A Cascade of Consequences Pain doesn’t just exist in isolation—it shapes nearly every aspect of a person’s daily life. Dr. VachonPresseau explains that the relationship between pain and mental or physical health is circular and self-reinforcing. “Of course, if you remove pain from these individuals, naturally their mood and other aspects will improve,” he says. “So the pain can, on some level, cause these risk factors, but they are also present before the pain arrives. It’s all embedded.” Dr. Vachon-Presseau’s recent work draws from one of the world’s largest biomedical databases, the UK Biobank, which includes data from a half-million participants. With access to this vast resource, he and his colleagues trained predictive models of machine learning to understand how different factors (biological, psychological and social) predict chronic pain. “When we only use biological measurements, such as blood tests, where you have inflammatory markers, or brain networks seen via scans, we can make some predictions about specific conditions, for instance, who will likely develop arthritis,” he explains. But when it came to predicting the experience of pain, the self-reported intensity and distribution of discomfort, the biological data fell short. “When we only looked at biological data, we failed to predict who would experience chronic pain,” Dr. Vachon-Presseau says. “We couldn’t find biological measurements that could accurately predict the intensity of pain that a person experiences.” Instead, it was psychosocial information, including sleep quality, stress levels, mood, financial strain, and lifestyle habits, that proved the most powerful predictors. “We could predict, using about one hundred different social and psychological features describing the individual, how they will report their pain,” he says. In other words, chronic pain can trigger a cascade of consequences: poor sleep, increased stress, depression and reduced activity. “If you look across different diseases—multiple sclerosis, nerve damage, fibromyalgia—these psychosocial features are good predictors of how the participant will report their pain,” he notes. When pain makes sleep difficult or dampens mood, those same factors, in turn, intensify the perception of pain. This creates a cycle that’s hard to break, one in which biology, psychology, and behaviour constantly influence each other. Dr. Vachon-Presseau’s research also suggests a hopeful idea that interventions aimed at improving sleep, reducing stress, and supporting mental health can make a real difference. Therapies like cognitive behavioural therapy, mindfulness, and pain education programs all target the psychological side of suffering. “Pain management is not just a single approach,” he says. “It’s a multidisciplinary approach that includes psychologists, physical activity, education, sometimes medication. These are all tools to help people live better with chronic pain.” Pain doesn’t just exist in isolation—it shapes nearly every aspect of a person’s daily life. The relationship between pain and mental or physical health is circular and self-reinforcing. 23 Issue 6 | 2025 | Issues and People
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