The role of psychological factors in chronic pain

The traditional view conceptualizes pain as being directly associated with the extent of physical pathology. The observations that there are a number of patients who report pain in the absence of physical pathology, the conve rse, asymptomatic individuals who evidence objective physical pathology, th e inconsistency in response of patients with identical diagnoses, and the l ow association between impairments and disability suggest that factors othe r than physical pathology contribute to the reports of pain. The role of be havioral, cognitive, and affective factors have each been shown to have dir ect effects on the report of pain, adaptation, and response to treatment, a s well as indirect effects by influencing sympathetic nervous system and ne urochemical factors associated with nociception. The direct and indirect ef fects of behavioral (operant), cognitive, and affective factors in chronic pain are described.