The article discusses the use of the Dynamic Model of Psychological Processes in Chronic Pain (DM) in the clinical diagnostic practice. DM includes 8 consecutive stages of psychological processes in chronic pain: 1) Pain beliefs and attitude toward pain before the development of chronic pain condition. 2) Trigger processes, 2a) pain and 2b) pain evaluation. 3) The first affective stage, which includes fear and other affects directly associated with pain. 4) Coping, „the crossroad“ between adaptation and maladaption to pain. 5) The second affective stage that includes activation, pain resistance and euthymia in case of effective coping; anxiety, anger and depression in case of ineffective coping. 6) Perception of self: a self-assessment “I am able to cope with my pain” facilitates adaptation; “I am not able to cope with my pain” indicates maladaptation. 7) A change of the patient’s behavior that represents the final stage of individual adaptation or maladaptation to pain. 8) Effects of the patient’s adaptive or maladaptive behavior on behavior of others (caregivers, family members). DM further includes 3 feedback processes: a) Neuropsychological feedback that involves for example aggravation of pain sensation by fear; b) Cognitive feedback that influences pain evaluation via perception of self being able or not able to cope with pain. c) Social feedback that represents an influence of others on the patient’s pain evaluation. The stages, included in the current (final) version of DM, were tested with fifteen psychological tests. Statistical analyses resulted in a decreased number of nine tests containing 31 scales in total. Further statistical evaluations allowed for a reduction to 11 scales that enable testing of psychological processes in chronic pain in time-efficient manner, with only minimal loss of diagnostically relevant information. The article presents a description and characteristics of the nine diagnostic tests, detailed characteristics of the included scales, an overview of typical test-score profiles, as well as examples of atypical ones that may indicate co-morbid psychic disturbances or reactions to high-impact life events that may complicate pain management.

Department of Neurology Albert Einstein College of Medicine New York

Department of Pain Mdidicine and palliative Care Beth Israel Medical Center New York

Oddělení klinické psychologie a Centrum pro léčení a výzkum bolestivých stavů FN Motol Praha

Dynamic model of psychological processes in chronic pain: application in diagnostics

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