A diathesis-stress model of chronic pain and disability following traumatic injury.

One of the perplexing features of pain is the wide variability in patients' responses to ostensibly the same extent of physical pathology. A range of cognitive, affective and behavioural factors are related to the perception of pain, maintenance of pain and disability, exacerbation of pain and response to treatment. Moreover, there is some evidence that individual differences and prior learning history also have a significant influence on the experience of pain and related disability. The role of these psychological factors in the maintenance of disability following traumas such as motor vehicle accidents and work-related injuries has generated considerable interest. This paper provides a brief overview of a set of predisposing factors, cognitive processes and behavioural principles that appear to be particularly important in the maintenance of disability following trauma. In particular, anxiety sensitivity, anticipation and avoidance of fear or harm, catastrophizing ideation, causal attributions for symptoms, self-efficacy and operant conditioning are discussed. Each of these factors is integrated in a diathesis-stress model that emphasizes the interaction of predisposing factors with a trauma, setting in motion a cascade of interpretive cognitive processes and reinforcement contingencies that maintain disability following the trauma. This model proposes a sequential process to explain the variation observed among people following a relatively minor trauma. The model is intended to be heuristic. It may be a useful conceptualization that can serve to guide prevention efforts and the development of treatment interventions.