Psychology of pain in traumatology

Pain is a complex, distressing sensory and emotional experience directly associated with actual or potential tissue damage. Short-term pain serves a protective signaling function; however, under prolonged action of pathogenic factors and dysfunction of the nociceptive system, acute pain responses can transform into a pathological state. This state is characterized by a persistent pain syndrome lasting beyond normal healing time (usually more than 3–6 months), leading to the development of Chronic Pain Syndrome (CPS) and Chronic Post-Traumatic Pain (CPTP). These phenomena entail complex negative consequences: persistent physiological shifts, significant functional limitations, neurological disorders, and various mental disorders.

Chronic Pain Syndrome has a profoundly negative impact on all aspects of patients’ quality of life. A critically important aspect is its ability to significantly hinder the rehabilitation process. The present article details the clinical phenomena of CPS and CPTP, analyzes their specific impact on the psychoemotional status and, consequently, on patients’ rehabilitation potential. Scientific data is presented demonstrating how various negative factors of the pain syndrome directly impede the implementation of therapeutic measures, reduce treatment adherence, and diminish the effectiveness of rehabilitation programs in patients who have suffered various injuries. The article also describes the influence of attachment style on patients’ individual experience of pain and introduces the hypothesis that rehabilitation of such patients might be possible using psychological techniques aimed at strengthening self-identity of self. The article emphasizes the necessity of a comprehensive treatment approach integrating pain management and psychological intervention.

1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982. https://doi.org/10.1097/j.pain.0000000000001939.

2. Shahabpour M, Abid W, Van Overstraeten L, De Maeseneer M. Wrist Trauma: More Than Bones. J Belg Soc Radiol. 2021;105(1):90. https://doi.org/10.5334/jbsr.2709.

3. Karateev AE, Nesterenko VA, Makarov MA, Lila AM. Chronic post-traumatic pain: rheumatological and orthopedic aspects. Rheumatology Science and Practice. 2022;60(5):526–537. (In Russ.) https://doi.org/10.47360/1995-4484-2022-526-537.

4. DiPietro LA. Angiogenesis and wound repair: When enough is enough. J Leukoc Biol. 2016;100(5):979–984. https://doi.org/10.1189/jlb.4MR0316-102R.

5. Li L, Tuan RS. Mechanism of traumatic heterotopic ossification: In search of injury-induced osteogenic factors. J Cell Mol Med. 2020;24(19):11046–11055. https://doi.org/10.1111/jcmm.15735.

6. Sass FA, Fuchs M, Pumberger M, Geissler S, Duda GN, Perka C et al. Immunology guides skeletal muscle regeneration. Int J Mol Sci. 2018;19(3):835. https://doi.org/10.3390/ijms19030835.

7. Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Nociplastic pain: Towards an understanding of prevalent pain conditions. Lancet. 2021;397(10289):2098–2110. https://doi.org/10.3390/ijms19030835.

8. Hiraga SI, Itokazu T, Nishibe M, Yamashita T. Neuroplasticity related to chronic pain and its modulation by microglia. Inflamm Regen. 2022;42(1):15. https://doi.org/10.1186/s41232-022-00199-6.

9. McKernan LC, Johnson BN, Crofford LJ, Lumley MA, Bruehl S, Cheavens JS. Posttraumatic stress symptoms mediate the effects of trauma exposure on clinical indicators of central sensitization in patients with chronic pain. Clin J Pain. 2019;35(5):385–393. https://doi.org/10.1097/AJP.0000000000000689.

10. Wood MJ, Miller RE, Malfait AM. The genesis of pain in osteoar-thritis: Inflammation as a mediator of osteoarthritis pain. Clin Geriatr Med. 2022;38(2):221–238. https://doi.org/10.1016/j.cger.2021.11.013.

11. Gosens T, den Oudsten BL. Psychology in orthopedics and traumatology: an instructional review. EFORT Open Rev. 2023;8(5):245–252. https://doi.org/10.1530/EOR-23-0038.

12. Майленова ФГ. Восприятие боли в медицине и психологии. В: Лекторский ВА, Буданов ВГ (ред.). Третьи Степинские чтения. Перспективы философии науки в современную эпоху: материалы международной конференции. Москва, 20–21 июня 2023 г. Курск: ЗАО «Университетская книга»; 2023. 680 с. Режим доступа: https://www.elibrary.ru/cspvnm.

13. Shevchenko NA. Personal characteristics of transplantologists and dermatovenerologists. Young Scientist. 2019;240(2):46–47. (In Russ.) Available at: https://moluch.ru/archive/240/55627/.

14. Shevchenko NA, Ivashkina MG, Stakhanova EA. Personal characteristics of a physician in a transplant clinic. Vestnik Transplantologii i Iskusstvennykh Organov. 2018;20(1):182–183. (In Russ.) Available at: https://journal.transpl.ru/vtio/issue/viewFile/42/42.

