Complexity theory in the management of patients with pain


  • Mauro Andreu a Universidad Nacional De La Matanza (UNLaM), Departamento de Salud, San Justo, Buenos Aires, Argentina; b Facultad de Ciencias de la Salud, Universidad de las Américas (UDLA), Quito, Ecuador
  • Pablo Policastro c KINÉ- Kinesiología Deportiva y Funcional, Buenos Aires, Argentina; d Unidad de Kinesiología, Hospital Durand, Buenos Aires, Argentina.
  • Tatiana Dias de Carvalho a Universidad Nacional De La Matanza (UNLaM), Departamento de Salud, San Justo, Buenos Aires, Argentina.
  • Yolanda Pardo e Consorcio de Investigación Biomédica en Red, Epidemiología y Salud Pública, Barcelona, España; f Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, España; g Universidad Autónoma de Barcelona, Barcelona, España.



complexity, contextual factors, pain, health professionals, placebo, nocebo


Nonlinear systems are not susceptible to being investigated with reductionist methods. In this sense, complexity theory offers an alternative approach to quantify the importance of contextual factors (CFs) in the patient with pain. The result of the positive (placebo) or negative (nocebo) use of CFs in the therapeutic setting could be responsible for a large part of a non-specific component of the efficacy of the treatment, directly affecting the quality of the results related to the patient's health (for example, pain, disability, or satisfaction). In recent years, understanding of the value of these effects has increased. Despite growing interest, knowledge, and awareness of them is currently limited and heterogeneous among health professionals, reducing their translational value in the field of health.


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