Can pain-related fear be reduced? The application of cognitive-behavioural exposure in vivo.

Johan Ws Vlaeyen,Ank Mj Kole-Snijders,Maria Kerckhoffs-Hanssen,Jeroen R De Jong,Patrick Onghena

doi:10.1155/2002/493463

Johan Ws Vlaeyen, Ank Mj Kole-Snijders + Show 3 more

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https://doi.org/10.1155/2002/493463

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Abstract

Although cognitive-behavioural treatments of patients with chronic pain generally are reported to be effective, customization might increase their effectiveness. One possible way to customize treatment is to focus the intervention on the supposed mechanism underlying the transition from acute to chronic pain disability. Evidence is accumulating in support of the conjecture that pain-related fear and associated avoidance behaviours are crucial in the development and maintenance of chronic pain disability. It seems timely to apply this knowledge to the cognitive-behavioural management of chronic pain. Two studies are presented here. Study 1 concerns a secondary analysis of data gathered in a clinical trial that was aimed at the examination of the supplementary value of coping skills training when added to an operant-behavioural treatment in patients with chronic back pain. The results show that, compared with a waiting list control, an operant-behavioural treatment with or without pain-coping skills training produced very modest and clinically negligible decreases in pain-related fear. Study 2 presents the effects of more systematic exposure in vivo treatment with behavioural experiments in two single patients reporting substantial pain-related fear. Randomization tests for AB designs revealed dramatic changes in pain-related fear and pain catastrophizing. In both cases, pain intensity also decreased significantly, but at a slower pace. Differences before and after treatment revealed clinically significant improvements in pain vigilance and pain disability.

Highlights

Est-il possible de réduire la peur reliée à la douleur ? L’application de l’exposition cognitivocomportementale in vivo
What might be the reason for this? A plausible explanation is that the operant treatment and graded activity program, not aimed at reducing pain-related fears, allow too many escape possibilities for patients
Philips [36] was one of the first to argue for the systematic application of graded exposure to produce disconfirmations among expectations of pain and harm, the actual pain, and the other consequences of the activity

Summary

Introduction

Est-il possible de réduire la peur reliée à la douleur ? L’application de l’exposition cognitivocomportementale in vivo. Cognitive-behavioural treatment of chronic pain douleur aiguë à l’incapacité par douleur chronique. La première porte sur une analyse secondaire de données colligées dans un essai clinique visant à examiner la valeur complémentaire de la formation aux habiletés d’adaptation ajoutée à un traitement par comportement opérant chez des patients souffrant de douleurs dorsales chroniques. Par rapport à un contrôle par des listes d’attente, un traitement par comportement opérant accompagné ou non de formation aux habiletés d’adaptation à la douleur a entraîné une diminution très modeste et cliniquement négligeable de la peur reliée à la douleur. La deuxième étude présente les effets d’un traitement par exposition in vivo plus systématique à des expériences comportementales chez deux patients célibataires faisant état d’une importante peur reliée à la douleur. The basic goal of these approaches is to increase quality of life (ie, to care for the sufferer), rather than remove the pain (ie, to cure the pain)

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