15. Yakhno NN, Kukushkin ML, Churyukanov MV, Davydov OS, Bakhtadze MA. New definition of pain by the international association for the study of pain. Russian Journal of Pain. 2020;18(4):5–7. (In Russ.) https://doi.org/10.17116/pain2020180415.

16. Ачкасов ЕЕ, Творогова НД. Психологические аспекты медицинской реабилитации. М.: ГЭОТАР-Медиа; 2018. 352 с.

17. Logvinenko VV, Shen NP, Lyashenko AN, Rakhmatullin RM. Relationships between patient’s personality type, postoperative pain and early postoperative period course quality in trauma and ortopeadic surgery. Regional Anesthesia and Acute Pain Management. 2013;7(2):23–27. (In Russ.) https://doi.org/10.17816/RA36181.

18. Pasechnik IN, Krylov SV, Salnikov PS. Postoperative anesthesia in traumatology and orthopedics: the role of regional anesthesia. Kremlin Medicine Journal. 2022;(3):83–88. (In Russ.) Available at: https://kremlin-medicine.ru/index.php/km/article/view/1653.

19. Vasilyeva NA. The Phenomenon of Fear: Ontological Status and Ways to Overcome Fear. Mir Nauki, Kul’tury, Obrazovaniya. 2014;(5):228–231. (In Russ.) Available at: https://amnko.ru/index.php/russian/journals/.

20. Yeleferenko YS. Peculiarities of the internal disease pattern formation of patients with multisystem trauma. Science and World. 2015;23(7):170–172. (In Russ.) Available at: https://scienceph.ru/f/scienceandworldno7%2823%-29july_1.pdf.

21. Пылина ДД. Проблема образа тела как многоаспектного конструкта. В: Социально-гуманитарные проблемы образования и профессиональной самореализации (социальный инженер-2023): сборник материалов Международной научной конференции молодых исследователей, Москва, 11–15 декабря 2023 г. М.: Российский государственный университет им. А.Н. Косыгина (Технологии. Дизайн. Искусство); 2023. 322 с. Режим доступа: https://www.elibrary.ru/ogtdto.

22. Shevchenko NA. The Problem of “Self-Identity of the Self” in Persons with Physical Disabilities. World of Psychology. 2023;115(4):85–95. (In Russ.) https://doi.org/10.51944/20738528_2023_4_85.

23. Chuloshnikov AI. Modeling the subject domain of psychological research on pain. Perm University Herald. Philosophy. Psychology. Sociology. 2020;(4): 579–595. (In Russ.) https://doi.org/10.17072/2078-7898/2020-4-579-595.

24. Clark D. Total pain: the work of Cicely Saunders and the hospice movement. Am Pain Society Bulletin. 2010;10(4):13–15. https://doi.org/10.1016/S0277-9536(99)00098-2.

25. Chuloshnikov AI, Levchenko EV. Psychology of pain: classification of types of pain, based on subjective experience. Social Sciences and Humanities: Theory and Practice. 2018:1(2):714–723. (In Russ.) Available at: https://sciup.org/147228563.

26. Cosio D. The Perseverance Loop: The Psychology of Pain and Factors in Pain Perception. Pract Pain Manag. 2020;20(1). Available at: https://www.medcentral.com/psychiatry/cbt/perseverance-loop-psychology-pain-factors-pain-perception.

27. Лазарус Р. Эмоциональный стресс: теория стресса и психофизиологические исследования. М; 1970.

28. Bella GP, Silveira-Moriyama L, Cliquet AJr. Pain and quality of life in athletes vs non-athletes with spinal cord injury: Observational study. J Spinal Cord Med. 2024;47(1):181–186. https://doi.org/10.1080/10790268.2023.2253393.

29. Цыкунов МБ, Переверзев ВС, Колесов СВ, Еремушкина СМ. Методологические аспекты изучения образа тела у Колесов пациентов с идиопатическим сколиозом на этапах хирургического лечения. В: Очкуренко АА. Приоровские чтения – 2023: сборник работ X Всероссийской научно-практической конференции, посвященной 100-летию академика Волкова М.В., и Конференции молодых ученых, Москва, 15–16 декабря 2023 г. М.: ФГБУ «НМИЦ травматологии и ортопедии имени Н.Н. Приорова» Минздрава России, издательство ФГБОУ ВО «Тюменский государственный медицинский университет» Минздрава России; 2023. 220 с. Режим доступа: https://www.elibrary.ru/ayvqhf.

30. De Paepe AL, Legrain V, Van der Biest L, Hollevoet N, Van Tongel A, De Wilde L et al. An investigation of perceptual biases in complex regional pain syndrome. PeerJ. 2020;8:8819. https://doi.org/10.7717/peerj.8819.

31. Shevchenko NA. Correlation of Self-Identity to Resilience in Young People with Physical Disabilities. World of Psychology. 2024;118(3):94–106. (In Russ.) https://doi.org/10.51944/20738528_2024_3_94.