Psychological and psychosocial evaluation of the chronic pain patient

Pain is among the most common and disabling chronic health problems in the United States (Health United States 2006). The ubiquity of chronic, non-malignant pain and the complexities encountered with its management have prompted efforts to establish theoretical models to unveil, and otherwise explicate, factors other than those which are purely physical/sensory that contribute to the perception of pain and its associated impairments. One such model, the biopsychosocial model (Engel 1980), has gained significant appeal, emphasizing the bidirectional influences of psychological states and social/environmental factors with medical disorders and their associated symptoms, including pain. Rather than dichotomizing between physical and psychological origins, the biopsychosocial perspective maintains that the experience of pain, one's presentation, and response to treatment are determined by the interaction of biological factors, the patient's psychological makeup, the presence of psychological comorbidities, and the extent of social support and extenuating environmental circumstances (Gallagher 1999, Leo 2007).