Meerwijk et al. ( 2011 ), toward a unifying definition of psychological pain, stated, loss and trauma are often associated with psychological pain. Analysis indicated that psychological pain may best be described as a lasting, unsustainable and unpleasant feeling resulting from negative appraisal of an inability or deficiency of the self. This negative self appraisal is typically brought on by loss of someone

or something or failure to achieve something that is Immediately linked to core psychological needs.

Chronic pain is associated with activity in multiple networks in the central nervous system ( CNS ). Chronic pain is considered a CNS disorder ( Seminowicz, D.A. Moayed, M. ( 2017 ). The dorsolateral prefrontal cortex in acute and chronic pain.

Chronic pain is considered to develop as a result of the persistence of pain memory and inability to erase pain memory after injury. Considering its’ importance in extinction of fear behaviours, impaired mPFC activation could lead to a failure in the elimination of subcortically driven fear behaviors, thereby resulting in pain chronification ( Apkarian, A.V. et al., 2009 ). Towards a theory of chronic pain. Thompson J.M; Neuge-Bauer, V.Cortico-limbic pain mechanisms.

Pain catastrophizing and fear of pain have also been recognized as playing a crucial role in the transition from acute to chronic pain. Van Cleff, LMG, et al.,( 2009 ), Vol 21. Dimensional and componential structure of a hierarchical organization of pain-related anxiety constructs.

Pain-catastrophizing research has found that a fear of anxiety-related symptoms and exaggerated fears of future injury or illness are important variables in understanding chronic pain. Reiss, et al ( 1986 ). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness ( Stewart, S. H., & Asmudson, G.I.G., 2006 ). Anxiety sensitivity and its Impact on pain experiences and conditions:  A State of the

Art. Reiss, (1991 ). Expectancy model of fear, anxiety and panic. Taylor, ( 1993 ), The structure of fundamental fears.

There is a large body of evidence confirming the major impact of pain catastrophizing and fear of pain on the amplification of pain and associated disability. ( e.g. Crombez,et al. 1999; Peters et al 2002; Sullivan et al, 1998; Vlaeyen & Linton, 2000; Vancleef, LMG et al,, 2009, Vol 21. ). Dimensional and componential structure of a hierarchical organization of pain-related anxiety constructs.

Parent pain history has also been found to be associated with children’s experience with pain and somatic complaints and health care utilization in children. Levy, R.L. et al., ( 2004 ). Increased somatic complaints and health care utilization in children.

Recent findings in clinical samples of youth have suggested that parental beliefs about pain contribute to pain perceptions and impact. Vowels, et al (2010 ). Dissent angling the complex relations among caregiver and adolescent responses to adult chronic pain, adolescent chronic pain. Parent catastrophizing about their adolescent’s pain may increase the likelihood that adolescents will catastrophize themselves.

Some research has found that parent catastrophizing was a significant predictor of adolescent somatic symptoms and pain-related disability, beyond the contribution of parent pain and adolescent catastrophizing , mediated the association between parent catastrophizing and adolescent pain-related disability. Wilson A. et al., ( 2013 ). Parent pain and catastrophizing are associated with pain somatic symptoms and pain related disability among early adolescents.

Research has shown that child catastrophizing parents might be most likely to engage in behaviors that restrict child activity engagement. In chronic pediatric pain, long-standing avoidance of daily activities, ( e.g. going to school or playing with friends ), may contribute to increased disability and maintain or exacerbate the pain problem. Caes et at., ( 2011 ). Parental catastrophizing about child’s pain and its relationship with activity restriction. of parental distress pain.

Multiple research teams confirm chronic pediatric pain and long-standing avoidance of daily activities may contribute to increased disability and maintain or exacerbate the pain problem.(  Leeuw, M. et al, 2006; Vlaeyan JWS;  Linton S., 2000; Guite JW. et al, 2009; Chambers CT, 2003; Goubert L. Eccleston C, Verroort, T, Jordan A, Crombez G, 2006; Van Slyke, DA, Walker, LS, 2006 ).

