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Fordyce discussion
131
43 (1990) 131-132 Elsevier
Pain,
PAIN 01658
A comment on the Schmidt/Fordyce
discussion
Johan W.S. Vlaeyen, Ank M.J. Kole-Snijders, Joop A. Schuerman, Hugo Van Eek and Nice H. Groenman Chronic Pain Research Program, Institute for Rehabilitation Research, Lucas Foundation for Rehabilitation, University of Limburg, Zandbergsweg Ill, 6432 CC Hoensbroek (The Netherland)
(Accepted 26 April 1990)
Dear Editor, In a recent discussion on ‘pain behavior’ and ‘pain ratings,’ held by Fordyce et al. and Schmidt (Pain, 33 (1988) 385-389), the latter introduces a pain dimension with on one extreme ‘pain behavior,’ and ‘nociception’ on the other. Furthermore, Schmidt adds a third concept: ‘pain perception’ of which he states that it: ‘ . . . takes a middle position on the pain dimension, relating to both pain behavior and nociception.’ The author also considers pain ratings, for example those obtained by the visual analog scale (VAS), a measure for pain perception. Later, Schmidt refers to this pain dimension as the 3-factor model of pain. He states: ‘I repeat: pain ratings are neither pain behaviors nor nociception but - as an operationalization of pain perception - have a distinct status on the pain dimension between nociception and pain behavior. This is called the 3-factor model of pain.’ This statement may lead to a conceptual confusion. First of all, a distinction needs to be made between pain constructs and the assessment method or instrument to quantify it. A pain rating is an instrument and cannot be placed on the same line with nociception and pain behaviors, which are constructs. The second, and more important, point is the erroneous introduction of the 3-factor model of pain, better known as the 3-systems model of pain. Schmidt refers to this model as if it presents 0304-3959/90/$03.50
0 1990
a unidimensional representation of pain constructs, ranging from nociception to pain behavior, with pain perception in the middle. This is a clear misunderstanding of the model. The 3-systerns model of pain is in fact an application of the 3-systems model of emotion, first introduced by Lang [2] and Rachman [3], and widely applied to the area of anxiety research. According to this model, emotions are thought to be expressed by 3 different response systems: verbal report, overt motor responses, and expressive physiology. Emotions can, therefore, best be studied through these response systems, which should be considered as ‘a set of loosely coupled components.. . ,’ as they do not correlate [3]. The assumption is that emotions can be generated by 3 ‘channels’ which act partially independently from one another. Instead of a unidimensional conceptualization, a 3-dimensional one is suggested, an emotion being represented as a vector in a 3-dimensional space [6]. Although they acknowledged that some problems remain unresolved, Vlaeyen et al. [8] have argued in favor of the use of this model as a heuristic framework in chronic pain research, assessment, and treatment. Basically, their proposition is based on (1) the international recognition that pain is also an emotional experience [l], (2) the assumption that chronic pain might be considered a pathologic emotion [5], and (3) the observation that in the literature on chronic pain conceptualization, assessment and psychological treat-
Elsevier Science Publishers B.V. (Biomedical Division)
132
ment, pain is approached as a trimodal condition involving gross motor, cognitive and physiological events [4,7]. Unlike what is suggested by Schmidt’s statement, the notion of nociception is not included in the model. The physiological response system refers to the psycho-physiological correlates of pain. Therefore, one of the benefits of this model is that its application is not restricted to chronic benign pain.
References 1 International Association for the Study of Pain, Pain terms: A list with definitions and notes on usage. Pain, 6 (1979) 249-252.
2 Lang, P., Fear reduction and fear behavior: problems in treating a construct, Res. Psychother., 3 (1968) 90- 102. 3 Rachman, S., Human fears: a three systems analysis. Stand. J. Behav. Ther., 7 (1978) 237-245. 4 Sanders, S.H., Behavior assessment and treatment of chrome pain: appraisal and current status. In: M. Hersen. R.M. Eisler and P.M. Miller (Eds.), Progress in Behavior Modification, Vol. 8, Academic Press, New York, 1979. pp. 249-291. 5 Swanson, D.W.. Chronic pain as a third pathologic emotion, Am. J. Psychiat., 141 (1984) 210-214. 6 Van Egeren, L.F., Psychophysiological aspects of systematic desensitization: some outstanding issues, Behav. Res. Ther.. 9 (1978) 65-77. 7 Vlaeyen, J.W.S., Van Eek, H., Schuerman, J.A. and Green man, N.H., Dimensions and components of observed chronic pain behavior, Pain, 31 (1987) 65-75. 8 Vlaeyen, J.W.S, Snijders. A.M.J.. Schuerman, J.A.. Van Eek, H., Groenman, N.H. and Bremer J.J.C.B., Chronic pain and the three-systems model of emotions. A critical examination. C‘rit. Rev. Phys. Rehab. Med., 1 (1990) 67-7.5.
