Psychological Interventions for the Treatment of Chronic Pain in Adults

Abstract

The high prevalence and societal burden of chronic pain, its undertreatment, and disparities in its management have contributed to the acknowledgment of chronic pain as a serious public-health concern. The concurrent opioid epidemic, and increasing concern about overreliance on opioid therapy despite evidence of limited benefit and serious harms, has heightened attention to this problem. The biopsychosocial model has emerged as the primary conceptual framework for understanding the complex experience of chronic pain and for informing models of care. The prominence of psychological processes as risk and resilience factors in this model has prompted extensive study of psychological treatments designed to alter processes that underlie or significantly contribute to pain, distress, or disability among adults with chronic pain. Cognitive-behavioral therapy is acknowledged to have strong evidence of effectiveness; other psychological approaches, including acceptance and commitment therapy, mindfulness, biofeedback, hypnosis, and emotional-awareness and expression therapy, have also garnered varying degrees of evidence across multiple pain conditions. Mechanistic studies have identified multiple pathways by which these treatments may reduce the intensity and impact of pain. Despite the growing evidence for and appreciation of these approaches, several barriers limit their uptake at the level of organizations, providers, and patients. Innovative methods for delivering psychological interventions and other research, practice, and policy initiatives hold promise for overcoming these barriers. Additional scientific knowledge and practice gaps remain to be addressed to optimize the reach and effectiveness of these interventions, including tailoring to address individual differences, concurrently addressing co-occurring disorders, and incorporating other optimization strategies.

The Role of Environmental Context and Physical Activity in Prescribed Opioid Use and Pain in Daily Life among Patients With Chronic Low Back Pain

“…Consistent with behavioral economic theory and the general literature on psychosocial treatments for chronic pain [40], these results suggest that environmental factors may influence the likelihood of prescription opioid use among patients with chronic low back pain. Patients with chronic pain, who are more likely to have lower socioeconomic status, be unemployed or underemployed, and are generally at higher risk to experience co-occurring physical or mental health conditions [41], may be more likely to live in environments with fewer or less accessible activities.…”

“…Indeed, chronic pain patients who have more social connections, are engaged with their environment, and are overall physically active report lower pain levels [42]. There is an increasing awareness of the effectiveness of psychosocial treatment, both by itself and in integration with pharmacology, for chronic pain [40,43]. Less work has examined the potential benefit of behavioral intervention for management of prescribed opioid use, though some work has examined problems with opioid use in patients with chronic pain [44].…”

Are Prayer-Based Interventions Effective Pain Management Options? A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…2011), and multimodal pain treatment programs addressing biopsychosocial factors (e.g., pain-related beliefs and pain coping responses) are more effective than exclusively biomedical treatments (Driscoll et al, 2021;Eccleston et al, 2013;Morley & Williams, 2015;Roditi & Robinson, 2011;Vervoort et al, 2018;Vowles et al, 2020;Williams et al, 2012). Recent research has also highlighted the relevance of spirituality/religiosity and spiritual/religious practices in influencing pain experience (Baetz & Bowen, 2008;Büssing et al, 2009;Dezutter et al, 2011;Ferreira-Valente et al, 2020Hatefi et al, 2019;Illueca & Doolittle, 2020;Lysne & Wachholtz, 2010).…”

The analgesic effect of nostalgia elicited by idiographic and nomothetic approaches on thermal stimulus

“…Using psychological strategies for treating pain is important and timely, 26 yet the effect of nonpharmacological analgesics may be somewhat limited 27 . For instance, this can be reflected in the varying analgesic effects achieved using different methods or intensities of noxious stimuli (low intensity vs. high intensity) 28,29 .…”