Psychological Pain Treatment Research Articles

Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers.

PM&REarly View SPECIAL CONTRIBUTION Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers Karlyn A. Edwards PhD, Corresponding Author Karlyn A. Edwards PhD [email protected] orcid.org/0000-0002-5821-3733 Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, California, USA Correspondence Karlyn A. Edwards, Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA 94304, USA. Email: [email protected]Search for more papers by this authorDavid E. Reed II PhD, David E. Reed II PhD Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration Puget Sound Health Care, Seattle, Washington, USA Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USASearch for more papers by this authorDerek Anderson PhD, Derek Anderson PhD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USASearch for more papers by this authorKaitlin Harding PhD, Kaitlin Harding PhD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USASearch for more papers by this authorAaron P. Turner PhD, Aaron P. Turner PhD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USASearch for more papers by this authorBosco Soares MD, Bosco Soares MD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USASearch for more papers by this authorPradeep Suri MD, MS, Pradeep Suri MD, MS orcid.org/0000-0002-9449-4165 Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, Washington, USASearch for more papers by this authorRhonda M. Williams PhD, Rhonda M. Williams PhD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USASearch for more papers by this author Karlyn A. Edwards PhD, Corresponding Author Karlyn A. Edwards PhD [email protected] orcid.org/0000-0002-5821-3733 Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, California, USA Correspondence Karlyn A. Edwards, Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA 94304, USA. Email: [email protected]Search for more papers by this authorDavid E. Reed II PhD, David E. Reed II PhD Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration Puget Sound Health Care, Seattle, Washington, USA Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USASearch for more papers by this authorDerek Anderson PhD, Derek Anderson PhD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USASearch for more papers by this authorKaitlin Harding PhD, Kaitlin Harding PhD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USASearch for more papers by this authorAaron P. Turner PhD, Aaron P. Turner PhD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USASearch for more papers by this authorBosco Soares MD, Bosco Soares MD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USASearch for more papers by this authorPradeep Suri MD, MS, Pradeep Suri MD, MS orcid.org/0000-0002-9449-4165 Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, Washington, USASearch for more papers by this authorRhonda M. Williams PhD, Rhonda M. Williams PhD Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USASearch for more papers by this author First published: 12 January 2023 https://doi.org/10.1002/pmrj.12912Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Management of chronic non-cancer pain in primary care.

Management of chronic non-cancer pain in primary care.

Utilizing Primary Care to Engage Patients on Opioids in a Psychological Intervention for Chronic Pain

Introduction Given the risks of opioids for pain management, we need nonpharmacological interventions that patients will engage in and that can reduce opioid use. The purpose was to examine whether offering a psychological intervention in primary care can engage patients receiving opioids for pain management and to explore whether the intervention influences opioid use. Methods This was a secondary analysis of a pilot randomized controlled trial (RCT) of a 5-session psychological intervention in primary care for chronic pain. Patients with chronic pain (N = 220) were approached to enroll in the RCT. Electronic health records were reviewed to determine whether patients were prescribed opioids or pain medications at the time they were approached about the RCT and the 6-months following the intervention. Results Enrollees and non-enrollees had similar rates of opioid prescriptions, morphine milligram equivalent dose of opioids, and rates of other pain medication prescriptions (p> .05). However, no males with an opioid prescription enrolled. Though not significant, those in the intervention had lower odds of having an opioid prescription 6 months following the intervention (p= .09, OR= .32). Those randomized to the intervention had lower odds of having a non-opioid pain medication prescription (p= .01, OR= .17). Conclusions Having an opioid prescription did not interfere with enrollment, suggesting that primary care may be useful for engaging patients on opioids in a psychological treatment for chronic pain. However, this may be true for women, and not men. This intervention also showed promise for decreasing opioid use and warrants further study.

Utilizing primary care to engage patients on opioids in a psychological intervention for chronic pain.

