{"id":8072,"date":"2026-07-19T14:55:56","date_gmt":"2026-07-19T12:55:56","guid":{"rendered":"https:\/\/blueportance.com\/knowledge-base\/expert-guides\/understanding-pain\/adaptive-pain-loops\/"},"modified":"2026-10-25T22:43:29","modified_gmt":"2026-10-25T21:43:29","slug":"adaptive-pain-loops","status":"publish","type":"page","link":"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/adaptive-pain-loops\/","title":{"rendered":"KB 3_Expert Guide_01_Understanding Pain_10_Adaptive Pain Loops"},"content":{"rendered":"\n\n  <style>\n    body{font-family:Arial,sans-serif;line-height:1.65;padding:20px;color:#333}\n    .bp-q-breadcrumb{font-size:.85rem;color:#6b7280;margin:0 0 20px}\n    .bp-q-breadcrumb a{color:#2a7fba;text-decoration:none}\n    h1{color:#0e2a47;font-size:1.8rem;line-height:1.25;margin:0 0 22px}\n    h2{color:#1a4d72;margin-top:42px;line-height:1.3}\n    h3{color:#0e2a47;margin-top:28px}\n    p{margin:0 0 16px}\n    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a:hover{text-decoration:underline;}\n<\/style>\n\n<nav class=\"bp-bdc-breadcrumb\" aria-label=\"Breadcrumb\">\n<a href=\"\/en\/\">Blue Portance<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/\">Knowledge Base<\/a> \u2192 <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/\">Understanding Pain<\/a> \u2192 Adaptive Pain Loops\n<\/nav>\n\n<div class=\"bp-bdc-header-card\">\n  <div class=\"bp-bdc-kicker\">Blue Portance Expert Guides<\/div>\n  <div class=\"bp-bdc-rule\"><\/div>\n  <div class=\"bp-bdc-dossier-title\">Understanding Pain<\/div>\n  <div class=\"bp-bdc-dossier-subtitle\">The biological, mechanical, and neurophysiological mechanisms of pain.<\/div>\n<\/div>\n\n<p class=\"bp-bdc-dossier-link\">\n  This article is part of the Expert Guide\n  <a href=\"https:\/\/blueportance.com\/en\/knowledge-base\/expert-guides\/understanding-pain\/\">\u201cUnderstanding Pain\u201d<\/a>.\n<\/p>\n\n<span class=\"bp-pillar-badge\">Synthesis article \u2014 Blue Portance Knowledge Base<\/span>\n\n<h1>When Physical Pain and Psychological Suffering Sustain Each Other: Adaptive Pain Loops<\/h1>\n\n<div class=\"bp-bdc-epistemic\">\n  <strong>Epistemic note<\/strong> \u2014 This article does not propose a new pathophysiological mechanism. It describes a level of organization: the way several mechanisms that have already been studied \u2014 tissue stresses, nerve involvement, sensitization, stress, sleep, attention, emotions, and behaviors \u2014 can interact and sometimes sustain one another. The notion of \u201cadaptive pain loops\u201d is an integrative interpretive framework proposed by Blue Portance, drawing on knowledge from the biopsychosocial model, the neurophysiology of pain, and the sciences of adaptation. It does not replace a medical diagnosis or the individual analysis of a clinical situation.\n<\/div>\n\n<section class=\"bp-summary\">\n  <p>\n    <strong>Summary<\/strong> \u2014 Persistent physical pain can disrupt sleep, reduce activity, strain social relationships, and cause genuine psychological suffering. In return, chronic stress, hypervigilance, fear of movement, changes in behavior, and impairment of certain descending controls can increase sensitivity to pain. These interactions do not mean that the pain is \u201call in the head\u201d: they show that chronic pain can become a dynamic system in which several adaptations, initially protective, end up sustaining one another. Blue Portance proposes describing this organization with the term <strong>adaptive pain loops<\/strong>, an application to the field of pain of the more general concept of the <strong>adaptive system (C7)<\/strong>.\n  <\/p>\n<\/section>\n\n<nav class=\"bp-bdc-toc\" aria-label=\"Table of contents\">\n  <h2>Table of Contents<\/h2>\n  <ul>\n      <li><a href=\"#pourquoi-cet-article-est-il-important\">Why does this article matter?<\/a><\/li>\n      <li><a href=\"#1-comment-une-douleur-physique-peut-elle-devenir-une-souffrance-globale\">1. How can physical pain become all-encompassing suffering?