The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.

The Central Sensitization Inventory (CSI) is a new patient-reported instrument, which measures symptoms related to Central Sensitivity Syndromes and Central Sensitization. The aim of this study was to translate the CSI into Spanish, and then to perform a psychometric validation, including a factor analysis to reveal the underlying structure. In this two-stage psychometric study participated 395 subjects with various chronic pain conditions and that were recruited from two Primary Care Centres. The CSI was cross-culturally adapted to Spanish through double forward and backward translations. The psychometric properties were then evaluated with analyses of construct validity, factor structure and internal consistency. One subgroup (n = 45) determined test-retest reliability at 7 days. The Spanish Version of CSI demonstrated high internal consistency (α = 0.872) and test-retest reliability (r = 0.91). Factor structure was one-dimensional and supported construct validity. The psychometric properties of the Spanish version were found to be strong, with high test-retest reliability and internal consistency, with similar psychometric properties to the English language version. Unlike the English version, however, a one factor solution was found to be a best fit for the Spanish version.

Fear-avoidance (FA) beliefs are significantly associated with the experience of pain, especially when the pain becomes chronic in nature. The anticipated threat of intense pain will often result in the constant vigilance and monitoring of pain sensations, which, in turn, can cause even low-intensity sensations of pain to become unbearable for the person. Just the anticipation of increased pain or reinjury can further stimulate avoidance behaviors. A vicious cycle may develop, in which fears of increased pain or reinjury contribute to the avoidance of many activities, leading to inactivity and, ultimately, to greater disability. Anyone who assesses and treats pain-related disability should also be prepared to assess and treat pain-related FA. J Orthop Sports Phys Ther 2016;46(2):38–43. doi:10.2519/jospt.2016.0601

The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain assessment, prevention, and treatment. Currently, this model also provides the best foundation for tailoring the most comprehensive pain management program for each specific patient. Chronic pain patients have an increased risk for developing deficits in physical functioning, emotional reactivity, and cognition. Interdisciplinary treatment, based on the biopsychosocial model, is vital to address these multifaceted issues facing chronic pain sufferers. These interdisciplinary pain management strategies have progressed with advancements in science and technology in an attempt to provide the best possible outcomes for pain patients. However, while research has made enormous advances, there are still some clinical research gaps to be addressed. This article will begin with a historical overview of pain management in order to demonstrate the evolution in theory from ancient practices to the modern biopsychosocial model. Additionally, functional restoration and other early interdisciplinary intervention programs will be highlighted for their importance and effectiveness in chronic pain management, assessment, and prevention.