• Mark P Jensen, Dawn M Ehde, and Melissa A Day.
• Department of Rehabilitation Medicine, University of Washington, Seattle, Washington. Electronic address: mjensen@uw.edu.
• J Pain. 2016 May 1; 17 (5): 529.e1-529.e18.

UnlabelledEvidence from a number of sources supports the existence of two relatively independent neurophysiological systems that underlie avoidance- and approach-related emotions, cognitions, and behavior. There is considerable overlap between 1) the emotions, cognitions, and behaviors controlled by these two systems, and 2) the known effects of chronic pain. Here we propose a 2-factor model of chronic pain on the basis of these well established 2-factor models, and discuss the implications of the model for understanding the effects of pain and mechanisms of psychological pain treatments. The model makes specific hypotheses, which are unique to the proposed model, regarding the mechanisms underlying pain's negative influence and the benefits of psychological pain treatments. The model also provides an overarching framework that could enhance outcomes by 1) broadening the assessment of factors that may be influencing pain and its effect on individual patients, and 2) suggesting that specific techniques from different treatments may be combined to better target these factors.PerspectiveThe 2-factor model presented in this report provides a framework for understanding the effects of psychological pain treatments, and makes specific a priori hypotheses regarding the specific mechanisms of those treatments. Clinical applications of the model have the potential for enhancing treatment outcomes.Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

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