<\/a><\/li>\n      <li><a href=\"#2-comment-la-souffrance-psychique-peut-elle-amplifier-la-douleur\">2. How can psychological suffering amplify pain?<\/a><\/li>\n      <li><a href=\"#3-pourquoi-parle-t-on-de-boucle-plutot-que-de-chaine\">3. Why speak of a loop rather than a chain?<\/a><\/li>\n      <li><a href=\"#4-toutes-les-adaptations-ne-sont-pas-pathologiques\">4. Not all adaptations are pathological<\/a><\/li>\n      <li><a href=\"#5-comment-les-articles-precedents-s-articulent-ils-dans-ce-modele\">5. How do the previous articles fit into this model?<\/a><\/li>\n      <li><a href=\"#6-ce-que-le-modele-biopsychosocial-apporte-et-ce-qu-il-ne-dit-pas\">6. What the biopsychosocial model contributes \u2014 and what it does not say<\/a><\/li>\n      <li><a href=\"#7-lecture-proposee-par-blue-portance-du-systeme-adaptatif-aux-boucles-de-la-douleur\">7. The interpretation proposed by Blue Portance: from the adaptive system to pain loops<\/a><\/li>\n      <li><a href=\"#une-application-du-concept-c7-systeme-adaptatif\">An application of the C7 concept \u2014 Adaptive System<\/a><\/li>\n      <li><a href=\"#8-peut-on-sortir-d-une-boucle-adaptative\">8. Is it possible to get out of an adaptive loop?<\/a><\/li>\n      <li><a href=\"#9-pourquoi-certaines-douleurs-deviennent-elles-si-difficiles-a-traiter\">9. Why does some pain become so difficult to treat?<\/a><\/li>\n      <li><a href=\"#a-retenir\">Key takeaways<\/a><\/li>\n      <li><a href=\"#questions-frequentes\">Frequently asked questions<\/a><\/li>\n      <li><a href=\"#references-scientifiques\">Scientific references<\/a><\/li>\n  <\/ul>\n<\/nav>\n\n<h2 id=\"pourquoi-cet-article-est-il-important\">Why does this article matter?<\/h2>\n\n<p>\n  The previous articles presented several levels of pain separately: nociceptive pain, mechanical involvement of a nerve, neuropathic pain, nociplastic pain, nervous system hypersensitization, neurosensory learning, and psychological suffering. This separation was indeed necessary in order to understand each mechanism precisely.\n<\/p>\n\n<p>\n  In real life, however, these mechanisms rarely remain isolated. Pain can alter sleep, movement, attention, mood, social relationships, and protective strategies. These changes can then act back on the pain. This synthesis article therefore shifts to a different level of explanation: it no longer describes an additional mechanism, but <strong>how the mechanisms are organized in relation to one another<\/strong>.\n<\/p>\n\n<blockquote>\n  Chronic pain is not always sustained by a single cause. It can persist because several responses of the living organism, having become interdependent, reinforce one another.\n<\/blockquote>\n\n<h2 id=\"1-comment-une-douleur-physique-peut-elle-devenir-une-souffrance-globale\">1. How can physical pain become all-encompassing suffering?<\/h2>\n\n<p>\n  In fact, prolonged physical pain does not necessarily remain confined to the area that hurts. When it recurs or persists, it can disrupt sleep, reduce endurance, limit getting around, make certain positions dreaded, and curtail activities that were previously routine.\n<\/p>\n\n<p>\n  In particular, lack of sleep increases fatigue and reduces adaptive capacity. Reduced activity can lead to deconditioning, a loss of confidence, and fewer reassuring bodily experiences. Diagnostic uncertainty or repeated treatment failures can foster worry. When social relationships, work life, or intimacy are affected, physical pain also becomes biographical and psychological suffering.\n<\/p>\n\n<p>\n  The literature on the comorbidity of pain and depression shows that these two dimensions are frequently associated and that their coexistence tends to increase functional impact <span class=\"bp-inline-ref\">(Bair et&nbsp;al., 2003)<\/span>. This association does not establish a single causal direction: pain can promote psychological suffering, psychological suffering can precede pain, and the two can share certain vulnerability factors.