Evaluating the role of physical, operant, cognitive, and affective factors in the pain behaviors of chronic pain patients.
For chronic pain, physical, cognitive, and emotional variables predict pain behaviors; reinforcement history does not.
01Research in Context
What this study did
The team looked at the adults with fibromyalgia. They wanted to know what best predicts pain behaviors like grimacing or guarding.
They measured four groups of variables: physical (strength, tenderness), cognitive (pain beliefs), affective (mood), and operant (reinforcement history). Then they ran regression models to see which set mattered most.
What they found
Physical, cognitive, and affective factors together explained a large share of the variance in pain behaviors. Adding operant variables did not improve the model.
In plain words: knowing how others might reward pain behaviors told us almost nothing extra.
How this fits with other research
Schmitt (1986) pushed covert conditioning, an operant method, for pain control. Lord et al. (1997) counters that operant factors add no unique predictive power.
Feinstein et al. (1988) showed matching treatment to function works for self-injury. The pain study borrows that data-driven logic but finds different drivers.
Rojahn et al. (1994) also showed internal states matter: anxious college students gained less from pain self-control. The fibromyalgia data line up—internal variables trump external contingencies.
Why it matters
If reinforcement history barely predicts pain behaviors, skip lengthy operant interviews for chronic pain clients. Focus your assessment on strength tests, pain-cognition questionnaires, and mood logs. Then craft interventions that target those physical, cognitive, and emotional variables instead of contingency contracts.
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02At a glance
03Original abstract
Behavioral manifestations of pain, distress, and suffering have been characterized as pain behaviors. Although acquisition and maintenance of pain behaviors have been considered to occur through reinforcement contingencies, empirical evidence suggests that pain behavior is better understood as a multidimensional entity. The present study was designed to evaluate the contributions of physical, operant, cognitive, and affective factors to individual differences in pain behaviors. A total of 63 chronic pain patients diagnosed with the disorder fibromyalgia underwent medical, physical, and psychological evaluations. Hierarchical regression analyses revealed that the physical, cognitive, and affective factors, but not operant factors, were significantly related to observed pain behaviors. The set of all factors accounted for 53% of the variance in observed pain behavior. The results in this study suggest that pain behaviors should be conceptualized as behavioral manifestation of pain based on a complex interaction of various psychological and physical factors.
Behavior modification, 1997 · doi:10.1177/01454455970213001