Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models

Abstract

Ariane Delgado-Sanchez,1 Christopher Brown,2 Manoj Sivan,3 Deborah Talmi,4 Christiana Charalambous,5 Anthony KP Jones1 1Division of Human Communication, Development, and Hearing, University of Manchester, Manchester, UK; 2Institute of Population Health, University of Liverpool, Liverpool, UK; 3Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; 4Department of Psychology, University of Cambridge, Cambridge, UK; 5Department of Mathematics, University of Manchester, Manchester, UKCorrespondence: Ariane Delgado-Sanchez, Clinical Sciences Building, Salford Royal Foundation Trust, Salford, Greater Manchester, United Kingdom, Email [email protected]: Identifying biopsychosocial factors underlying chronic pain vulnerability is essential for the design of preventative efforts. Multiple chronic pain vulnerability models exist, however, there is a lack of comprehensive evaluation of these models in the literature, potentially due to the lack of guidelines that specify the criteria by which these types of work should be assessed. In this work, we created evaluation criteria (based on the general goals of conceptual models), and we then used them to critically review the chronic pain vulnerability models available in the current peer-reviewed literature (identified through a systematic search). Particularly, we evaluated the models on the basis of conceptual clarity/specificity of measures, depth of description of aetiological and mechanistic factors, use of a whole system approach, and quality of the evidence associated with the models. We found nine conceptual models that have been explored in detail (eg, fear avoidance model, diathesis-stress model). These models excel at clarity and are supported mostly by self-report evidence of a psychological nature (anxiety sensitivity, pain catastrophizing, etc.), but provide little explanation of mechanistic and aetiological factors. In the future, models could be improved by complementing them with proposals from other models and exploring potential causal factors and mechanisms maintaining the condition. This task could be carried out through prospective cohort studies, and computational approaches, amongst others.Plain Language Summary: Several theories explain why some people are more vulnerable to develop chronic pain; however, there is no previous work that compares these theories or evaluates their quality. After evaluating these theories, we concluded that they are very good at identifying what psychological characteristics make someone vulnerable to develop chronic pain. However, they lack an explanation regarding what makes people develop those characteristics or how they lead to pain. We propose ways in which the different theories could be complemented.Keywords: vulnerability, evaluation, theory, conceptual model

Keywords

• vulnerability
• evaluation
• theory
• conceptual model