Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Orthopaedic Surgery & Duke Clinical Research Institute, Duke University Schoool of Medicine, Durham, North Carolina.
Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.
J Pain. 2024 Oct;25(10):104608. doi: 10.1016/j.jpain.2024.104608. Epub 2024 Jun 17.
Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.
尽管广泛支持将生物心理社会框架应用于疼痛，但在疼痛预防和管理的背景下，疼痛的社会方面仍很少得到解决。在这篇综述中，我们旨在：1）考察疼痛的广泛社会决定因素和后果及其在多个组织层次上的相互作用；2）提供一个框架，综合现有的概念和未来疼痛社会方面工作的潜在领域，借鉴社会生态学、交叉和生命历程方法。整合跨学科理论和证据，我们概述了多层次社会因素和疼痛随时间相互影响的途径。我们还简要总结了疼痛的个体内在方面，这些方面被认为在个体和社会环境之间的界面上运作。从微观因素到宏观因素，我们说明了疼痛的社会决定因素如何直接或间接地影响不同人群的疼痛体验、表达、风险、预后和影响。我们考虑：1）在人际层面，社会比较、社会关联性、社会支持、社会排斥、同理心和人际冲突的作用；2）在群体或社区层面，亲密群体、任务群体、社会类别和松散联系的作用；3）在社会层面，政治、经济和文化系统及其政策和实践的作用。我们在这些层面上展示了疼痛多层次后果的例子，并讨论了通过扩大疼痛研究和实践中的多层次社会方法来减轻疼痛负担和不平等的机会。观点：尽管广泛支持将生物心理社会框架应用于疼痛，但疼痛的社会方面通常定义不明确，这阻碍了它们在疼痛预防、管理和研究中的应用。我们总结了疼痛的社会方面的范围，并提供了一个框架，综合了现有的概念和未来工作的潜在领域。
