes of Health Research Senior Investigator Award to Ken- neth D. Craig. Related work in our laboratories has been supported by the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council of Canada, and the Health Services Utilization and Re- search Commission. We acknowledge Holly Luhning’s help in preparing and formatting the manuscript for submission to the publisher. We also thank Debra Riegert of Lawrence Erlbaum Associates for her support and enthusiasm about this project. Most importantly, we acknowledge the love and support of our families. They give us strength. —Thomas Hadjistavropoulos —Kenneth D. Craig An Introduction to Pain: Psychological Perspectives Thomas Hadjistavropoulos University of Regina Kenneth D. Craig University of British Columbia Pain is primarily a psychological experience. It is the most pervasive and universal form of human distress and it often contributes to dramatic re- ductions in the quality of life. As demonstrated repeatedly in the chapters to follow, it is virtually inevitable and a relatively frequent source of dis- tress from birth to old age. Episodes of pain can vary in magnitude from events that are mundane, but commonplace, to crises that are excruciating, sometimes intractable, and not so common, but still not rare. The costs of pain in human suffering and economic resources are extraordinary. It is the most common reason for seeking medical care, and it has been estimated that approximately 80% of physician office visits involve a pain component (Henry, 1999–2000). The distinction between pain and nociception provides the basis for fo- cusing on pain as a psychological phenomenon. Nociception refers to the neurophysiologic processing of events that stimulate nociceptors and are capable of being experienced as pain (Turk & Melzack, 2000). Instigation of the nociceptive system and brain processing constitute the biological sub- strates of the experience. But pain must be appreciated as a psychological phenomenon, rather than a purely physiological phenomenon. Specifically, it represents a perceptual process associated with conscious awareness, selective abstraction, ascribed meaning, appraisal, and learning (Melzack & Casey, 1968). Emotional and motivational states are central to understand- ing its nature (Price, 2000). Pain requires central integration and modula- tion of a number of afferent and central processes (i.e., sending messages 1 2 HADJISTAVROPOULOS AND CRAIG toward the central nervous