\n<\/p>\n\n<figure class=\"bp-figure\">\n  <img decoding=\"async\"\n    src=\"https:\/\/blueportance.com\/wp-content\/uploads\/X.1.From-physical-pain-to-psychological-suffering.png\"\n    alt=\"Diagram showing how persistent physical pain can progressively affect sleep, fatigue, activity, social relationships and psychological well-being.\"\n    loading=\"lazy\"\n  >\n  <figcaption>\n    <span class=\"bp-fig-title\">Figure 1 \u2014 From physical pain to psychological suffering<\/span>\n    <span class=\"bp-fig-text\">When it persists, pain can gradually disrupt sleep, increase fatigue, limit activities and social relationships, and then contribute to genuine psychological suffering. This progression is neither automatic nor identical in everyone.<\/span>\n  <\/figcaption>\n<\/figure>\n\n<h2 id=\"2-comment-la-souffrance-psychique-peut-elle-amplifier-la-douleur\">2. How can psychological suffering amplify pain?<\/h2>\n\n<p>\n  In fact, the nervous system never processes pain-related information independently of context. Attention, expectations, fear, emotional state, and threat appraisal influence the way signals are filtered, amplified, or inhibited. Descending pathways originating in the brain can exert inhibitory or facilitatory effects on nociceptive transmission <span class=\"bp-inline-ref\">(Ossipov et&nbsp;al., 2010)<\/span>.\n<\/p>\n\n<p>\n  Conditioned pain modulation shows that the nervous system\u2019s ability to dampen a pain signal varies from one person to another and can be impaired in some chronic pain conditions <span class=\"bp-inline-ref\">(Yarnitsky, 2010)<\/span>. This does not mean that psychological suffering necessarily \u201ccreates\u201d physical pain, but that it can alter the systems that appraise and regulate that pain.\n<\/p>\n\n<p>\n  Chronic stress, moreover, represents another level of interaction. Stress responses are normally adaptive: they mobilize the body in the face of a threat. When they are prolonged, however, they can alter sleep, attention, memory, emotional regulation, and several neurobiological systems involved in adaptation <span class=\"bp-inline-ref\">(McEwen, 2007)<\/span>.\n<\/p>\n\n<p>\n  The fear-avoidance model describes how a sensation interpreted as dangerous can trigger fear, vigilance, avoidance, and reduced activity. These responses are understandable and often protective in the short term. When they become generalized, however, they can contribute to deconditioning, to the loss of corrective experiences, and to the persistence of pain <span class=\"bp-inline-ref\">(Crombez et&nbsp;al., 2012)<\/span>.\n<\/p>\n\n<figure class=\"bp-figure\">\n  <img decoding=\"async\"\n    src=\"https:\/\/blueportance.com\/wp-content\/uploads\/X.2.From-psychological-suffering-to-amplification-of-physical-pain.png\"\n    alt=\"Diagram showing how chronic stress, fear, hypervigilance and altered descending modulation can amplify physical pain.\"\n    loading=\"lazy\"\n  >\n  <figcaption>\n    <span class=\"bp-fig-title\">Figure 2 \u2014 From psychological suffering to pain amplification<\/span>\n    <span class=\"bp-fig-text\">Chronic stress, hypervigilance, fear, and changes in descending modulation can intensify the pain experience. These neurobiological interactions do not imply that the pain is imaginary or exclusively psychological.<\/span>\n  <\/figcaption>\n<\/figure>\n\n<h2 id=\"3-pourquoi-parle-t-on-de-boucle-plutot-que-de-chaine\">3. Why speak of a loop rather than a chain?<\/h2>\n\n<p>\n  A chain implies a simple sequence: a cause produces an effect, and then the process stops. A loop, by contrast, describes a different kind of organization: the effect produced in turn becomes a new condition capable of reinforcing the initial process.\n<\/p>\n\n<p>\n  For example, pain disrupts sleep. Lack of sleep thus increases fatigue and lowers load tolerance. Fatigue reduces activity and increases the perceived cost of movement. Reduced activity limits reassuring experiences and can heighten attention to the body. Likewise, hypervigilance increases the detection of sensations. Those sensations then seem more threatening and can intensify the pain, which disrupts sleep even further.