Research has found catastrophizing parents do not act to rescue the child from their pain by reducing activities they believe can cause it, rather, catastrophizing parents act to limit the child’s activities to reduce their own levels of distress. Feelings of distress and associated escape and avoidance tendencies may be automatically activated when perceiving someone else in pain, and that feelings of sympathy only occur in a second phase after adequate regulation of distress. Goubert L, Vervoort,T, Crombez,

G., Pain demands attention from others: the approach avoidance paradox ( 2009 ); Yamada M, Decety, J. Unconscious affective processing and empathy: an investigation of painful facial expressions ( 2009 ).

Medicine regards pain as a signal of physical injury to the body, despite evidence contradicting the linkage and despite the exclusion of vast members of sufferers who experience psychological pain. By broadening our concept of pain and making it more inclusive, we would not only better accommodate the basic concept of pain, but also would recognize what is really appreciated by the lay-person, that pain from diverse sources, physical and psychological, share an underlying felt structure. Biro, D., ( 2010 ). Is there such a thing as psychological pain?

Experts have recently shifted to the recognition of psychological pain. In an addendum to their universally accepted definition of pain, an unpleasant sensory and emotional experience associated with actual or potential tissue damage, The International Association for the Study of Pain, IASP, 2007, concedes that people do report pain for strictly psychological reasons, and since such reports can’t be distinguished from instances where there is a physical cause, they should be taken at face value. If people regard their experience as pain, and if they report it in the same way as pain caused by tissue damage, it should be accepted as pain. Biro, D, ( 2010 ).

Researchers have found that psychological pain seems to run on the same neural tracks as physical pain. Eisenberger, N et al., ( 2003 ). Does rejection hurt ? An fMRI study of social exclusion. Gundel, H. et al., ( 2003 ). Functional neuroanatomy of grief.

Research has established that psychological pain shares the same neurobiological shares the same neurological substrates as physical pain. Eisenberger, N. ( 2013 ). The Neural bases of social pain: Evidence for shared representations with physical pain.

Multiple studies continue to confirm the same brain regions processing physical pains share a neural network of circuits for psychological pain. Bucchioni, G ( 2015 ) Study of postural, physiological, and corticospinal responses in empathy for pain and pain anticipation. Charvete C. et al., ( 2022 ). How to measure mental pain. A systemic review assessing measures of mental pain. Mokhta, RI, T. Lu-Peng Yue; Li Hu ( 2022 ). Exogenous melatonin alleviates neuropathic pain suppressing NF-KB/ NLRP3 pathways.

Researchers have proposed a neural network for psychological pain that includes the thalamus, anterior and posterior cingulate cortex, the prefrontal cortex, cerebellum, and parahippocampus gyrus. The proposed neural network for psychological pain overlaps to some extent with brain regions involved in physical pain, but results suggest a markedly reduced role for the insula, caudate, and putamen during psychological pain. Meerwijk, E.L.; Ford, J.M.; Weiss, S.J. ( 2012 ). Brain Imaging and Behavior.

There is never pure physical or pure psychological pain, but always combinations. Those suffering from grief and mental illness often have somatic complaints. At the same time, patients in physical pain inevitably suffer emotionally. Cherney N. I. et al., ( 1994 ). Suffering in the advanced cancer patient : A definition and taxonomy.

Anatomical studies have investigated the brain areas associated with emotional aspects of pain. Some research found a functional connectivity between the medial prefrontal cortex and NAE, ( both involved in emotion, motivation, and reward-related behavior. This suggests the processing of pain perception can be influenced by changes in these functional connections. Hashmi J.A. et al. ( 2013 ). Shape-shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits.

Another brain structure that has merited significant pain research is the anterior cingulate cortex, which is associated with affective and motivational aspects of pain. The activation of ACC-PFC-PAE circuitry, and increased activity in the ACC is associated with negative emotions. Villemure, C; Bushnell, M.C. ( 2009 ). Mood Influences, Supraspinal Pain Processing Separate from Attention.

Pain is shaped by a host of psychological factors. How individuals react to a new episode of pain is shaped and influenced by previous experience. Not surprisingly, pain catastrophizing is associated with a variety of problems that hinder recovery, making treatment more difficult and increasing the risk of developing persistent pain and disability. Linton,S.J., Shaw, W.S. ( 2011 ) Impact of psychological factors in the experience of pain.

