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Rethinking chronic pain: a dissociative framework for psychodynamic practice.

Tim Ho1, Mark Ryan2, Skye Dong3

  • 1Sydney Medical School, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

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Chronic pain disrupts self-experience, trapping consciousness in sensation. This "stimulus entrapment" model links pain to dissociation, suggesting psychodynamic therapies can restore self-coherence and agency.

Keywords:
chronic paindissociationembodimentpsychodynamictrauma

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Area of Science:

  • Psychology
  • Neuroscience
  • Psychiatry

Background:

  • Chronic pain is increasingly understood as affecting self-experience beyond sensory processing.
  • Existing models often overlook the disruption of identity and narrative continuity in persistent pain.

Purpose of the Study:

  • To introduce and explore the concept of "stimulus entrapment" as a dissociative phenomenon in chronic pain.
  • To link chronic pain to psychodynamic and dissociation theories by framing it as a disorder of self-integration.
  • To propose that this framework explains the limitations of biomedical interventions and highlights the need for psychodynamic approaches.

Main Methods:

  • Conceptual analysis integrating theories of chronic pain, dissociation, and psychodynamics.
  • Drawing parallels between "stimulus entrapment" in pain and dissociative states in trauma.
  • Examining the fragmentation of selfhood and its impact on coping mechanisms.

Main Results:

  • "Stimulus entrapment" describes consciousness being trapped in overwhelming bodily sensations, fragmenting self-narrative and identity.
  • Chronic pain can lead to a split between the embodied "pain self" and the socially presented self, amplifying distress.
  • This fragmentation hinders adaptive coping and explains why biomedical treatments alone are often insufficient.

Conclusions:

  • Chronic pain involves disrupted self-integration, conceptualized as "stimulus entrapment."
  • Psychodynamic therapies focusing on narrative repair and self-coherence may effectively treat chronic pain by reintegrating the "pain self."
  • "Stimulus entrapment" provides a unifying concept for chronic pain, trauma, and dissociation, opening new therapeutic avenues.