Social and Societal Factors Interact with Psychological Factors to Shape Pain Outcomes in a Community Sample with Chronic Pain: A Network Study.

Although the biopsychosocial model of chronic pain is widely recognized, few studies include social and societal factors as variables of interest, limiting our understanding of their role and importance in managing chronic pain. In the present study, we examined how social and societal factors interact with psychological factors to shape pain outcomes. We recruited 262 participants with chronic pain from the community (e.g., through the university, online distribution, GP and physiotherapist offices) to collect self-reported data about emotional states (e.g., mood symptoms, positive affect), pain coping strategies (e.g., pain acceptance, pain avoidance), social interactions (e.g., emotional support, pain invalidation), societal stressors (e.g., financial worry, access to health care) and pain outcomes (quality of life, pain disability and pain intensity). In line with previous network studies, our partial correlation network including only psychological factors showed that multiple psychological factors are uniquely associated with pain disability. We then extended the partial correlation network with social and societal factors, and demonstrated that these had strong direct relationships with quality of life, and were indirectly related to pain intensity and pain disability through pain-related worry and pain acceptance. Overall, our results indicate that social and societal factors are important for understanding pain outcomes and should thus be considered in interventions targeting chronic pain, alongside psychological factors. Future work should examine the interactions among social-societal and psychological factors in more depth to inform ways to incorporate this into individual pain management and societal interventions for chronic pain.