Context: Chronic pain, one of the most prevalent issues encountered in primary care, is often treated with opioid prescriptions. Overuse of these medications can cause overdose and death, creating a dire need for alternative treatment methods. Psychological interventions are effective for improving pain and distress, yet are underutilized. Physicians report difficulty engaging patients already on opioids in these interventions; it is possible that offering this intervention in a primary care setting may alleviate this barrier. Objective: Determine whether opioid prescriptions are related to patients engaging in a brief psychological intervention for chronic pain management in primary care. Study Design: Secondary analysis of a pilot randomized clinical trial of a 5-session psychological intervention for chronic pain. Setting: Primary care clinic in an urban setting Patient Population: Patients with chronic pain (N= 220) were approached to enroll in a pilot randomized clinical trial (RCT) for a brief, psychological intervention for pain in primary care. Of these, 60 participated and 160 declined. Instruments: Electronic health records were reviewed to determine whether patients were prescribed opioids or pain medications at the time they were approached about the RCT. Main outcome: Comparing opioid prescriptions in enrollees versus non-enrollees. Results: There was not a significant difference between enrollees and non-enrollees in the rate of opioid prescriptions (18.3% vs. 20%, p= .78), the morphine milligram equivalent dose of opioids (M= 17.64, SD= 22.91 vs. M= 18.07, SD= 18.19; p= .95), or the rate of non-opioid pain prescriptions (33.3% vs. 40%, p = .37). When examining for gender differences, among women, there were similar rates between enrollees and non-enrollees in the rate of opioid prescriptions (23.4% vs. 17%, p = .36). However, no males with an opioid prescription enrolled, whereas 25% of men who did not enroll had an opioid prescription. Conclusions: Among all patients, opioid prescriptions were not related to enrollment in the RCT. This suggests that engaging patients who are on opioids in a psychological treatment for chronic pain, specifically in a primary care setting, may increase utilization. However, this may be true for women, but not men. Further work needs to be done to identify methods to increase psychological intervention engagement among all patients receiving opioids, but especially men.

Baseline Sleep Disturbances Modify Outcome Trajectories in Adolescents With Chronic Pain Receiving Internet-Delivered Psychological Treatment

Over 50% of adolescents with chronic pain report comorbid sleep disturbances (eg, difficulties with falling asleep), which is associated with increased pain-related disability and poorer quality of life. However, limited longitudinal data are available to understand how sleep disturbance may impact response to psychological treatment. Our primary hypothesis was that baseline sleep disturbances would significantly modify how adolescents responded to an internet-delivered psychological intervention for chronic pain in terms of outcome trajectories. The sample included 85 adolescents, 12 to 17 years, with chronic pain recruited from a multidisciplinary pain clinic and headache clinic who received access to an internet-delivered psychological intervention for chronic pain. Baseline sleep assessment included actigraphy monitoring for 7 days and survey measures. Outcomes were assessed at baseline, 8 weeks, and 3 months including core pain-related outcomes, executive functioning, fatigue, positive and negative affect. Results demonstrated that greater baseline insomnia and poorer sleep quality was associated with worse outcome trajectories for pain-related disability, depression, anxiety, fatigue, negative affect, and executive functioning. Findings extend the limited studies that examine how sleep disturbance may modify effectiveness of psychological treatments for adolescent chronic pain and emphasize the importance of treating comorbid sleep disturbance. This trial was registered at clinicaltrials.gov (NCT04043962). PerspectiveOur study suggests that sleep deficiency, in particular insomnia and poor sleep quality, may modify the effectiveness of psychological treatments for chronic pain, highlighting the urgent need to screen youth for sleep problems prior to initiating treatment, and to consider implementation of sleep-specific treatments such as cognitive-behavioral therapy for insomnia.

A Randomized Controlled Trial of the Sources of Meaning Card Method: A New Meaning-Oriented Approach Predicts Depression, Anxiety, Pain Acceptance, and Crisis of Meaning in Patients with Chronic Pain.

