• Flavia P Kapos, Kenneth D Craig, Steven R Anderson, Sónia F Bernardes, Adam T Hirsh, Kai Karos, Edmund Keogh, Reynolds LosinElizabeth AEADepartment of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania., Joanna L McParland, David J Moore, and Claire E Ashton-James.
• Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Orthopaedic Surgery & Duke Clinical Research Institute, Duke University Schoool of Medicine, Durham, North Carolina. Electronic address: flavia.kapos@duke.edu.
• J Pain. 2024 Oct 1; 25 (10): 104608104608.

AbstractDespite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.

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