Research Corner

Here is a selection of recent research findings and other articles of interest. You may also like to read The Purpose of Pain page, watch some of the videos or if you are a GP, here are some thoughts.

Pain and Stress in a Systems Perspective

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J Pain. 2008 Feb; 9(2): 122–145.

This paper advances a psychophysiological systems view of pain in which physical injury, or wounding, generates a complex stress response that extends beyond the nervous system and contributes to the experience of pain. Through a common chemical language comprising neurotransmitters, peptides, endocannabinoids, cytokines and hormones, an ensemble of interdependent nervous, endocrine, and immune processes operates in concert to cope with the injury. These processes act as a single agent and comprise a supersystem. Acute pain in its multiple dimensions, and the related symptoms that commonly occur with it, are products of the supersystem. Chronic pain can develop as a result of unusual stress. Social stressors can compound the stress resulting from a wound or act alone to dysregulate the supersystem. When the supersystem suffers dysregulation, health, function and sense of well-being suffer. Some chronic pain conditions are the product of supersystem dysregulation. Individuals vary and are vulnerable to dysregulation and dysfunction in particular organ systems due to the unique interactions of genetic, epigenetic and environmental factors, as well as the past experiences that characterize each person.

Perspective

Acute tissue injury activates an ensemble of interdependent nervous, endocrine and immune processes that operate in concert and comprise a supersystem. Some chronic pain conditions result from supersystem dysregulation. Individuals vary and are vulnerable to dysregulation due to the unique interactions of genetic, epigenetic and environmental factors, and past experiences that characterize each person. This perspective can potentially assist clinicians in assessing and managing chronic pain patients.

Grand Unified Theory of Female Pain

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Toward a Theory of Motivational Interviewing

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The widely-disseminated clinical method of motivational interviewing (MI) arose through a convergence of science and practice. Beyond a large base of clinical trials, advances have been made toward “looking under the hood” of MI to understand the underlying mechanisms by which it affects behaviour change. Such specification of outcome-relevant aspects of practice is vital to theory development, and can inform both treatment delivery and clinical training. An emergent theory of MI is proposed, emphasising two specific active components: a relational component focused on empathy and the interpersonal spirit of MI, and a technical component involving the differential evocation and reinforcement of client change talk A resulting causal chain model links therapist training, therapist and client responses during treatment sessions, and post-treatment outcomes.