Fad, Fashion and Forward Progress in Psychological Approaches to Chronic Pain Management

Abstract

ISSN 1758-1869 10.2217/PMT.11.58 © 2011 Future Medicine Ltd Pain Manage. (2011) 1(6), 491–493 From a psychological point of view, chronic pain is a very interesting even if very difficult problem. It is interesting because it presents paradoxes, naturally subverts long-term success and by its nature causes significant confusion. With chronic pain, apparent solutions can cause more problems than they solve, and responses that appear successful in the short term can be spectacularly unsuccessful in the long term. As examples, consider the effects of excess rest, activity avoidance and what is pejoratively called ‘doctor shopping.’ ‘In the moment’ each of these appears to promise the possibility of relief and progress. In the long term, however, what they actually deliver for many is failure, increasing disability and frustration. In a way the same processes that underlie suffering with pain are often mirrored in other human pursuits. It happens not just when we wrestle with chronic pain but when we, as professionals or researchers, wrestle with wrestling with chronic pain, when we try to advance the field of chronic pain management and produce better treatments. Psychologists and behavioral scientists that pursue these advances are no more immune to an excessive focus on the short-term consequences, and no more able to change their behavior than anyone else. We call this psychological inflexibility and it is endemic in human behavior. Current psychological approaches to chronic pain are dominated by cognitive– behavioral approaches, often referred to simply as CBT. CBT for chronic pain was actually one of the early success stories in psychological applications outside of mental health, to physical health conditions [1]. In the 1980s there were already numerous published treatment trials of CBT for chronic pain and by the early 1990s there was at least one systematic review affirming the benefits of these treatments [2]. The methods used within CBT at that time included skills training for managing moods, thoughts, attention, and activity, including relaxation, physical exercise, and methods for increasing positive thinking and beliefs, goal-setting, and the like.