Psychological therapies for the management of chronic pain (excluding headache) in adults

Abstract

Benefits of CBT emerged almost entirely from comparisons with treatment as usual/waiting list, not with active controls. CBT but not behaviour therapy has weak effects in improving pain, but only immediately post-treatment and when compared with treatment as usual/waiting list. CBT but not behaviour therapy has small effects on disability associated with chronic pain, with some maintenance at six months. CBT is effective in altering mood and catastrophising outcomes, when compared with treatment as usual/waiting list, with some evidence that this is maintained at six months. Behaviour therapy has no effects on mood, but showed an effect on catastrophising immediately post-treatment. CBT is a useful approach to the management of chronic pain. There is no need for more general RCTs reporting group means: rather, different types of studies and analyses are needed to identify which components of CBT work for which type of patient on which outcome/s, and to try to understand why.

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

“…77 Despite the intent at integration, psychological treatments continue to be divided depending on whether they are predominantly cognitive or behavioral in focus. 17,94 The FA model can be considered a more specifically focused cognitive behavioral model. 82 In this model, for some people, catastrophizing about pain-related movements leads to painrelated fear and hypervigilance, and these lead to avoidance, disability, and depression, in a continuing cycle.…”

“…Approaches to treatment that include diverse methods, and are not focused on a few core therapy processes, may not be the best means for creating progress in the field. 17,94 The FA model appears specific, includes measurable variables that sit in defined relations to each other, and leads to directly testable principles. 82 The model has led to specific approaches to treatment.…”

“…62,64,74,94 These are the answer to the question of what must be changed during the experience of treatment so that treatment outcome will be as beneficial as possible. Researchers developing CBT-based approaches have perhaps not always adopted a focus on processes of therapeutic change and have not always included process Psychological Flexibility and Chronic Pain 17 measures in their research trials.…”

Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome – A systematic review and meta‐analysis of randomized controlled trials

“…(2) Traditional cognitive behavioural therapy (CBT), which requires monitoring of one's own thoughts, feelings and behaviours with respect to the target symptom (e.g. by a symptom diary) and the promotion of alternative ways of coping with the target symptom (also labelled as problem-solving techniques, self management, coping skills), through methods such as activity participation and skill-building or practice opportunities (Williams et al, 2012). (3) Self management education programmes, which require information on the clinical picture of FMS, cognitive and behavioural skills mastery to manage pain and limitations of daily activities, and modelling as supplied by the facilitators to target cognitive, behavioural and emotional change (Warsi et al, 2003).…”

“…When there was more than one measure for an outcome we gave preference to the measure that was most frequently used. Also, when there was a choice between singleitem and multi-item self report tools, we chose multi-item tools on the basis of inferred increased reliability (Williams et al, 2012).…”