From the Guidelines
The central tenet of the classical pathology model regarding the relationship between pathology and pain is that increased pain is associated with increased pathology, proposing a direct relationship between the severity of tissue damage or disease and the intensity of pain experienced by the patient. This model suggests that as structural damage worsens, pain symptoms should correspondingly increase in severity, as supported by the definition of pain by the International Association for the Study of Pain (IASP) which states that pain is ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’ 1. The classical pathology model has traditionally guided medical approaches to pain management, with the assumption that identifying and treating the underlying pathological condition will resolve the pain.
However, it's essential to consider that this model may not fully capture the complexities of pain, particularly in chronic pain conditions. The study by 1 highlights the multidimensional nature of pain, influenced by biological, psychological, and social factors, which can affect the individual interpretation of pain. Additionally, the process of pain transmission is regulated by descending pathways and inhibitory interneurons, which can modulate the nociceptive information at the spinal dorsal horn, as described in the study 1.
Key points to consider:
- The classical pathology model proposes a direct relationship between pathology and pain
- Pain is a multidimensional phenomenon, influenced by various factors
- The process of pain transmission is complex and involves multiple pathways and neurotransmitters
- Chronic pain conditions often involve neuroplastic changes, psychological factors, and social contexts that can significantly influence pain perception, as mentioned in the study 1.
In real-life clinical practice, it's crucial to consider these factors when managing pain, rather than relying solely on the classical pathology model. A comprehensive approach to pain management should take into account the biological, psychological, and social factors that contribute to an individual's pain experience, as supported by the study 1.
From the Research
Classical Pathology Model
The classical pathology model is not directly addressed in the provided studies. However, the relationship between pathology and pain can be inferred from the following points:
- Pathological pain is nonprotective and maladaptive, whereas physiological pain states, such as nociceptive and inflammatory pains, are protective and adaptive 2
- Pathological pain, such as neuropathic pain and central nervous system dysfunctional pain, results from neuroplasticity of the peripheral and central nervous system 2
- The development of persistent postsurgical pain is an example of the complex process involving pathological pain 2
- Abdominal pain can be induced by stimulation of visceral nociceptors, which usually requires previous sensitization by pathological events, such as inflammation, ischemia, or acidosis 3
- The interactions between visceral pathology and alterations of the central pain processes represent an explanation for the discrepancy between objective signs of peripheral lesions and severity of the symptoms 3
Key Findings
Some key findings related to the relationship between pathology and pain include:
- Pain is a complex biopsychosocial experience, and chronic pain need not involve any structural pathology 4
- Treatment of the specific mechanisms responsible for pain should be aimed at preventing and/or reducing dysfunctional neuro-plasticity resulting from poorly controlled chronic pain 4
- The main consequences of alterations in central pain processing for patients are central sensitization and alteration of the endogenous pain modulation, leading to a spread of pain to other body regions and an amplification of the pain perception 3