Toward a Transformed Understanding: From Pain and Movement to Pain With Movement

TLDR

Chronic pain is a widespread nervous system disease whose management is inadequate, prompting a call to transform its understanding by integrating sensory, psychological, and motor factors into a comprehensive model. The authors aim to introduce a conceptual model that integrates sensory, psychological, and motor factors to study pain with movement. They provide a historical overview of pain research to lay the groundwork for their conceptual model.

Abstract

Pain serves as a protective mechanism that leads to changes in movement.1,2 For more than 116 million Americans with chronic pain, however, the pain experience persists beyond a normal, protective phase and develops into a chronic, disabling disease.3 Altered movement may be appropriate in early protective phases, but, if maintained, this altered movement can contribute to poor recovery, continued disability, and decreased quality of life. The Institute of Medicine identifies chronic pain as a nervous system disease and a high-priority societal health concern.3 However, current management of this disease and its complications, such as movement impairments and subsequent reductions in function, is inadequate.3 The Institute of Medicine has called for the health care community to transform its understanding of pain as a key step for improving prevention, treatment, and assessment of pain.3 The Institute of Medicine specifically highlighted the need for “wider use of existing knowledge” as a main objective for transforming our understanding of pain.3 One way to meet this objective is to integrate existing knowledge into a comprehensive model that considers pain to be a dynamic, multifactorial experience that includes a movement component. Although researchers have extensively studied the sensory, psychological, and motor factors related to pain, they often have studied these factors separately or in limited combinations. Isolated investigation of these factors limits the advancement of our understanding of how pain impairs movement and how pain symptoms can cascade into a disabling disease process. Integrated study of sensory, psychological, and motor factors as primary drivers of the pain experience is needed to help establish the collective impact of pain processing on movement and recovery. The purpose of this point of view is to introduce a conceptual model for studying pain with movement. First, we present a historical overview identifying …