\n<\/p>\n\n<p>\n  In another case, for example, pain while sitting leads to protective strategies. The person freezes, avoids certain weight-bearing positions, or holds a posture assumed to be less painful for long periods. These adaptations can temporarily reduce discomfort, but they can also decrease mechanical variability, concentrate stress on other areas, and reinforce the fear of moving. The protective response then becomes one of the conditions sustaining the very problem it was trying to avoid.\n<\/p>\n\n<div class=\"bp-definition\">\n  <strong class=\"bp-def-source\">Definition proposed by Blue Portance<\/strong>\n  <p>\n    <strong>Adaptive pain loops<\/strong> refer to the dynamic organization through which several biomechanical, neurophysiological, behavioral, emotional, and social adaptations interact to the point of becoming mutually sustained. They are neither a new category of pain nor an additional pathophysiological mechanism, but an interpretive framework for the interactions between mechanisms that are already known.\n  <\/p>\n<\/div>\n\n<figure class=\"bp-figure\">\n  <img decoding=\"async\"\n    src=\"https:\/\/blueportance.com\/wp-content\/uploads\/X.3.The-circle-of-interactions-adaptive-loops-of-pain.png\"\n    alt=\"Diagram connecting pain, sleep, emotions, attention, behavior, activity, mechanical stresses, sensitization and the social environment.\"\n    loading=\"lazy\"\n  >\n  <figcaption>\n    <span class=\"bp-fig-title\">Figure 3 \u2014 Adaptive loops in chronic pain<\/span>\n    <span class=\"bp-fig-text\">Several initially protective adaptations can interact and end up sustaining one another. The figure does not represent an additional mechanism, but a level of organization connecting the mechanical, nervous, behavioral, emotional, and social dimensions of pain.<\/span>\n  <\/figcaption>\n<\/figure>\n\n<h2 id=\"4-toutes-les-adaptations-ne-sont-pas-pathologiques\">4. Not all adaptations are pathological<\/h2>\n\n<p>\n  In fact, the term \u201cadaptive\u201d does not mean that every adaptation is beneficial in the long term. It first describes a response of the living organism to a stress. Temporarily taking weight off a painful area, slowing down movement after an injury, or increasing vigilance in the face of a threat are coherent responses. In this sense, they protect the system during a phase when its capacities are reduced.\n<\/p>\n\n<p>\n  The difficulty arises when the stress changes but the adaptation persists, becomes generalized, or combines with other responses. A strategy that is useful for a few days can become costly when it shapes movement, attention, or behavior over the long term. The protection is not \u201cwrong\u201d in that case; it has become ill-suited to the new state of the system.\n<\/p>\n\n<p>\n  This distinction avoids two symmetrical errors: regarding every adaptation as pathological, or assuming that a biological response is necessarily favorable because it is natural. In other words, an adaptation can be immediately protective while becoming, over time, a sustaining factor.\n<\/p>\n\n<h2 id=\"5-comment-les-articles-precedents-s-articulent-ils-dans-ce-modele\">5. How do the previous articles fit into this model?<\/h2>\n\n<p>The notion of adaptive loops offers a way to revisit the previous articles without conflating them:<\/p>\n\n<ul>\n  <li><strong>Article 3 \u2014 Nociceptive pain:<\/strong> a stress exceeds a tissue\u2019s adaptive capacity and produces nociceptive activity.<\/li>\n  <li><strong>Article 4 \u2014 Compressed nerve or nerve under tension:<\/strong> mechanics, microcirculation, and nerve gliding can interact over time.<\/li>\n  <li><strong>Article 5 \u2014 Neuropathic pain:<\/strong> a lesion or disease of the somatosensory system can persist after the initial stress has disappeared and lead to new adaptations.<\/li>\n  <li><strong>Article 6 \u2014 Nociplastic pain:<\/strong> the processing of pain-related information can be lastingly altered without tissue or nerve damage sufficient to explain the intensity of the clinical picture.