We know that chronic pain does have a biological interface. There are structural and functional changes in the brain, such as gray matter loss and a functional reorganization. We also know that chronic pain is associated with systemic effects, such as increased inflammation throughout the body such as IL-6 and C-reactive protein. Chronic pain also tends to increase stress reactivity, such as enhanced cortisol reactivity after the induction of some sort of a stressor.
These factors could be psychological such as positive affect or self-efficacy. They could be behavioral such as getting a good night sleep or having a good social relationship with your family and your friends. There are existential factors such as having life purpose or acceptance. So there are multiple factors, which is really nice from an intervention sense because we can utilize multiple resources to enhance these various protective or resilience factors in people.
There have been a number of studies that have looked at various interventions in terms of reducing stress responsiveness, also reducing gene expression that’s associated with enhanced inflammatory signaling. I think this is probably an area that is really going to start to burgeon and we’re going to start to see some nice effects from some of these interventions. I think that in terms of treatments to invest in, traditionally we’ve been focused on kind of a vulnerability path. What are the vulnerability and the risk factors associated with pain, its development, its maintenance? And not that we should exclude that, because that’s a key piece of the puzzle, but I think that we should also take a dual perspective, not just these vulnerability factors but really focusing in on the resilience factors – what are personal strengths that can help people adapt to the complexities of pain? Being able to incorporate both of these into a treatment package may have some benefits in bolstering our current pain therapies.