Ronald Melzack Award Lecture: Putting the brain to work in cognitive behavioral therapy for chronic pain.

Abstract

Healthcare practitioners may not be familiar with biopsychosocial therapies such as cognitive-behavioral therapy (CBT), and may view psychosocial treatments as only appropriate for those with mental illness. Further, practitioners may not know that treatments based on a biopsychosocial model have a biological basis. Treating patients with pain as if all pain is related to ongoing tissue damage that must be located and repaired (a biomedical model) has led to the false impression that hurt = harm and that “real” pain is detectable with a biomedical marker and correctable with the right biomedical intervention. Many of our patients do not know that the brain is critically important to the perception of pain and in pain self-management. In this review, I describe recent research using a simplified gate-control schematic as a treatment rationale for biopsychosocial pain education and CBT with low-income, multiply disadvantaged patients. Using the cognitive model of pain (simplified as “Think → Feel → Act”), I provide examples of how psychosocial health care providers train patients in skills they can independently use to work with their thoughts to motivate and implement pain self-management behaviors. Moving into a brief examination of treatment mechanism (mediation, moderation), I will conclude with the argument that effective psychosocial interventions share more commonalities than sometimes acknowledged, and that these treatments can be used as part of interdisciplinary treatment to help patients self-manage their pain.