Psychological Characteristics of Chronic Pain: a Review of Current Evidence and Assessment Tools to Enhance Treatment

  • Rhondene M. Miller
  • Ronald S. Kaiser
Anesthetic Techniques in Pain Management (D Wang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Anesthetic Techniques in Pain Management


Purpose of Review

The complicated nature of chronic pain involves an interplay between psychological and physical factors, often resulting in increased emotional distress and reduced quality of life. This review is designed to help the medical practitioner who is working with chronic pain patients to be aware of psychological assessment techniques that can add to comprehensive patient understanding and more effectively guide treatment. Enhanced ability to assess and understand the emotional life of the chronic pain patient provides a basis for intervening and treating more successfully.

Recent Findings

There are a broad range of assessment techniques, some of which require a background in psychology and some that do not, that can identify psychological differences in chronic pain patients and serve to guide intervention strategies. Chronic pain is often comorbid with depression, anxiety, catastrophizing, and various ineffective coping strategies. Some patients, however, have demonstrated more adaptive and effective strategies for cognitively and behaviorally coping with pain and normalizing their lives. Proper assessment enables the individualization of treatment to overcome and/or build upon each patient’s psychological frame of mind to maximize the potential for effective functioning.


The use of standardized and documented psychological assessment techniques can lead to a better understanding of chronic pain patients and contribute in ways that can enhance response to medical treatment and improve quality of life. It is recommended that certain psychological tools be included to supplement the medical assessment of patients who have chronic pain. A basic assessment can include a short psychological-based clinical interview along with brief measures of depression, anxiety, and coping strategies. It is also recommended that the pain physician have access to professional psychological practitioners as a resource for more complicated assessments and psychological intervention services.


Psychological assessment Anxiety Depression Catastrophizing Coping strategies Cognitive-behavioral therapy 


