New Developments in the Psychological Management of Chronic Pain

Abstract

After reviewing how psychological treatment for chronic pain comes to have its current form, and summarizing treatment effectiveness, we explore several areas of development. We describe third wave therapies, such as mindfulness; we discuss what the research literature aggregated can tell us about what trials are more useful to conduct; and we outline some areas of promise and some failures to deliver on promise. The article is drawn together using the framework of the normal psychology of pain, identifying some of its most important implications for improving life for people with chronic pain. W W W Nouveaux développements de la prise en charge psychologique de la douleur chroniqueAprès avoir étudié comment le traitement psychologique de la douleur chronique en est venu à sa forme actuelle, et résumé l'efficacité des traitements, nous explorons plusieurs domaines du développement. Nous décrivons les thérapies de troisième vague comme la pleine conscience, nous discutons de ce que peut nous apprendre la littérature de recherche regroupée à propos des essais les plus utiles à mener, nous présentons des domaines prometteurs et d'autres qui n'ont pas tenu leur promesse. La structure de l'article est le cadre de la psychologie normale de la douleur, qui identifie certaines des implications les plus importantes pour améliorer la vie des personnes souffrant de douleur chronique. P sychological treatments for chronic pain have been in continuous development since the 1960s, broadly parallel to changes in mainstream psychological treatments, especially within the ambit of CBT. There are several conceptual threads that can be discerned in the current state. 1 BehaviouralBehavioural methods apply operant learning theory to the analysis of pain. The primary objective is to modify a range of pain-related behaviours, such as activity, medication use, and social interactions, by changing environmental contingencies and the settings in which pain-related behaviour occurs. The cardinal feature of the original behavioural approach was that it explicitly eschewed direct attempts to modify the sensory-intensity component of the pain experience. 2

Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis

“…While recent studies have yielded similar positive effects of mindfulness for pain, these effects tend to be small to medium and based on a body of evidence that is, at best, of moderate quality. A potential way to advance research on chronic pain would be to improve intervention and control group descriptions, identify different effects of various components of complex interventions, and work toward a standard criterion for assessing therapeutic gain [68]. Head-to-head trials that compare mindfulness interventions of a similar category but with variations in components or dose may be helpful to tease out the most effective elements of these interventions [69].…”

The effects of a novel psychological attribution and emotional awareness and expression therapy for chronic musculoskeletal pain: A preliminary, uncontrolled trial

“…Half of the patients had pain at or below 2.0 on a 0 to 10 scale after 6 months, and some (6.9% were fully pain-free). After just five sessions—one individual consultation and four group sessions—these durable improvements appear to surpass substantially those obtained by standard CBT or acceptance and mindfulness-based psychological interventions for chronic musculoskeletal pain [6, 9, 12]. …”

“…The most popular treatment program, cognitive behavior therapy (CBT), teaches patients that their pain should be viewed as a chronic condition that will not be cured medically but can be successfully self-managed using a variety of skills including goal setting, activity pacing, environmental changes, attention management, cognitive restructuring, behavioral experiments, and problem solving [6]. CBT has been widely tested in clinical trials, and meta-analytic reviews typically conclude that CBT is efficacious for a range of pain-related outcomes [7–9].…”

“…We also hypothesized that the treatment would change key theoretical processes: increasing patients’ psychological attributions of pain, emotional awareness, and emotional approach coping, and decreasing alexithymia; and we hypothesized that improvements in these processes would be associated with improvements in pain-related outcomes. Finally, patients with emotional disturbances such as depression often show less benefit from CBT approaches than patients with less depression [32– 34], and reviews indicate that patients with widespread pain or fibromyalgia achieve little or no significant pain reduction from CBT and mindfulness-based approaches [6, 35]. Thus, we tested whether this novel therapy would be successful for patients with elevated depression and widespread pain, compared to less depressed patients and those with more localized pain.…”

What is the Latest in Pain Mechanisms and Management?

“…5 Nondrug strategies include healthy lifestyle, therapeutic exercise, psychological strategies, and complementary approaches. In this In Review series, Morley and Williams 6 provide an excellent and concise review of key developments in the psychological management of pain.…”