<\/li>\n  <li><strong>Article 7 \u2014 Nervous system hypersensitization:<\/strong> increased sensitivity, hypervigilance, and avoidance behaviors can reinforce one another.<\/li>\n  <li><strong>Article 8 \u2014 Neurosensory deprogramming:<\/strong> certain learned responses can be gradually modified through new sensory and motor experiences.<\/li>\n  <li><strong>Article 9 \u2014 Psychological pain:<\/strong> psychological suffering is a biological and subjective reality that can interact with physical pain.<\/li>\n<\/ul>\n\n<p>\n  Article 10 therefore does not replace any of the preceding mechanisms. It shows why chronic pain can become difficult to understand when several levels \u2014 tissue, nerve, central, behavioral, emotional, and social \u2014 change at the same time.\n<\/p>\n\n<h2 id=\"6-ce-que-le-modele-biopsychosocial-apporte-et-ce-qu-il-ne-dit-pas\">6. What the biopsychosocial model contributes \u2014 and what it does not say<\/h2>\n\n<p>\n  The biopsychosocial model was proposed to move beyond a strictly biomedical conception in which every disease should be explained by an isolated lesion <span class=\"bp-inline-ref\">(Engel, 1977)<\/span>. Applied to chronic pain, it calls for biological, psychological, and social factors to be analyzed together rather than set against one another <span class=\"bp-inline-ref\">(Gatchel et&nbsp;al., 2007)<\/span>.\n<\/p>\n\n<p>\n  This approach does not mean that all pain is psychological, nor that all factors carry the same weight in every person. An active mechanical stress may remain dominant; a nerve lesion may explain an essential part of the clinical picture; hypersensitization may become predominant; major stress or a social rupture may profoundly alter the trajectory.\n<\/p>\n\n<div class=\"bp-controversy\">\n  <h3>Important limitation<\/h3>\n  <p>\n    Adaptive loops cannot, however, be automatically inferred from the presence of chronic pain. They must be looked for and ranked in each situation. Not everyone presents the same interactions, and no general figure can, on its own, determine the dominant mechanism of an individual person\u2019s pain.\n  <\/p>\n<\/div>\n\n<h2 id=\"7-lecture-proposee-par-blue-portance-du-systeme-adaptatif-aux-boucles-de-la-douleur\">7. The interpretation proposed by Blue Portance: from the adaptive system to pain loops<\/h2>\n\n<div class=\"bp-model\">\n  <h2 id=\"une-application-du-concept-c7-systeme-adaptatif\">An application of the C7 concept \u2014 Adaptive System<\/h2>\n\n  <p>\n    In the Blue Portance framework, the <strong>adaptive system (C7)<\/strong> refers to the capacity of living organisms to respond to stresses through biomechanical, neurophysiological, behavioral, and psychological adjustments. <strong>Adaptive loops of living systems<\/strong> describe the general principle according to which several of these responses can interact. <strong>Adaptive pain loops<\/strong> are the application of this principle to the field of chronic pain.\n  <\/p>\n\n  <p>\n    This interpretation thus does not seek to attribute pain to a single dimension. It proposes identifying the active relationships: which stress is still sustaining nociceptive activity? Which postural adaptation is concentrating weight-bearing? Which behavior is limiting variability? Which sleep disturbance is reducing adaptive capacity? Which fear is preventing exposure to a reassuring experience? Which social factor is maintaining a state of alert?\n  <\/p>\n\n  <p>\n    In fact, the clinical value of the model does not lie in treating everything indiscriminately. It consists in identifying the dominant loops and the points where a change may produce cascading effects. In some situations, the main lever remains mechanical. In others, it concerns sleep, movement, perceived safety, nerve recovery, or the reduction of hypersensitization.\n  <\/p>\n<\/div>\n\n<figure class=\"bp-figure\">\n  <img decoding=\"async\"\n    src=\"https:\/\/blueportance.com\/wp-content\/uploads\/X.4.Blue-Portance-integrative-model-adaptive-loops-of-pain.png\"\n    alt=\"Integrative Blue Portance model linking mechanical stresses, nervous system function, sleep, emotions, behaviors and environment.