The DMS-5 defines dissociative symptomatology as the disruption of and or discontinuity in the normal integration of consciousness, identity, emotion perception, body representation, motor control, and behavior. Regarding chronic pain, dissociation is believed to serve to minimize memories of traumatic events, including the minimization or magnification of the pain perceptions, the pain focus. Duckworth, M.P. et al., ( 2000 ). Dissociation and post-traumatic stress symptoms in patients with chronic pain, Vogel M. et al., ( 2019 ). Dissociation and pain, catastrophizing. Absorptive detachment as a higher order factor in control of pain. Related fearful anticipations prior to total prayer to total knee anthroplasty.

Experimental research suggests an overlap between PC and dissociation and theoretical considerations do so regarding catastrophic cognitions and dissociative experiences. This assumption is based on the notion that symptoms, be it dissociation or chronic pain, are perceived and processed in accordance to the meaning which the individual ascribes to them. Specifically, according to Ehlers and Steil, the co-occurrence of helplessness and detachment dissociation serves to maintain mental control by preventing exposure to feared material. Gomez-Perez L; Lopez Martinez A.E. Asmundson C.J. Predictors of trait dissociation and peritraumatic dissociation induced via cold pressor ( 2013 ). Ehlers A; Steil, R., Maintenance of Intrusive memories in  posttraumatic stress disorder, a Cognitive Approach (1995 ).

The patients examined in our fMRI study, Reisch et al., ( 2010 ), reported high levels of dissociation. Consistent with this, during recall of mental pain associated with the suicidal behavior, we found a striking similarity of brain activation with neural correlates of trauma reactivation known from PTSD studies, ( e.g. Lanius et al., ( 2001 ). In particular, reduced activity in the left medial prefrontal cortex BA 6-10/11 and the anterior cingulate gyrus BA 32. This is not surprising in view of the fact that the association of suicidal behavior with trauma is well established. ( Orbach 1994; Mann and Currier 2010,; Bruffaerts et al. 2010;  Reisch T., Seifritz, E., Esposito, F. Wiest, R. Valich, L. and Michael K. 2010 ).

We believe that psychological pain, such as it occurs in grief or unhappiness, represent different entities with different neurobiological correlates. Therefore, in our opinion, future neuroimaging studies will be best advised to focus on clearly defined and specific forms of psychological pain to include the time dimension and to apply a validated measuring instrument such as the OMMP of psychological pain.

Researchers have found pain catastrophizing and chronic pain to be linked to childhood abuse, paralleling the respective associations between dissociation and prior trauma. Bremner, J.D. 2010, Cognitive Processes and Dissociation, comment on Giesbrecht et al. ( 2008 ).

Scale is a 13-item rating scale that assesses thoughts and feelings on a 5-point Likert scale.

In order to develop appropriate therapeutic targets for chronic pain, it is important to understand factors that affect the transition of acute pain to chronic pain and the mechanisms underlying the development of chronic pain. Some research has found medications used for physical pain have helped to reduce psychological hurt. DeWall, NC, et al. ( 2010 ). Acetaminophen reduces social pain.

Research concludes parents can be taught strategies to regulate their distress when faced with their child in pain in order to allow feelings of sympathy and adaptive helping behaviors. Dix T. et al. ( 2004 ). The affective structure of supportive parenting, depressive symptoms, immediate emotions, and child-oriented motivation. Penner L.A. et al. ( 2008 ). Parents’ empathetic responses in pain and distress in pediatric patients.

Pain has been classified into three major types, nociceptive, inflammatory, and neuropathic. Nociceptive pain is the response to sensory systems to actual or potentially harmful stimuli detected by nociceptors around the body. Inflammatory pain is associated with tissue damage and the resulting inflammatory process which may lead to responses such as hyperalgesia, allodynia, and sympathetically maintained pain. Neuropathic pain is a localized sensation of unpleasant discomfort caused by damage or disease in the peripheral and or CNS that persists after a primary lesion or dysfunction. Yam MF et al. ( 2018 ).

General pathways of pain, sensation, and the major neurotransmitters involved in pain regulation.

Factors predicting poor prognosis. Three pain beliefs have been shown to put patients at greatest risk of a poor prognosis. One, pain catastrophizing. Two, fear avoidance, a belief that all activity should be avoided to reduce pain, and three, poor expectations for recovery. Assessing these patient beliefs about pain may be even more important than reaching a definitive diagnosis or explaining what set of factors actually contributed to pain onset. Linton, SJ.; Shaw, W.S. ( 2011 ). Impact of Psychological Factors in the Experience of Pain.