Toward a biopsychomotor conceptualization of pain - Implications for research and intervention

Objectives: Nearly 400 years ago, Rene Descartes proposed a model of pain perception that characterized pain as a purely physical phenomenon, devoid of psychologic influence. The characterization of pain as an exclusively sensory (or experiential) phenomenon continues to dominate current conceptualizations of pain. Methods: This paper advances the view that the exclusive focus on pain sensation or experience as the essential feature of the pain system has given rise to conceptual frameworks that are incomplete and flawed. It is argued that individuals with pain differ from individuals without pain not only in how they feel but they differ in how they behave. Results: Arguments are put forward advocating for a biopsychomotor conceptualization of pain where pain behaviors are construed as integral components of the pain system. The biopsychomotor model proposes that at least 3 partially independent behavioral subsystems are integral components of pain. These include communicative pain behaviors, protective pain behaviors, and social response behaviors. Evidence is reviewed suggesting that different dimensions of pain behavior are functionally distinct, and questions are raised about the nature of motor programs responsible for the elicitation and maintenance of different forms of pain behavior. Discussion: Clinical and theoretical implications of a biopsychomotor conceptualization of pain are discussed.