Last updated: Wed, Feb 26, 2025
There's nothing either good or bad, but thinking makes it so
Substantial amounts of research have been done into the relationships between pain on the one hand and various aspects of behavior on the other. It may seem straightforward and obvious that pain should affect behavior. If pain didn't affect behavior, why should pain exist? The flip side of this is that behaviors or states of mind might affect the experience of and the effects of pain. If so, we may be in a position to influence or control how pain affects us and those around us. The LaMaze birthing classes are a well-known and fairly successful application of the notion that pain can be influenced by behavior. There is evidence that birthing classes have a measurable effect (greater than roughly 10%) on the level of pain experienced by the mother (The McGill Pain Questionnaire).
The remainder of this section provides an analysis of behaviorally-oriented theories around pain. It reports on the results of behaviorally-oriented studies which examine links between behavior and pain. What follows isn't a comprehensive review, but covers several ideas that are popular subjects for research, and illustrates some of the limitations of various types of behavioral pain research.
(As you go over these experimental results, notice whether they establish the direction of causality. Notice also whether the experimenters have identified the strength of effects.)
A consensus psychological view of chronic pain and the chronic pain patient emerged in the medical pain community beginning in the mid-1970s. That view overlays a behaviorist view of pain with the view that pain experience is influenced by cognitive processes, and is called the cognitive-behavioral perspective on chronic pain. I've chosen to call this view the standard behaviorist model of pain.
Behaviorist psychology originated as a research perspective on the behavior of animals, including us. Whatever inner intellectual lives most animals have are hidden from us. It is natural that research on non-human animals should ignore any inner thoughts or feelings or whatever may be going on invisibly inside of them. Human behaviorist psychology is an extension of this viewpoint to humans, and also a reaction to psychodynamic or introspective approaches to human psychology, such as the Freudian or Jungian schools. Applying the behaviorist psychology to humans allows us to look at animals as (perhaps simplified) models for humans. Ignoring human thoughts and feelings and whatever else may be going on inside of us eliminates the need to deal with thoughts and feelings at all, and in particular sidesteps the need to explain subjective reports or to reconcile subjective reports with objective findings.
Behavioral psychology embraces two principal modes of associative learning, which are called pavlovian and respondent. These two modes are "associative". They associate behavior with events and conditions that exist in the organism's environment. Through pavlovian conditioning the organism learns to perform certain built-in behaviors when it is cued by appropriate events or conditions in its environment. Pavlovian conditioning helps the organism by teaching it to predict or anticipate biologically-important events.
Through respondent conditioning the organism learns to perform actions that result in rewards and to avoid actions that result in punishments. While pavlovian conditioning is about cues or stimuli, respondent conditioning is about rewards and punishments.
The standard model includes pain learning theories based on the pavlovian or respondent learning model:
The standard model also includes the concept that the development and experience of pain, especially chronic pain, is influenced in humans by "cognitive factors." These cognitive factors include beliefs related to pain and also apparently include habits, personal and social history, and the social environment of the pain sufferer. The set of factors included seems to be united more by the idea that their effects can be controlled by reappraisal and conscious effort than by the common etiology or nature of the cognitive factors.
The term "cognitive" in this school of psychology is meant to include the evaluation of the significance of events and conditions, a process called appraisal, which, according to the model, results in emotions. I present these cognitive factors and their associated theory and evidence in a third section:
The standard model, as you can perhaps surmise from what I have already said, is an abstract one. While physiological models almost always refer to concrete things, the standard model refers to abstract things like "learning" and "rewards" and "beliefs." The standard model is also, I would say, an abstruse one. As an example, pain, which is generally recognized to be a subjective experience, is not acknowledged in a behavioral model of pain. How this could be certainly requires some comment. The standard model is not, in the sense that a physiological model is, unified. It is not uniformly well-proven. Its implications are of course not always clear.
All of these qualifications do not necessarily imply that the standard model is not true or useful. They do, I believe, imply that it is not an easy model to evaluate or to explain. Some of the treatment implications claimed for the standard model are dramatic, concrete, and rather counterintuitive. If you are a pain sufferer, you will encounter these claimed treatment implications if you haven't encountered them already. As examples, you may be told that pain is not the same as harm--that you shouldn't necessarily respond when you feel that your pain is telling you to adjust your activities--that you shouldn't take pain meds when you hurt--that assistance from others may be harmful to you.
If these claims are true, it is good news. In that case it is very important that you believe them, whether they are intuitive or not. In fact it is more than good news, it is great news! (A cognitive-behavioral therapist will tell you that beliefs can be adaptive or maladaptive. If you are wise, you'll go for the adaptive ones.) If these claims are not true, it is equally important that you reject them.
My own assessment of the standard model is that there is both truth and falsity in it, unevenly distributed and not clearly distinguished. While parts of it are correct, useful, and worth knowing, the true parts are intermixed with parts that are dangerously false. Because of this, and because the model itself is a collection of ideas rather than a unified structure, I have chosen to present the model itself in the words of two authorities on and advocates of it, Herta Flor and Dennis C. Turk. Their explanation of the model is taken from Chapter 18, Cognitive and Learning Aspects, of Wall and Melzack's Textbook of Pain. I place my own explanations, interpretations, and comments alongside their work in the tradition of Medieval scholarly manuscripts. See The CBT Model of Pain and Pain Behavior.
Within this section...
The Basic Problem with Behavioral Pain (Last updated: Wed, Feb 26, 2025)
Cognitive-Behavioral Theories of Pain (This page is incomplete.)
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The Neuromatrix Model of Pain (Last updated: Fri, Feb 7, 2025)