43 (1990) 131-132 Elsevier
Pain,
PAIN 01658
A comment on the Schmidt/Fordyce
discussion
Johan W.S. Vlaeyen, Ank M.J. Kole-Snijders, Joop A. Schuerman, Hugo Van Eek and Nice H. Groenman Chronic Pain Research Program, Institute for Rehabilitation Research, Lucas Foundation for Rehabilitation, University of Limburg, Zandbergsweg Ill, 6432 CC Hoensbroek (The Netherland)
(Accepted 26 April 1990)
Dear Editor, In a recent discussion on ‘pain behavior’ and ‘pain ratings,’ held by Fordyce et al. and Schmidt (Pain, 33 (1988) 385-389), the latter introduces a pain dimension with on one extreme ‘pain behavior,’ and ‘nociception’ on the other. Furthermore, Schmidt adds a third concept: ‘pain perception’ of which he states that it: ‘ . . . takes a middle position on the pain dimension, relating to both pain behavior and nociception.’ The author also considers pain ratings, for example those obtained by the visual analog scale (VAS), a measure for pain perception. Later, Schmidt refers to this pain dimension as the 3-factor model of pain. He states: ‘I repeat: pain ratings are neither pain behaviors nor nociception but - as an operationalization of pain perception - have a distinct status on the pain dimension between nociception and pain behavior. This is called the 3-factor model of pain.’ This statement may lead to a conceptual confusion. First of all, a distinction needs to be made between pain constructs and the assessment method or instrument to quantify it. A pain rating is an instrument and cannot be placed on the same line with nociception and pain behaviors, which are constructs. The second, and more important, point is the erroneous introduction of the 3-factor model of pain, better known as the 3-systems model of pain. Schmidt refers to this model as if it presents 0304-3959/90/$03.50
0 1990
a unidimensional representation of pain constructs, ranging from nociception to pain behavior, with pain perception in the middle. This is a clear misunderstanding of the model. The 3-systerns model of pain is in fact an application of the 3-systems model of emotion, first introduced by Lang [2] and Rachman [3], and widely applied to the area of anxiety research. According to this model, emotions are thought to be expressed by 3 different response systems: verbal report, overt motor responses, and expressive physiology. Emotions can, therefore, best be studied through these response systems, which should be considered as ‘a set of loosely coupled components.. . ,’ as they do not correlate [3]. The assumption is that emotions can be generated by 3 ‘channels’ which act partially independently from one another. Instead of a unidimensional conceptualization, a 3-dimensional one is suggested, an emotion being represented as a vector in a 3-dimensional space [6]. Although they acknowledged that some problems remain unresolved, Vlaeyen et al. [8] have argued in favor of the use of this model as a heuristic framework in chronic pain research, assessment, and treatment. Basically, their proposition is based on (1) the international recognition that pain is also an emotional experience [l], (2) the assumption that chronic pain might be considered a pathologic emotion [5], and (3) the observation that in the literature on chronic pain conceptualization, assessment and psychological treat-
Elsevier Science Publishers B.V. (Biomedical Division)
132
ment, pain is approached as a trimodal condition involving gross motor, cognitive and physiological events [4,7]. Unlike what is suggested by Schmidt’s statement, the notion of nociception is not included in the model. The physiological response system refers to the psycho-physiological correlates of pain. Therefore, one of the benefits of this model is that its application is not restricted to chronic benign pain.
References 1 International Association for the Study of Pain, Pain terms: A list with definitions and notes on usage. Pain, 6 (1979) 249-252.
2 Lang, P., Fear reduction and fear behavior: problems in treating a construct, Res. Psychother., 3 (1968) 90- 102. 3 Rachman, S., Human fears: a three systems analysis. Stand. J. Behav. Ther., 7 (1978) 237-245. 4 Sanders, S.H., Behavior assessment and treatment of chrome pain: appraisal and current status. In: M. Hersen. R.M. Eisler and P.M. Miller (Eds.), Progress in Behavior Modification, Vol. 8, Academic Press, New York, 1979. pp. 249-291. 5 Swanson, D.W.. Chronic pain as a third pathologic emotion, Am. J. Psychiat., 141 (1984) 210-214. 6 Van Egeren, L.F., Psychophysiological aspects of systematic desensitization: some outstanding issues, Behav. Res. Ther.. 9 (1978) 65-77. 7 Vlaeyen, J.W.S., Van Eek, H., Schuerman, J.A. and Green man, N.H., Dimensions and components of observed chronic pain behavior, Pain, 31 (1987) 65-75. 8 Vlaeyen, J.W.S, Snijders. A.M.J.. Schuerman, J.A.. Van Eek, H., Groenman, N.H. and Bremer J.J.C.B., Chronic pain and the three-systems model of emotions. A critical examination. C‘rit. Rev. Phys. Rehab. Med., 1 (1990) 67-7.5.