Abstract
The present case study describes an elderly mental health client with a long history of medication misuse, who in recent years also experienced back pain. Behavior analysis revealed that interpersonal conflicts or negative emotional states usually preceded pain "flare-ups" and subsequent medication misuse. Cognitive-behavioral treatment consisting of covert assertion, a combination of thoughtstopping with positive self-talk, allowed her to manage pain and cope with its antecedents. Treatment resulted in decreases in pain flare-ups, medication use and noncompliance, depression, and anxiety. Success was maintained throughout a one year follow-up. Relapse of medication misuse occurred three years post-treatment, following an injury and transfer of care to a new physician. The results support the use of cognitive-behavioral approaches in the prevention and management of pain, and suggest physicians' roles in the prevention of medication misuse.
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