Pain, mind, and movement: an expanded, updated, and integrated conceptualization.

hron ic pain an d its often associated movem entdysfunct ion are pervasi ve, intrigui ng, and complexpro blems and many fact ors can account for theirpersi stence into chronic pain disabi lity. Concept ualizati onof pa in and movem en t dy sfunction as 2 aspect s of aninteg rated syst em has increa sed our unde rsta nding ofboth . How ever, that con ceptualizat ion remain s inco m-plete until it also includes the mind. Indeed , pain, mind,and movem ent are each co mplex constru cts an d are eacha compon ent of an integ rated syst em co mplex.For many years pain was co nceptual ized, managed ,and studi ed as a sympt om of pa thology or injur y and as asensory phe nomenon only . Mov ement dysfunct ion, andpsych osocial distress wer e de emed a consequen ce of thatsensory pr oblem. Rese arch ov er the last few decades hassho wn that pain is not just a sympt om but that it canpersi st and become a pa thophysi ologic conditio n in andof itself. Movement dy sfunction is not just a con sequenceof an ticipatin g and mini mizing pain but is the motorcomp onent of a much broad er problem ; and, psycho logicfact ors (cogni tions an d emoti ons) an d soc ial and envi-ron mental facto rs e! e ctively media te and mo derate thepercep tion and the behavior al co mponent of chro nic painas a co mplex multidim ensional co nstruct.The limited succe ss to date in solving the cha llengeof pain, mind, and movem ent di"cul ties is in part due tothe fact that resear ch studi es have frequent ly focused onisol ated facto rs, an d managem en t methods have adopteda OOone size Þts allOO approach . Pain and the person withpain must be resear ched and managed within a co mplex ,indivi dualiz ed system of proxim ate and dist al bio logicand environm ental facto rs, using an intensive, integrati ve,and inter discip linary approach. To be e! e ctive, suc h anapproach req uires co alescing basic and clinical scientist sand practiti oners who specia lize in pain from a broadrange of perspect ives.Thi s specia l issue of the Clini cal Journal of Painrepresen ts a series of pape rs from the Þrst Pain, M ind,and Mo vement confere nce, a satel lite confere nce ofthe Inter nationa l Associat ion for the Stud y of Pain 11thWorld Congr ess of Pai n in Cairns, Austral ia. Thi sfocussed satellite confere nce boug ht together ba sic andclinical scient ists and clinical pr actitioner s from a rangeof disci plines in a forum aimed to facilit ate synergi es ofexpertise and to a! or d an unde rstanding of the integ ratedcomplex ities and chall enges relative to mechani sms,measuremen t, and optim al managem ent of pain,mind, and movem ent problem s. A key theme from theconfere nce was the notion that pain and mo vementdi"culti es must be concep tualized, invest igated , andmanaged in a mult idimen sional, integ rated manner; basicresearch must address both a! erent and e! e rent syst emsand the integ ration of both, and translat ional researchmust proceed in an iterative, bidir ection al way that us esmultime asure, multime thod ap proaches. The papers inthis special issue indivi dually and as a whole illustr atethe stat e of the scienc e, the art, an d the thinki ng in thisexciting and important area.An integ rated model of pa in, mind, an d mo vementis argued in Sullivan Os revie w paper. Using a biopsych o-motor con ceptual model he proposes that there are 3distinct be haviora l aspect s of movem ent related to pain:protective behavior , communi cativ e behavior , and socialbehavior . Cl early these 3 behavior al charact eristicsinvolve the mind at a con scious or unconscious level . As suc h the mod el provides a us eful fram ewor k on whichto tempor arily OOhang OOand test the integ rity of hyp othesesrelevant to pain, mind, and movem ent.Arendt -Niels en and Graven -Nielse n present s theresults of systemat ic experi menta l resear ch that ha sfocussed on muscl e respon se to pa inful stimuli at restand during mov ement. By delivering nox ious stimuli tothe muscl e in individ uals with or wi thout pain, they haveexamined the relat ionshi p betw een pa in and muscleactivity, both at rest and during move ment. Cont raryto popular clinical belie f, they ha ve found that elect ro-myogra phic activit y is not increa sed at rest in painful