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The Stressful Characteristics of Pain That Drive You NUTS: A Qualitative Exploration of a Stress Model to Understand the Chronic Pain Experience.

  • Pagé, M Gabrielle1, 2, 3
  • Dassieu, Lise2
  • Develay, Elise2
  • Roy, Mathieu4, 5
  • Vachon-Presseau, Etienne4, 5, 6, 7
  • Lupien, Sonia8
  • Rainville PhD, Pierre3, 9
  • 1 Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. , (Canada)
  • 2 Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada. , (Canada)
  • 3 Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, QC, Canada. , (Canada)
  • 4 Department of Psychology, Faculty of Science, McGill University, Montreal, QC, Canada. , (Canada)
  • 5 Alan Edwards Centre for Research on Pain, McGill University Health Centre (MUHC), Montreal, QC, Canada. , (Canada)
  • 6 Faculty of Dentistry, McGill University, Montreal, QC, Canada. , (Canada)
  • 7 Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, QC, Canada. , (Canada)
  • 8 Department of Psychiatry, Centre for Studies on Human Stress, Montreal Mental Health University Institute, Faculty of Medicine, University of Montreal, Montreal, QC, Canada. , (Canada)
  • 9 Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de l'île de Montréal, Montreal, QC, Canada; ‡‡Department of Stomatology, Université de Montréal, Montreal, QC, Canada. , (Canada)
Published Article
Pain medicine (Malden, Mass.)
Publication Date
May 21, 2021
DOI: 10.1093/pm/pnaa370
PMID: 33319901


Despite decades of research on the identification of specific characteristics of situations that trigger a physiological stress response (novelty, unpredictability, threat to the ego, and sense of low control [NUTS]), no integrative research has examined the validity of this framework applied to pain experiences. This study aimed to 1) explore the stressful characteristics of pain among individuals living with chronic pain and 2) examine whether the NUTS framework comprehensively captures the stressful nature of pain. Participants were 41 adult participants living with chronic pain. Interviews in six focus groups were conducted in French using a semistructured interview guide. Participants first discussed how pain is stressful. Then, they were introduced to the NUTS framework and commented on the extent to which it captured their experience. The verbatim transcriptions of interviews were reviewed using reflexive thematic analysis. Analyses were conducted in French; quotes and themes were translated into English by a professional translator. The pain-NUTS framework adequately captured participants' experiences. Multiple aspects of pain (pain intensity fluctuations, pain flare-up duration, pain quality and location, functional limitations, diagnosis and treatment) were associated with one or more stress-inducing characteristics. In addition, a second layer of meaning emerged in the context of chronic pain that provided contextual information regarding when, how, and why pain became more or less stressful. The NUTS characteristics seem to offer a comprehensive framework to understand how pain and its context of chronicity can be a source of stress. This study provides preliminary support for the pain-NUTS framework to allow the formal integration of pain and stress research. © The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected]

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