Chronic pain: a consequence of dysregulated protective action. Issue 1 (February 2019)

• Record Type: Journal Article
• Authors: Hill, Patrick
• Other Names: Scott Whitney guest-editor.
• Is Part Of: British journal of pain. Volume 13:Issue 1(2019)
• Page Start: 13
• Page End: 21
• Publication Date: 2019-02
• Subjects: Chronic pain -- fibromyalgia -- pain management -- chronic fatigue -- transition from acute to chronic -- cognitive behavioural psychology -- biopsychosocial -- central sensitisation; Pain -- Periodicals; Pain -- Treatment -- Periodicals; 616.0472
• DOI: 10.1177/2049463718799784
• Languages: English
• ISSNs: 2049-4637

Abstract

Introduction: Pain is considered to be one of a number of idiosyncratic, context-dependent 'protective actions' projected into the conscious domain by the central nervous system (CNS), as a result of a series of complex interactions in response to perceived threat. A model is described which proposes chronic pain and a variety of long-term, systemic functional neurological conditions to be a consequence of significant dysregulation of these protection systems. The Model: Previous research has demonstrated that a cognitive–behavioural model, first described in 1995 by Surawy et al., for chronic fatigue has been successful in predicting the transition from acute to chronic states in a number of conditions. This model includes predisposing, precipitating and perpetuating biopsychosocial factors. This article discusses the potential role of these factors in affecting descending inhibition in the CNS, significantly altering its ability to modulate the threat detection system. The development of 'central sensitisation' is considered in this context. Conclusion: This model proposes that chronic pain, chronic fatigue and other so-called functional neurological phenomena can, perhaps, be more helpfully seen as the actions of a dysregulated neurological protection system, rather than symptoms of an untreatable and deteriorating medical condition. Recommendations are made for the development of appropriate therapeutic interventions indicated by this model.