Pain Theory Continued

In my last blog I discussed the Progression of Pain Theory looking at one of the first theory’s from the ancient Athenian philosopher Plato to more recent theories by David Wall and Ronald Melzack which views pain through a mind-body perspective. At present pain is defined as “an unpleasant sensory and emotional experience associated with the actual and potential tissue damage or described in terms of such damage”. This definition fits well when considering the biopsychosocial pain model which recognises an individual’s biology or pathology, cognitive aspects and social aspects of an individual’s life.

The biopsychosocial model was first introduced in medicine by George L. Engel and was mostly related to all chronic illness. Engel’s model suggested that as a medical illness became more chronic in nature, then psychosocial “layers” e.g., distress, illness behaviour, and the sick role emerged to complicate assessment and treatment. Later, J.D. Loeser, applied this model to pain. Taking into account these perspectives, there were four dimensions related to the idea of pain: nociception, pain, suffering, and pain behaviour.

  • Nociception refers to the physiological components associated with sensory input—such as nerve receptors and fibre
  • Pain is described as a subjective perception resulting from sensory input.
  • Suffering can be seen as a negative affective response to nociception or pain.
  • Pain behaviour is described in one’s actions while suffering from pain e.g. fear of recurrence of injury often leads to inactivity which, in turn, can delay the progression of recovery.

The current Biopsychosocial model is described as a pain experience with three dimensions,

Biological factors, psychological factors and social factors.

  • Biological factors include genetics, physiology, neurochemistry, tissue health
  • Psychological factors include perceived control, catastrophic thinking, depression, anxiety, hypervigilance
  • Social factors include socioeconomic status, social support, social learning, scepticism.

As time has gone on and our understanding of pain theory has developed, how someone experience pain unique to the individual and their circumstances. When assessing chronic pain conditions as exercise physiologist we have to consider all of these components in order to effectively treat an individual and get the best outcome possible.

Stayed tuned for my next pain theory instalment where I will look at the assessment process and what Exercise physiologists need to consider when assessing chronic pain.

Claire Hills ( B.EXSpSc,Grad.Dip.(Clin.Ex.Phys))
Senior Accredited Exercise Physiologist (AEP) (ESSAM)


Adams, L., & Turk, D. (2018). Central sensitization and the biopsychosocial approach to understanding pain. Journal Of Applied Biobehavioral Research23(2), e12125. doi: 10.1111/jabr.12125

The Biopsychosocial Approach. (2020). Retrieved 24 September 2020, from