Psychological Interventions For Chronic Pain Research Articles

Invited review: Psychological treatment of chronic pain: A selective review

Chronic pain occurs commonly in patients who have either physical or mental disorders, or both. Almost any psychiatric diagnosis may be involved, but affective and somatoform disorders predominate, together with adjustment disorders and psychological factors affecting physical condition. Psychological treatments for chronic pain have developed rapidly within thelast 15 years. Most treatment is provided in the form of multi-faceted ‘packages’ incorporating a range of methods which are derived from operant or cognitive-behavioural theories. A selective review of these approaches leads to the conclusion that in general there is good evidence for their efficacy, despite the limitations of many research reports. There is still considerable uncertainty about the most effective treatments for different patients with different disorders. The effects on treatment outcome of litigation and compensation and of family factors are briefly considered. Despite the considerable cost resulting from chronic pain there appears to be meagre treatment available in the United Kingdom, particularly for the most severely disabled.

Psychological treatment for chronic pain: A selective review

The status of biofeedback and biofeedback assisted relaxation, operant conditioning, and cognitive behavioral treatment for chronic pain management is discussed. Successful treatment outcomes have been reported for each approach. Unfortunately, various weaknesses in the designs of the studies reporting positive outcome, such as the absence of control groups, inadequate patient sample descriptions, and few long term follow-ups do not allow unqualified acceptance of the efficacy of these approaches. Evaluations of the current status of each approach and suggestions for future research are presented. The need to develop a prescriptive approach for assessment and treatment is stressed.

Therapeutic aspects in chronic pain: Modulation of nociception, alleviation of suffering, and behavioral analysis

In this paper, the medical treatment of patients with chronic pain of benign origin is briefly reviewed. Modulation of nociceptive pain stimuli can be achieved by decreasing afferent nervous impulses with nerve blocks or by augmenting nervous impulses with the use of electrical stimulation. Psychotropic medications are often used to control affective responses (depression and anxiety) often seen in chronic pain patients. Behavioral techniques such as those described in preceding papers of this series have the potential of advancing our knowledge of chronic pain behavior patterns and clarifying the effects of physical and psychological treatments for chronic pain.