The Role of Behavioral and Social Factors in the Development of Drug-Induced Headache

Abstract

A number of investigators have reported that social and behavioral factors play an important role in the development and maintenance of pain-related behavior (Wooley et al. 1978; Fordyce 1974). A popular notion in behavioral literature on pain is that social reinforcement (i.e., consolation by relatives, friends, hospital staff, and physicians) increases the incidence of verbal reports of pain and overt behavioral signs of pain (Sternbach 1974; Fordyce 1977). Moreover, most investigators agree that receipt of analgesics helps to reinforce a patient’s perception of pain. According to one particular theory, pain-relieving medication reinforces excess use of pain-related behavior by the process of immediate pain relief (operant conditioning) and moreover by the psychotropic action of most analgesics. The latter action results in elevated mood and mild euphoria. Termination of pain (headache) through the assumed action of the drug may increase the probability of drug intake in the future (negative reinforcement). Positive consequences result in a drug intake behavior (i.e., drug abuse) which is associated with increasing frequency and intensity of pain.