The establishment, maintenance, and adaptation of high and low impact chronic pain: a framework for biopsychosocial pain research.

Christopher Eccleston, Emma Begley, Hollie Birkinshaw, Ernest Choy, Geert Crombez, Emma Fisher, Anna Gibby, Rachael Gooberman-Hill, Sharon Grieve, Amber Guest, Abbie Jordan, Amanda Lillywhite, Gary J Macfarlane, Candida S. McCabe, John McBeth, Anthony E Pickering, Tamar Pincus, Hannah M Sallis, Samantha Stone, Danielle Van der WindtDiego Vitali, Elaine Wainwright, Colin Wilkinson, Amanda C. de C Williams, Anica Zeyen, Edmund Keogh

Research output: Contribution to journalArticlepeer-review

2 Citations (SciVal)


We present a framework for the study of states of chronic pain and transitions between those states. We capture in the framework the dynamic nature of pain: people live with pain that changes over time. First, we offer definitions of both acute and chronic pain, and explore the contextual considerations related to the common use of this temporal dichotomy. Second, we promote the importance of incorporating the impact pain has on a person’s life. Finally, we discuss the challenges and opportunities inherent in implementing this common approach. Our goal is to produce a framework for the study of the development, maintenance, and resolution of chronic pain. Whether a single brief event or a constant feature of life, pain interrupts to prioritise protection, interferes with activity, reduces quality of life, and can alter identity. [44] Protection is achieved by escape from harm, avoidance of perceived danger, withdrawal for respite and repair, and communication of incapacity and environmental risk; longer term protection is achieved by learning the cues for pain and injury. [53] From this perspective, pain is most usefully considered a need state, fundamentally a motivational drive to protect [49]. This approach centres our attention on the consequences of pain for the person in their context, on its duration and its impact.
Original languageEnglish
Pages (from-to)2143–2147
Number of pages5
Issue number10
Early online date16 Jun 2023
Publication statusPublished - 1 Oct 2023

Bibliographical note

This work was supported by a joint and equal investment from UKRI [grant numbers MR/W004151/1 and MR/W026872/1] and the charity Versus Arthritis [grant number 22891] through the Advanced Pain Discovery Platform (APDP) initiative. For UKRI,
the initiative is led by the Medical Research Council (MRC), with support from the Biotechnology and Biological Sciences Research Council (BBSRC) and the Economic and Social Research Council (ESRC). No authors reported any conflicts of interest associated with this manuscript.

Data availability: There are no data associated with this manuscript.


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