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Reasons that patients experience pain differently
Why would two patients with the same condition and treatment report vastly different levels of pain, and are genetic factors mainly responsible?
Pain is a variable personal experience that is influenced by genetics, but also involves multiple interactive biopsychosocial processes, says a leading pain researcher speaking recently to the American Pain Society (APS) Annual Scientific Conference. Individual differences in pain responses have been a longstanding research concern, says Roger B. Fillingim, PhD, professor at the University of Florida College of Dentistry in Gainesville. However, clinicians often dismiss pain variability as a nuisance and refer to those whose pain responses differ from the norm as outliers. Renewed interest in the issue has been spurred by the genetic revolution.
"Though genetic influences are a significant force that determines someone's response to pain, both genetic and nongenetic variables interact to influence the pain experience," said Fillingim.
He said individualized differences in pain responses should be studied. "Characteristics such as age, sex, race, and ethnicity, and personality all have been associated with pain responses, as well as situational variables like mood, stress, and cognitive processes."
Fillingim explained that in the biopsychosocial model of pain response, individual differences are determined by the complex interaction of biological, psychological, and sociocultural factors, and not by linking pain with clinical pathology. "Abundant evidence shows that pain and tissue damage are poorly related and there are significant differences among individual patients in their perception of pain that extend beyond pathology," he said.
Knowing the social and psychological situations of their patients can help you gauge responses to pain and to medications, Fillingim said. "It's true that one size does not fit all, so we can't assume everyone is average when it comes to managing pain," he said.
Psychological, social, and cultural factors, as well as life experiences, play a role in pain responses, Fillingim said. "The best course for clinicians is to get to know your patients better from a holistic perspective and gain a more complete understanding of their life situations and how they might influence pain responses," he said. "Don't just rely on clinical symptoms and clinical pathology to predict responses to pain and pain management treatments."