A four-stage model of pain processing was proposed, consisting of pain sensation intensity, pain unpleasantness (stage 1 affect), suffering (stage 2 affect), and pain behavior. We studied 506 chronic pain patients (230 male and 276 female) using a multivariate statistical technique (LISREL) in order to demonstrate the structural relationship among multiple indicators of pain processing; and to characterize these stages in terms of their interactions. A strong relationship was revealed between the majority of the underlying indicators of each pain processing stage. A linear stage sequence best fitted the relationship between the four stages. Successive stages did not have recursive effects on earlier pain components. A confirmatory LISREL analysis was conducted with an additional sample of 502 chronic pain patients. In this replication analysis the structural equation model consisted of pain intensity, unpleasantness (stage 1 affect), emotional suffering (stage 2 affect), and pain behavior. This study extends the validation of these pain dimensions, as well as the validity of the measure(s) of each separate stage.
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