Abstract
According to evidence from recent decades, multicomponent programs of psychological intervention in people with chronic pain have reached the highest levels of efficacy. However, there are still many questions left to answer since efficacy has mainly been shown among upper-middle class patients in English-speaking countries and in controlled studies, with expert professionals guiding the intervention and with a limited number of domains of painful experience evaluated. For this study, a program of multicomponent psychological intervention was implemented: (a) based on techniques with empirical evidence, but developed in Spain; (b) at a public primary care center; (c) among patients with limited financial resources and lower education; (d) by a novice psychologist; and (e) evaluating all domains of painful experience using the instruments recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The aim of this study was to evaluate this program. We selected a consecutive sample of 40 patients treated for chronic non-cancer pain at a primary care center in Utrera (Seville, Spain), adults who were not in any employment dispute, not suffering from psychopathology, and not receiving psychological treatment. The patients participated in 10 psychological intervention sessions, one per week, in groups of 13–14 people, which addressed psychoeducation for pain; breathing and relaxation; attention management; cognitive restructuring; problem-solving; emotional management; social skills; life values and goal setting; time organization and behavioral activation; physical exercise promotion; postural and sleep hygiene; and relapse prevention. In addition to the initial assessment, measures were taken after the intervention and at a 6-month follow-up. We assessed the program throughout the process: before, during and after the implementation. Results were analyzed statistically (significance and effect size) and from a clinical perspective (clinical significance according to IMMPACT standards). According to this analysis, the intervention was successful, although improvement tended to decline at follow-up, and the detailed design gave the program assessment a high degree of standardization and specification. Finally, suggestions for improvement are presented for upcoming applications of the program.
Highlights
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (Merskey, 1994)
22 (55%) were suffering from chronic low back pain, 12 (30%) from fibromyalgia and the remaining six (15%) from chronic headaches. They had been dealing with chronic pain for 2–30 years, with an average of 16.75 years and a standard deviation of 9.14 years
Comparing the clinical significance at pre-test and follow-up, we find that the deterioration does not represent a return to the starting point in all the variables studied, because there is a substantial change in Profile of Mood States (POMS)-T, POMS-H, and POMS-V, and a moderately important change in POMS-F, POMS-D and POMS-M
Summary
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (Merskey, 1994). Pain and chronic pain are global, complex experiences for human beings, and interdisciplinary theoretical models have been developed to study them. Painful experience is defined at different levels here, including the sensory, behavioral, emotional and cognitive level, all of which are integrated in a more comprehensive framework of stress processes (for a more detailed description, see Gatchel et al, 2007). For this reason, psychology’s contribution to the study and treatment of chronic pain has been critically important for the past few decades
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