The contribution of psychosocial factors to the development of chronic pain: The key to better outcomes for patients?

There is growing evidence that aspects of the psychosocial environment are associated with a higher likelihood of reporting pain, particularly chronic pain (Hoogendoorn et al., 2000; Bongers et al., 2002), including some evidence from longitudinal studies that these aspects are potential risk factors for future development of musculoskeletal pain (Nahit et al., 2003; Hartvigsen et al., 2004). By contrast, results from psychosocial intervention studies for pain have, overall, delivered modest outcomes in community settings (Karjalainen et al., 2001; Hay et al., 2005; Jellema et al., 2005; Jones et al., 2006). Chronic pain is a significant public health problem and we need effective interventions that are deliverable in community settings, so we need to understand the reasons (and they are likely to be multiple) why this has occurred. The disappointing findings may relate to the quality of the interventions or the skills of those delivering them. Several interventions for pain which have shown null results have provided brief training to those delivering it, e.g., brief training of physiotherapists to deliver behavioural therapy (Jones et al., 2006), which may not equip them with sufficient skills. However, an over-arching reason for disappointing findings from