What do social factors have to do with pain and rehabilitation?

As research in the pain space has advanced, a consensus has formed: pain is a unique, personal experience shaped by biological, psychological and social factors, known as the "biopsychosocial" model. The biological part has never been short of attention. Injections, the latest buzzing and zapping machines, new medications, lifestyle changes and plenty more. Psychological factors are catching up too, with growing recognition of the role treatments like cognitive functional therapy (CFT), acceptance and commitment therapy (ACT) and pain reprocessing therapy (PRT) may play.

But social factors, in our opinion, get the least attention of the three. They're the least "sexy" and the easiest to overlook. Before moving on, it is important to mention: these three factors don't work in isolation. They interact and intertwine, and pulling them apart is useful for thinking but never quite matches how real life works.

A quick story

Consider two people with near enough the same back injury.

The first heads home to a partner who gently takes over the heavy jobs, tells him to rest up and not push it, and worries out loud about his back. Kind, well meant, and completely understandable. But months on, he's doing less and less, his world has narrowed, and the message he's absorbed is that his back is fragile and needs protecting.

The second heads home to a household that expects her to stay part of things, backs her to keep moving within reason, and treats the injury as something she's working through rather than something that's broken her. She has a workmate who had the same issue and came good, so she's not frightened it's permanent.

Same injury, different context and interaction and often, over time, this can result in quite different outcomes. None of this is anyone's fault, and it isn't about willpower. It's a glimpse of how much the world around a person shapes their recovery.

Social factors linked to persistent pain

Here are some social factors research has shown to be related to persistent pain. Related is the key word. These are associations, not proven causes, and having one in your life does not mean pain is guaranteed. Some may surprise you:

• Social connection. Isolation and loneliness are linked to higher pain levels, while more positive social connection tends to go with lower pain.
  

• Perceived injustice. Thoughts and feelings of blame around the pain, towards a surgeon, an employer, an insurer, are associated with a harder road.
  

• The people closest to us. Support matters, but the type matters too. Very protective, "let me do that for you" support, however loving, can sometimes feed disability over time. A lack of support, or feeling disbelieved, can do harm in the other direction.
  

• Earlier life experiences. Previous trauma and early life adversity are considered individual risk factors for developing persistent pain. Again, a risk factor is not a sentence. Many people with these histories never develop persistent pain at all.
  

• Stigma and not feeling believed. Sadly common, and it sometimes turns up in the very system meant to help, including healthcare.
  

• Labels and beliefs. The words and ideas we absorb shape how we make sense of pain and what we do about it. These often come from around us: family, friends, the media, healthcare professionals and our broader culture.
  

• The big one: the systems people have to navigate after a work related injury, like workers compensation. On average, recovery tends to take longer for people navigating the workers compensation system than for people with the same injury who are not. This is at no fault of the person but more a reflection of how complex these systems are to move through, even though they are meant to support recovery in a timely way.

Written by

Samuel Bulten

Exercise Physiologist | Masters in Medicine (Pain Management)

Director, Adapt Movement

Disclaimer

This information is for educational purposes only and is not a substitute for personal medical advice. These blogs are written by Sam Bulten and represent his opinions and insights and are based on his experience and interpretation of the research. As Sam is a human, these opinions and insights are not absolute truths.