Pain behavior: Unitary or multidimensional phenomenon?

Abstract

The behavioral alterations observed in individuals experiencing pain have been referred to as “pain behavior.” This chapter begins with a brief overview of protocols that have been developed for the assessment of pain behaviors, both in clinical and nonclinical settings. We then provide an overview of studies that have been conducted on the functions, determinants, and consequences of pain behaviors. We conclude the chapter by summarizing arguments and evidence in support of a multidimensional conceptualization of pain behavior. The multidimensional view of pain behavior is supported by evidence indicating that different types of pain behaviors are only modestly interrelated, and that different types of pain behaviors have different degrees of temporal stability. The multidimensional view is also supported by research suggesting that different types of pain behaviors likely serve different functions and have different determinants. Importantly, research indicates that different types of pain behaviors have a differential impact on functional and occupational disability outcomes, which provides further support the multidimensional nature of pain behavior. On the basis of research conducted to date, it appears clear that a multidimensional conceptualization of pain behavior will be required to further advance our knowledge on the functions, determinants and consequences of pain behaviors. A multidimensional conceptualization of pain behavior will also be required in order to pave the way for the development of new treatment interventions designed to minimize pain behaviors and their potentially negative impact on pain-related outcomes.