Chronic pain in people with physically disabling conditions : a review of the application of biopsychosocial models

There are a wide range of conditions which can result in physical disabilities, affecting more than a billion people or approximately 15% of the population worldwide (World Health Organisation, 2011). Disability is an umbrella term for the restrictions and impairments arising from the interaction between an individual with a health condition and the environment (World Health Organisation, 2011). The physical conditions from which disability arises are diverse and heterogeneous, but include both diseases, such as multiple sclerosis, as well as traumatic and non-traumatic injuries, including spinal cord injury and brain injuries. Research concerning the occurrence of chronic pain (defined as pain persisting beyond the period of healing, usually operationalized as three or six months) among people with physical disabilities, and the impact upon those individuals affected, is relatively limited compared to that focusing on primary pain conditions, such as low back pain. Within the available literature the focus is largely biomedical, with the majority of available research exploring biological factors and medical interventions. A great deal has been gained in the management of primary pain conditions through investigating psychological and social factors, and developing interventions such as cognitive behavioural pain management programs to target these factors. This chapter will describe the current understanding of the role of psychological and social factors in understanding the experience of chronic pain in the context of a physically disabling condition, and the use of interventions addressing these factors in this population.