Chronic Pain as a Complex Dynamic System: Conceptual Foundations and a Narrative Review of Network Approaches
Abstract
Despite extensive medical, psychological, and social research and substantial healthcare investment, chronic pain remains highly prevalent, and a leading cause of years lived with disability. While multimodal and interdisciplinary treatments are recommended, progress may be limited by the lack of an integrative theoretical framework that captures the complexity of chronic pain across levels of analysis. We introduce a complex dynamic systems perspective as a unifying theoretical framework in which chronic pain emerges from interactions among biological, psychological, and social components over time, and we present a methodological toolbox based on the network approach to operationalize this perspective by modeling such interactions. We conducted the first narrative review of network studies in chronic pain, identifying 54 studies published up to June 30, 2026. Most studies used cross-sectional network models to examine associations among pain-related variables, comorbidity patterns, and group differences, whereas longitudinal and within-person approaches were rare. Across studies, findings support the view that chronic pain-related factors form interconnected systems; however, substantial heterogeneity in variable selection and study design limits comparability and generalizability. Overall, current applications provide an important first step toward modeling the complexity of chronic pain but so far remain limited in capturing temporal dynamics and individual-level processes. Advancing this field will require theory-driven, multi-level, and longitudinal research that aligns network methods with system-level questions. In the longer term, this approach holds the promise to support the development of parsimonious models of key mechanisms, informing interventions that target not only symptoms but the dynamic processes that sustain chronic pain.
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BibTeX
@misc{scholten2026chronic,
title = {{Chronic Pain as a Complex Dynamic System: Conceptual Foundations and a Narrative Review of Network Approaches}},
author = {Saskia Scholten and Gwen van der Wijk and Jonas Haslbeck and Felicitas Kininger and Julia Glombiewski and Johan W.S. Vlaeyen},
howpublished = {PsyArXiv},
year = {2026},
month = nov,
doi = {10.31234/osf.io/mnj6b_v1},
url = {https://osf.io/preprints/psyarxiv/mnj6b_v1/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Chronic Pain as a Complex Dynamic System: Conceptual Foundations and a Narrative Review of Network Approaches
AU - Saskia Scholten
AU - Gwen van der Wijk
AU - Jonas Haslbeck
AU - Felicitas Kininger
AU - Julia Glombiewski
AU - Johan W.S. Vlaeyen
PY - 2026
DA - 2026/11/05
PB - PsyArXiv
DO - 10.31234/osf.io/mnj6b_v1
UR - https://osf.io/preprints/psyarxiv/mnj6b_v1/
AB - Despite extensive medical, psychological, and social research and substantial healthcare investment, chronic pain remains highly prevalent, and a leading cause of years lived with disability. While multimodal and interdisciplinary treatments are recommended, progress may be limited by the lack of an integrative theoretical framework that captures the complexity of chronic pain across levels of analysis. We introduce a complex dynamic systems perspective as a unifying theoretical framework in which chronic pain emerges from interactions among biological, psychological, and social components over time, and we present a methodological toolbox based on the network approach to operationalize this perspective by modeling such interactions. We conducted the first narrative review of network studies in chronic pain, identifying 54 studies published up to June 30, 2026. Most studies used cross-sectional network models to examine associations among pain-related variables, comorbidity patterns, and group differences, whereas longitudinal and within-person approaches were rare. Across studies, findings support the view that chronic pain-related factors form interconnected systems; however, substantial heterogeneity in variable selection and study design limits comparability and generalizability. Overall, current applications provide an important first step toward modeling the complexity of chronic pain but so far remain limited in capturing temporal dynamics and individual-level processes. Advancing this field will require theory-driven, multi-level, and longitudinal research that aligns network methods with system-level questions. In the longer term, this approach holds the promise to support the development of parsimonious models of key mechanisms, informing interventions that target not only symptoms but the dynamic processes that sustain chronic pain.
ER -