Although considered the first-line psychological treatment for chronic pain, cognitive behavioral therapy has recently been criticized as being too limited, insufficient, and sometimes ineffective in the treatment of patients with chronic pain. Moreover, important existential perspectives are sparsely or not at all integrated into cognitive behavioral therapy. We therefore propose to complement chronic pain treatment with a meaning-based intervention, the Sources of Meaning Card Method (SoMeCaM). This study tested its efficacy. A randomized controlled trial was conducted with 42 patients with chronic pain. The trial compared an intervention group (standard care and participation in the SoMeCaM, a meaning-oriented approach) with a control group (standard care). We evaluated both groups at baseline and at 1 (t1) and 2 months (t2) after the intervention. The primary outcome assessed was pain acceptance, while depression, anxiety, pain intensity, pain medication, satisfaction with life, meaningfulness, and crisis of meaning were examined as secondary outcomes. Comparisons within and between groups showed significant treatment effects at t1. Higher increases in pain acceptance and decreases in anxiety, depression, and crisis of meaning were observed in the intervention group. Improvements in pain acceptance and anxiety persisted until t2, when pain intensity was also lower. Effect sizes at t2 were medium to large. Our preliminary work demonstrates the importance of the existential perspective in chronic pain therapy.

\u201cThere\u2019s a huge benefit just to know that someone cares:\u201d a qualitative examination of rural veterans\u2019 experiences with TelePain

BackgroundVeterans in the United States are at an increased risk of chronic pain and have higher reported pain prevalence and severity than nonveterans. This qualitative study aims to examine veterans’ perspectives on the acceptability of receiving pain care through TelePain, a telehealth program implemented by the Veterans Health Administration (VA) that offers specialty pain care to rural veterans in their homes or in a video conferencing room at a nearby outpatient clinic.MethodsThe VA electronic health record was used to identify patients who were referred to TelePain from rural clinics located in Washington, Oregon, and Alaska between 12/01/2019 and 03/31/2020. The study team completed 16 semi-structured interviews with rural veterans about their experiences with TelePain. After interview transcripts were recorded digitally and transcribed, Atlas.ti was used to organize data and facilitate qualitative coding. Interview transcripts were analyzed using thematic analysis.ResultsVeterans reported general satisfaction with receiving pain care through telehealth and valued having supportive, knowledgeable providers who provided useful information and resources. In addition, veterans appreciated the convenience of telehealth. Barriers to care included problems with program follow-up, negative perceptions of mental health care for pain, and preference for in-person care. Although some patients suggested that telehealth audio and video could be improved, most patients did not have any significant problems with telehealth technology.ConclusionsIn this sample of rural veterans who used TelePain, many reported satisfaction with the program and positive experiences with providers. Targets for quality improvement include streamlining the program’s referral and scheduling process and improving patient motivation to engage in psychological pain treatments. Results indicate that delivering pain services over telehealth is an acceptable modality for this patient population.

Comparison of meta-analysis of the effectiveness of second and third wave therapies on chronic pain

Introduction: Researchers seek to find more effective therapeutic approaches to treat various diseases. The aim of this study was to compare meta-analysis of the effectiveness of second and third wave therapies on chronic pain. Methods: The research method is meta-analysis. The study population includes all scientific research articles published in Iran that have been performed in the field of effectiveness of second and third wave psychological treatments for chronic pain. The sample size also includes scientific research articles that have been published between 2001 and 2017 and have the necessary conditions in terms of methodology. The research tool is a content analysis checklist by examining the magnitude of the effect of each of the second and third wave psychotherapies. The effect size scale was the mean difference and the statistical analysis was performed with comprehensive meta-analysis software. Results: The results showed that the average size of Cohen's effect in the second wave studies was 1.816 and in the third wave studies was 1.181 and in 74% of cases, second wave psychotherapy and in 65% of cases, third wave psychotherapy had a significant effect on chronic pain intensity. has it. Conclusion: It seems that the second and third wave psychotherapy has a high effect on reducing the severity of chronic pain. However, the effect of the second wave of psychotherapy is greater.

