What are the mechanisms of pain misinterpretation?

From the Guidelines

Pain misinterpretation occurs through a complex interplay of neurological and psychological mechanisms, including central sensitization, neuroplasticity, catastrophizing, and emotional states, which can amplify pain perception and create persistent pain experiences. The brain can misinterpret non-painful stimuli as painful through central sensitization, where repeated nerve stimulation increases pain sensitivity 1. Neuroplasticity allows pain pathways to become reinforced over time, creating persistent pain even without ongoing tissue damage. Psychological factors like catastrophizing, where individuals expect the worst outcomes, can amplify pain perception 1. Emotional states such as anxiety and depression directly influence pain processing in the brain. Past trauma can rewire pain responses, making normal sensations feel threatening. Cultural and social factors shape how individuals interpret bodily sensations. The descending pain modulation system, which normally helps regulate pain signals, can malfunction and amplify rather than inhibit pain. Cognitive biases like hypervigilance cause excessive attention to bodily sensations, making normal stimuli seem painful.

• Key factors that contribute to pain misinterpretation include:
  • Central sensitization and neuroplasticity, which can create persistent pain pathways 1
  • Catastrophizing and negative expectancy, which can amplify pain perception and create fear-avoidance behaviors 1
  • Emotional states, such as anxiety and depression, which can directly influence pain processing in the brain 1
  • Past trauma, which can rewire pain responses and make normal sensations feel threatening
  • Cultural and social factors, which can shape how individuals interpret bodily sensations
• Understanding these mechanisms is essential for effective pain management, as it highlights the importance of addressing both physical and psychological factors in the treatment of chronic pain 1.
• A comprehensive approach to pain management should include education on the mechanisms of pain misinterpretation, as well as strategies to address catastrophizing, negative expectancy, and emotional states, such as cognitive-behavioral therapy and mindfulness-based interventions 1.

From the Research

Mechanisms of Pain Misinterpretation

• Pain can be categorised as nociceptive, neuropathic, or nociplastic, which affects work-up and treatment decisions 2
• The biopsychosocial model of pain presents physical symptoms as the result of a dynamic interaction between biological, psychological, and social factors 2
• Psychological distress and sleep problems can contribute to pain misinterpretation, and these associations are bidirectional 2
• Factors promoting resilience, such as emotional support systems and good health, can promote healing and reduce pain chronification 2

Pain Classification and Treatment

• Pain classification is considered a continuum, with considerable overlap between different types of pain mechanisms within and between patients 2
• A personalised multimodal, interdisciplinary treatment approach is recommended, which may include pharmacotherapy, psychotherapy, integrative treatments, and invasive procedures 2
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) are used in the treatment of neuropathic pain and fibromyalgia, with moderate evidence for efficacy 3
• SNRIs, such as venlafaxine and duloxetine, have been shown to be effective in the treatment of painful diabetic neuropathy and polyneuropathy 3

Pain Assessment and Management

• Appropriate treatment of pain requires an understanding of the characteristics of pain, including severity and nature 4
• Pain assessment and management involve a range of skills, including the use of tools to assist with assessment and the implementation of management strategies 5
• Barriers to effective pain assessment and management must be addressed to provide optimal care for patients with pain 5