\"\n    loading=\"lazy\"\n  >\n  <figcaption>\n    <span class=\"bp-fig-title\">Figure 4 \u2014 The integrative Blue Portance model<\/span>\n    <span class=\"bp-fig-text\">The goal is not to act indiscriminately on all factors, but to identify the dominant loops and the leverage points likely to change the system as a whole in a given situation.<\/span>\n  <\/figcaption>\n<\/figure>\n\n<h2 id=\"8-peut-on-sortir-d-une-boucle-adaptative\">8. Is it possible to get out of an adaptive loop?<\/h2>\n\n<p>\n  A loop is not, however, necessarily irreversible. Because it depends on relationships between several elements, it can change when one of those elements changes in a lasting way. Restoring sleep can improve emotional regulation and load tolerance. Gradually reintroducing movement can provide new safety information. Reducing a dominant mechanical stress can decrease the nociceptive activity that feeds the system as a whole.\n<\/p>\n\n<p>\n  The point is not to draw up a universal list of interventions, but to understand a logic: when pain is sustained by several loops, an isolated action may be insufficient, whereas a coordinated strategy may produce effects beyond the lever directly targeted.\n<\/p>\n\n<p>\n  This approach also helps avoid an interpretation that assigns blame. Indeed, a person does not \u201cchoose\u201d their adaptive loops. They develop out of biological responses, experiences, stresses, and contexts that are often imposed. Understanding how they are organized is thus intended to restore possibilities for action, not to place responsibility for the pain on the person experiencing it.\n<\/p>\n\n<h2 id=\"9-pourquoi-certaines-douleurs-deviennent-elles-si-difficiles-a-traiter\">9. Why does some pain become so difficult to treat?<\/h2>\n\n<p>\n  What makes chronic pain particularly difficult to treat is not always the persistence of an isolated mechanism. In reality, it is sometimes the gradual formation of several loops that sustain one another. Each becomes both a consequence of the others and a factor sustaining them.\n<\/p>\n\n<p>\n  Understanding these interactions certainly does not mean that they are all present in every person. It can, however, help identify, for a given situation, which loops have become dominant, which remain secondary, and which relationships can be acted on.\n<\/p>\n\n<blockquote>\n  For a long time, the question was whether pain was physical or psychological. Current knowledge instead invites us to understand how physical, nervous, emotional, behavioral, and social dimensions can interact. Recognizing these interactions does not amount to psychologizing pain. It means recognizing the complex organization of living systems.\n<\/blockquote>\n\n<section class=\"bp-takeaway\">\n  <h2 id=\"a-retenir\">Key takeaways<\/h2>\n  <ul>\n    <li>Persistent physical pain can have a significant psychological, social, and functional impact.<\/li>\n    <li>Stress, hypervigilance, fear, lack of sleep, and protective behaviors can alter the perception and regulation of pain.<\/li>\n    <li>These interactions can thus form loops in which the consequences of pain in turn become sustaining factors.<\/li>\n    <li>Adaptive loops are not a new category of pain, but a level of organization connecting several mechanisms that have already been described.<\/li>\n    <li>In the Blue Portance framework, they represent the application to pain of the C7 concept \u2014 Adaptive System.<\/li>\n  <\/ul>\n<\/section>\n\n<section class=\"bp-faq\">\n  <h2 id=\"questions-frequentes\">Frequently asked questions<\/h2>\n\n  <details>\n    <summary>Does saying that pain has a psychological dimension mean that it is imaginary?<\/summary>\n    <div class=\"faq-content\">\n      <p>No. Pain is a real experience. Emotions, stress, and attention can, however, modify its intensity without negating the existence of tissue, nerve, or nociplastic mechanisms.<\/p>\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary>Is an adaptive loop always a vicious circle?