Generating Hypotheses Regarding Cognitive and Emotional Contributors to the Child’s Pain
As outlined in Melzack and Wall’s gate control theory (Melzack, 1993; Melzack & Wall, 1965), how a person thinks about pain can have a tremendous impact on how the individual experiences pain. This applies to everyone, not just individuals thought to have psychosomatic pain. Indeed, the entire notion of “psychosomatic” pain is obsolete. Scientists now know that psychological factors can affect almost all aspects of physiological functioning, from the level of heart rate down to basic T-cell immunological functioning (Oltmanns & Emery, 1998). Therefore, one must assume that, for every individual, psychological (cognitive and emotional) factors contribute in some way to the experience of pain. The important goal of the assessment process, therefore, is not to determine if psychological factors are playing a role for this individual, but rather to determine how psychological factors function for this particular individual. As part of this process, one can generate specific hypotheses regarding cognitive and emotional factors that might be contributing to or exacerbating the child’s pain problem. The possible hypotheses described in this chapter are not exhaustive. They are intended to suggest areas of inquiry that may be important in understanding a child’s pain experience.
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