Compliance with Ethical Standards

Conflict of Interest

Rhondene M. Miller and Ronald S. Kaiser declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003–7. PubMedPubMedCentralGoogle Scholar
  2. 2.
    Walk D, Poliak-Tunis M. Chronic pain management: an overview of taxonomy, conditions commonly encountered, and assessment. Med Clin North Am. 2016;100(1):1–16. Scholar
  3. 3.
    van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology–where do lifestyle factors fit in? British Journal of Pain. 2013;7(4):209–217.37. Scholar
  4. 4.
    Lattie E, Antoni M, Millon T, Kamp J, Walker M. MBMD coping styles and psychiatric indicators and response to a multidisciplinary pain treatment program. J Clin Psychol Med Settings. 2013;20(4):515–25. Scholar
  5. 5.
    Holmes A, Christelis N, Arnold C. Depression and chronic pain. Med J Aust. 2012:10–7.Google Scholar
  6. 6.
    • Turk DC, Fillingim RB, Ohrbach R, Patel KV. Assessment of psychosocial and functional impact of chronic pain. J Pain. 2016;17(9):21–49. A good source of additional available physical, psychosocial, and cognitive/emotional functioning and functionality assessment measures for use with pain patients. CrossRefGoogle Scholar
  7. 7.
    Bergbom S, Flink I, Boersma K, Linton S. Early psychologically informed interventions for workers at risk for pain-related disability: does matching treatment to profile improve outcome? J Occup Rehabil. 2014;24(3):446–57. Scholar
  8. 8.
    van Hecke O, Torrance N, Smith BH, Colvin L, Rowbotham DJ. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013;111(1):13–8. Scholar
  9. 9.
    •• Borkum J, Wootton J. Psychosocial assessment of chronic pain. In: Bajwa ZH, Wootton R, Warfield CA, editors. Principles and practice of pain medicine. 3rd ed. New York: McGraw-Hill; 2017. A thorough examination of assessment tools available for use with pain patients. Google Scholar
  10. 10.
    Munce SEP, Stewart DE. Gender differences in depression and chronic pain conditions in a national epidemiologic survey. Psychosomatics. 2007;48(5):394–9. Scholar
  11. 11.
    Surah A, Baranidharan G, Morley S. Chronic pain and depression. Contin Educ Anaesth Crit Care Pain. 2013;46.Google Scholar
  12. 12.
    •• Turk D, Okifuji A. Psychological aspects of chronic pain. In: Bajwa ZH, Wootton R, Warfield CA, editors. Principles and practice of pain medicine. 3rd ed. New York, McGraw-Hill; 2017. A comprehensive review of additional psychological aspects of pain including pain conceptualization models, behavioral/cognitive/affective factors, and pain patient heterogeneity. Google Scholar
  13. 13.
    Jordan KD, Okifuji A. Anxiety disorders: differential diagnosis and their relationship to chronic pain. Journal of Pain and Palliative Care Pharmacotherapy. 2011;25(3;3):231–45. Scholar
  14. 14.
    Vowles K, Zvolensky M, Gross R, Sperry J. Pain-related anxiety in the prediction of chronic low-back pain distress. J Behav Med. 2004;27(1):77–89. Scholar
  15. 15.
    Mccracken LM, Eccleston C. Coping or acceptance: what to do about chronic pain? Pain. 2003;105(1):197–204. CrossRefPubMedGoogle Scholar
  16. 16.
    Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther. 2011;91(5):700–11. Scholar
  17. 17.
    Arnow BA, Blasey CM, Constantino MJ, Robinson R, Hunkeler E, Lee J, et al. Catastrophizing, depression and pain-related disability. Gen Hosp Psychiatry. 2011;33(2):150–6. Scholar
  18. 18.
    Baranoff J, Hanrahan S, Kapur D, Connor J. Acceptance as a process variable in relation to catastrophizing in multidisciplinary pain treatment. Eur J Pain. 2013;17(1):101–10. Scholar
  19. 19.
    Bernini O, Rivas T, Berrocal C. The chronic pain acceptance questionnaire: preliminary evidence for the predictive validity of patients’ subgroups. Journal of Evidence-Based Psychotherapies. 2014;14(1):3.Google Scholar
  20. 20.
    Shean G, Baldwin G. Sensitivity and specificity of depression questionnaires in a college-age sample. J Genet Psychol. 2008;169(3):281–92. Scholar
  21. 21.
    Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1):9–19. CrossRefPubMedGoogle Scholar
  22. 22.
    Harris CA, D’eon JL. Psychometric properties of the beck depression inventory-second edition (BDI-II) in individuals with chronic pain. Pain. 2008;137(3):609–22. CrossRefPubMedGoogle Scholar
  23. 23.
    Lopez MN, Pierce RS, Gardner RD, Hanson RW. Standardized beck depression inventory-II scores for male veterans coping with chronic pain. Psychol Serv. 2013;10(2):257–63. Scholar
  24. 24.
    Williams N. Phq-9. Occup Med (Lond). 2014;64(2):139–40. Scholar
  25. 25.
    Seo J, Park S. Validation of the patient health questionnaire-9 (PHQ-9) and PHQ-2 in patients with migraine. J Headache Pain. 2015;16(1):1–7. CrossRefGoogle Scholar
  26. 26.
    Leyfer OT, Ruberg JL, Woodruff-Borden J. Examination of the utility of the beck anxiety inventory and its factors as a screener for anxiety disorders. J Anxiety Disord. 2006;20(4):444–58. Scholar
  27. 27.
    Beck A, Steer R. Beck anxiety inventory manual. San Antonio: The Psychological Corporation; 1993.Google Scholar
  28. 28.
    Orenius T, Koskela T, Koho P, Pohjolainen T, Kautiainen H, Haanpää M, et al. Anxiety and depression are independent predictors of quality of life of patients with chronic musculoskeletal pain. J Health Psychol. 2013;18(2):167–75. Scholar
  29. 29.
    Ersek M, Turner JA, Kemp CA. Use of the chronic pain coping inventory to assess older adults’ pain coping strategies. J Pain. 2006;7(11):833–42. Scholar
  30. 30.
    Romano JM, Jensen MP, Turner JA. The chronic pain coping inventory-42: reliability and validity. Pain. 2003;104(1):65–73. CrossRefPubMedGoogle Scholar
  31. 31.
    Truchon M, Côté D. Predictive validity of the chronic pain coping inventory in subacute low back pain. Pain. 2005;116(3):205–12. Scholar
  32. 32.
    Payne-Murphy JC, Beacham AO. Revisiting chronic pain patient profiling: an acceptance-based approach in an online sample. Clinical Psychology & Psychotherapy. 2015;22(3):240–8. Scholar
  33. 33.
    Vowles KE, Mccracken LM, Mcleod C, Eccleston C. The chronic pain acceptance questionnaire: confirmatory factor analysis and identification of patient subgroups. Pain. 2008;140(2):284–91. CrossRefPubMedGoogle Scholar
  34. 34.
    Jimenez SC. Using the Millon Behavioral Medicine Diagnostic (MBMD) to predict outcomes of spinal cord stimulation for the treatment of chronic nonmalignant pain for patients who identify as white. Chicago: Adler School of Professional Psychology; 2013.Google Scholar
  35. 35.
    Cipher D, Kurian A, Fulda K, Snider R, Beest J. Using the Millon Behavioral Medicine Diagnostic to delineate treatment outcomes in rehabilitation. J Clin Psychol Med Settings. 2007;14(2):102–12. Scholar
  36. 36.
    Ben-Porath YS, Tellegen A. Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press; 2008.Google Scholar
  37. 37.
    Greene A. The MMPI-2/MMPI-2RF: An interpretive manual. 3rd ed. Boston: Allyn & Bacon; 2011.Google Scholar
  38. 38.
    Turner JA, Dworkin SF, Mancl L, Huggins KH, Truelove EL. The roles of beliefs, catastrophizing, and coping in the functioning of patients with temporomandibular disorders. Pain. 2001;92(1):41–51. Scholar
  39. 39.
    Scott W, McCracken LM. Psychological flexibility, acceptance and commitment therapy, and chronic pain. Current Opinion in Psychology. 2015;2:91–6. Scholar
  40. 40.
    Muller R, Gertz KJ, Molton IR, et al. Effects of a tailored positive psychology intervention on well-being and pain in individuals with chronic pain and a physical disability: a feasibility trial. Clin J Pain. 2016;32(1):32–44. Scholar
  41. 41.
    Peters ML, Smeets E, Feijge M, van Breukelen G, Andersson G, Buhrman M, et al. Happy despite pain: a randomized controlled trial of an 8-week internet-delivered positive psychology intervention for enhancing well-being in patients with chronic pain. Clin J Pain. 2017;33(11):962–75. Scholar
  42. 42.
    Seligman MEP. Flourish: a visionary new understanding of happiness and well-being. New York: Free Press; 2013.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Jefferson Headache CenterThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Department of NeurologyThomas Jefferson UniversityPhiladelphiaUSA

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