<\/summary>\n    <div class=\"faq-content\">\n      <p>No. Adaptive loops first and foremost describe interactions. Some promote protection and recovery; others become costly when they persist or reinforce one another.<\/p>\n    <\/div>\n  <\/details>\n\n  <details>\n    <summary>Do all the factors need to be addressed at the same time?<\/summary>\n    <div class=\"faq-content\">\n      <p>Not necessarily. The key is to identify the dominant mechanisms and relationships. In some situations, a mechanical stress remains the priority; in others, sleep, fear of movement, nerve recovery, or hypersensitization plays a more important role.<\/p>\n    <\/div>\n  <\/details>\n<\/section>\n\n<div class=\"bp-cta\">\n  <h2 id=\"vous-cherchez-a-comprendre-ce-qui-entretient-vos-douleurs-en-position-assise\">Trying to understand what keeps your sitting-related pain going?<\/h2>\n  <p>\n    The analysis is based on location, stresses, mechanical variability, and the mechanisms likely to combine.\n  <\/p>\n  <a href=\"https:\/\/blueportance.com\/en\/personalized-pain-analysis\/\">Analyze my situation \u2192<\/a>\n<\/div>\n\n\n<section class=\"bp-references\">\n  <h2 id=\"references-scientifiques\">Scientific references<\/h2>\n  <ol>\n    <li>Yarnitsky D. Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states. <em>Current Opinion in Anaesthesiology<\/em>. 2010;23(5):611-615.<\/li>\n    <li>Ossipov MH, Dussor GO, Porreca F. Central modulation of pain. <em>Journal of Clinical Investigation<\/em>. 2010;120(11):3779-3787.<\/li>\n    <li>McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. <em>Physiological Reviews<\/em>. 2007;87:873-904.<\/li>\n    <li>Crombez G, Eccleston C, Van Damme S, Vlaeyen JWS, Karoly P. Fear-avoidance model of chronic pain: the next generation. <em>Clinical Journal of Pain<\/em>. 2012;28(6):475-483.<\/li>\n    <li>Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. <em>Archives of Internal Medicine<\/em>. 2003;163:2433-2445.<\/li>\n    <li>Engel GL. The need for a new medical model: a challenge for biomedicine. <em>Science<\/em>. 1977;196(4286):129-136.<\/li>\n    <li>Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. <em>Psychological Bulletin<\/em>. 2007;133(4):581-624.<\/li>\n  <\/ol>\n<\/section>\n\n<p class=\"bp-note\">\n  This article is educational in purpose. It therefore cannot establish the dominant mechanism of an individual person\u2019s pain, and it does not replace a medical diagnosis or personalized care.\n<\/p>\n\n<p class=\"bp-copyright\">\n  \u00a9 Gil Ayache. The concepts, diagrams, terminology, and principles presented on this page constitute a work protected by copyright. They are made available to Blue Portance under an intellectual property license agreement, without transfer of economic rights or of authorship.\n<\/p>\n\n\n","protected":false},"excerpt":{"rendered":"<p>Blue Portance \u2192 Knowledge Base \u2192 Understanding Pain \u2192 Adaptive Pain Loops Blue Portance Expert Guides Understanding Pain The biological, mechanical, and neurophysiological mechanisms of pain. This article is part of the Expert Guide \u201cUnderstanding Pain\u201d. Synthesis article \u2014 Blue Portance Knowledge Base When Physical Pain and Psychological Suffering Sustain Each Other: Adaptive Pain Loops [&#8230;]\n","protected":false},"author":6,"featured_media":0,"parent":8012,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_yoast_wpseo_title":"Adaptive Pain Loops: Body and Mind | Blue Portance","_yoast_wpseo_metadesc":"Adaptive pain loops: how persistent physical pain and psychological suffering can sustain each other.","footnotes":""},"pathologie_secondaire":[],"effet_positif":[],"class_list":["post-8072","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.7 (Yoast SEO v28.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Adaptive Pain Loops: Body and Mind | Blue Portance<\/title>\n<meta name=\"description\" content=\"Adaptive pain loops: how persistent physical pain and 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