Comparative efficacy of a single-session \u201cEmpowered Relief\u201d videoconference-delivered group intervention for chronic pain: study protocol for a randomized controlled trial

BackgroundChronic pain is naturally aversive and often distressing for patients. Pain coping and self-regulatory skills have been shown to effectively reduce pain-related distress and other symptoms. In this trial, the primary goal is to pilot test the comparative efficacy of a single-session videoconference-delivered group pain education class to a waitlist control among patients with chronic pain.MethodsOur study is a randomized clinical trial pilot testing the superiority of our 2-h single-session videoconference-delivered group pain education class against a waitlist control. We will enroll 120 adult patients with mixed etiology chronic pain and randomize 1:1 to one of the two study arms. We hypothesize superiority for the pain education class for bolstering pain and symptom management. Team researchers masked to treatment assignment will assess the outcomes up to 3 months post-treatment.DiscussionThis study aims to test the utility of a single-session videoconference-delivered group pain education class to improve self-regulation of pain and pain-related outcomes. Findings from our project have the potential to significantly reduce barriers to effective psychological treatment for pain, optimizing the delivery of increasingly vital online and remote-delivered intervention options.Trial registrationClinicalTrials.govNCT04546685. Registered on 04 September 2020.

Internet-delivered cognitive behavioral therapy for youth with functional abdominal pain: a randomized clinical trial testing differential efficacy by patient subgroup.

Inconsistent results of psychological treatments for pediatric functional abdominal pain (FAP) may be due to heterogeneity of patients' pain-related psychological characteristics. This randomized controlled trial tested whether statistically derived patient subgroups (high pain dysfunctional [HPD], high pain adaptive [HPA], and low pain adaptive [LPA]) moderated response to cognitive behavior therapy (CBT) for adolescents with FAP and their parents (n = 278 dyads; patients were 66% female, mean [SD] age was 14.62 [1.88] years, and parents were 95% female). Randomization to Internet-delivered CBT vs Internet-delivered pain education (EDU) was stratified by patient subgroup. Follow-up assessments of gastrointestinal (GI) symptoms (primary outcome), abdominal pain, and pain interference were at midtreatment, posttreatment, 6 months, and 12 months. Data were analysed using linear mixed effects models. Significant treatment × subgroup × time interaction effects showed that patient subgroup significantly moderated the effect of treatment on GI symptoms (t[853 = -2.93, P = 0.003) and abdominal pain (t(844) = -2.14, P = 0.03) across the treatment period. Among HPD youth, those in CBT had significantly greater GI symptom reduction than those in EDU through posttreatment. By contrast, among HPA and LPA youth, symptom improvement did not differ by treatment condition. Furthermore, among all patients assigned to CBT, HPD youth demonstrated significantly greater reductions in GI symptoms compared with HPA and LPA youth and greater reductions in abdominal pain compared with LPA youth. All subgroups maintained symptom reductions throughout the follow-up period. Results suggest that subgrouping FAP patients may inform treatment allocation and optimize treatment response.

The chicken or the egg: Longitudinal changes in pain and catastrophizing in women with interstitial cystitis/bladder pain syndrome.

Evidence-based psychological strategies are being used as clinicians look for helpful interventions for patients diagnosed with the enigmatic chronic urological pelvic pain condition of interstitial cystitis/bladder pain syndrome (IC/BPS). Pain and pain catastrophizing are associated with chronic pelvic pain outcomes but the longitudinal role of catastrophizing on patient pain in IC/BPS remains unknown. Women with IC/BPS were recruited from tertiary care clinics across North America and completed a battery of questionnaires, including demographics, pain, depression, catastrophizing at baseline, six months, and one year. A total of 226 patients completed baseline questions, 183 completed the six-month survey, and 151 completed the one-year survey. Using a cross-lagged analysis, early changes in pain catastrophizing predicted later changes in pain, but not vice versa. Followup subscale analyses revealed that early changes in magnification predicted later changes in pain, early changes in pain predicted later changes in rumination, and that there was a recursive relationship between changes in helplessness and changes in pain across the study. Pain catastrophizing should be considered a prime target in psychological treatment for chronic pain in patients with IC/BPS, particularly those thinking styles associated with pain onset and maintenance. Future research should be conducted with constructs such as pain catastrophizing in samples prioritizing diversity of patients with IC/BPS and mechanisms as to how to effectively decrease catastrophizing.

