Le fonctionnement émotionnel lors de la douleur chronique : état de la question

RésuméDe nombreuses variables psychologiques sont impliquées dans la douleur chronique. En l’occurrence, les émotions et le fonctionnement émotionnel ont montré un rôle important dans la modulation de l’intensité des aspects sensoriels et affectifs impliqués dans la douleur chronique. La suppression des émotions, l’évitement émotionnel et l’alexithymie sont associés à une intensité accrue des aspects sensoriels et/ou affectifs de la douleur, tandis que la compréhension du ressenti émotionnel et l’expression des émotions ont été mises en lien avec une intensité moindre dans le ressenti de la douleur. Les recherches récentes mobilisent des dispositifs méthodologiques relativement rigoureux, mais de nouvelles investigations restent à envisager.

Pain mobilizes numerous psychological variables, which involve the interaction of cognitions (attention, interpretation of the situation), feelings (fear, anger, anxiety) and behaviors (immobilization, avoidance). These various aspects generally have an adaptive role, necessary for the conservation of the body. However, in chronic pain, these mechanisms can become dysfunctional and cannot answer their initial function, and can even influence the appearance of psychopathologies. In this framework, feelings and emotional processing play an important role in the modulation of the intensity of sensory and emotional aspects of pain. In this particular case, suppression, emotional avoidance and alexithymia are associated with a greater intensity of the sensory or emotional aspects of pain. Although recent studies have employed relatively rigorous methodological devices, sometimes they used many tools which do not yet measure the dysfunction directly. Furthermore, emotional suppression was mainly studied during anger, which constitutes a specific phenomenon that cannot be generalized to all emotions. New studies are to be envisaged which would allow in particular the study of the effect of unregulated (insufficient control of experience or emotional expression) and untreated (arousing intrusive thoughts and the obstinacy of the emotional experience) emotions, defined by Baker et al. (2007), and the use of a tool permitting the differentiation and measurement of all possible dysfunctions. They could also allow for the control of the concomitant presence of various emotional dysfunctions in participants. Ideally, the realization of forward-looking studies could define the nature of the links between emotional dysfunctions and chronic pain.