Stress-induced physiologic changes as a basis for the biopsychosocial model of chronic musculoskeletal pain: a new theory?

OBJECTIVES: (1) To integrate the scientific literatures of the biopsychosocial model of chronic musculoskeletal pain and of stress-induced physiologic wound and muscle changes, and (2) to propose a clinical assessment and treatment model that incorporates this dual literature into the management of chronic musculoskeletal pain.
METHODS: English language literature search from January 1990 to February 2008 using the MEDLINE and PsycINFO databases and the keywords "wound healing," "musculoskeletal injury," "skeletal muscle injury," "psychological," "social," "stress," "anxiety," and "pain."
RESULTS: An illustrative case report is introduced. Review of the scientific literature revealed that psychologic stress is associated with slower or delayed wound healing in stressed older adults, restrained mice, socially isolated hamsters, adults with leg wounds, and surgical patients. One study showed that expressive writing positively affected the healing of a small skin puncture. Psychosocial stress affected aspects of muscle activity and spinal loading. Slaughter studies demonstrated that high preslaughter stress in pigs negatively affected postslaughter meat quality. A clinical model for the treatment of selected patients with painful musculoskeletal symptoms is offered. DISCUSSION: Important links exist between psychologic and social factors and recovery from insults to the "soft tissues." Identifiable biochemical and physiologic processes mediate this relationship. It is time to rethink and refine views of the role of psychologic and social factors in musculoskeletal illness, chronicity, and pain.