Cognitive behavioral therapy in the treatment of chronic migraine: a clinical case report

The paper describes a clinical case of a female patient with chronic migraine (CM) and shows a modern approach to diagnosing CM and assessing chronicity factors. The patient received interdisciplinary treatment that involved standard therapy and cognitive behavioral therapy (CBT), a psychological treatment for pain and emotional disorders. The use of CBT in this clinical case was justified by the fact that the patient had pain catastrophizing, emotional disorder, abuse of painkillers and their discontinuation problems, and unsatisfactory tolerability of preventive pharmacotherapy for migraine. CBT could change the patient's ideas about the causes and prognosis of the disease, increase her intraday activity, teach effective skills to overcome pain, and cope with the symptoms of anxiety and depression. A long-term (12-month) follow-up of the female patient receiving behavioral interdisciplinary treatment showed a clinically significant improvement as transformation from chronic to episodic of migraine, as normalization of the emotional state, and as an increase in daily activity.

Mindful Self-Compassion program for chronic pain patients: A randomized controlled trial.

Although evidence-based psychological treatments for chronic pain (CP) have been demonstrated to be effective for a variety of outcomes, modest effects observed in recent reviews indicate scope for improvement. Self-compassion promotes a proactive attitude towards self-care and actively seeking relief from suffering. Consequently, more compassionate people experience better physical, psychological and interpersonal well-being. We conducted a single-blind, randomized, controlled trial to examine the effects of a Mindful Self-Compassion program (MSC) on relevant clinical outcomes in patients with CP. Patients were randomly assigned to one of the two intervention arms: MSC or cognitive-behavioural therapy (CBT). The protocols of both intervention arms were standardized and consisted of a 150-min session once a week during 8weeks formatted to groups of no more than 20 participants. The primary outcome was self-compassion, measured with the Self-Compassion Scale (SCS). The secondary outcomes were other pain-related scores, quality-of-life measures, and anxiety and depression scores. In all, 62 and 61 patients were assigned to the MSC and CBT groups, respectively. The MSC intervention was more effective than CBT for self-compassion (average treatment effect [ATE]=0.126, p<0.05). The secondary outcomes, pain acceptance (ATE=5.214, p<0.01), pain interference (ATE=-0.393, p<0.05), catastrophizing (ATE=-2.139, p<0.10) and anxiety (ATE=-0.902, p<0.05), were also favoured in the experimental arm (MSC). No serious adverse events were observed. Mindful Self-Compassion is an appropriate therapeutic approach for CP patients and may result in greater benefits on self-compassion and emotional well-being than CBT. This randomized controlled trial compares the novel intervention (MSC program) with the gold standard psychological intervention for CP (CBT). MSC improves the levels of self-compassion, a therapeutic target that is receiving attention since the last two decades, and it also improves anxiety symptoms, pain interference and pain acceptance more than what CBT does. These results provide empirical support to guide clinical work towards the promotion of self-compassion in psychotherapeutic interventions for people with CP.

Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions.

The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.

Internet-Delivered Acceptance and Commitment Therapy for Adolescents with Chronic Pain and Their Parents: A Nonrandomized Pilot Trial.

Acceptance and Commitment Therapy (ACT) is an empirically supported treatment for chronic pain in adults. There is also a small but growing evidence base of ACT for pediatric chronic pain. However, because of limited access to psychological treatment for pain, and geographical distances from pain facilities, many patients will not receive such treatment. The aim of the study was to evaluate the feasibility and preliminary effects of an internet-delivered ACT for adolescents with chronic pain, and their parents. In this nonrandomized pilot study 28 self-recruited adolescents, aged 13-17 years, received 8 weeks of internet-delivered ACT, while outcomes were assessed at pre-, posttreatment, and at follow-up (17-25 weeks). Parents of the adolescents received an 8-week internet-delivered parental program, and their outcomes were assessed at the same timepoints. Both treatments were guided by a therapist experienced in ACT and chronic pain. Some threats to feasibility were identified such as slow recruitment rate, low compliance and a delay in completion of follow-up assessments. Preliminary outcome evaluation showed that adolescents showed a large significant improvement on their main outcome (pain interference, d = 1.09), and parents a medium improvement on their main outcome, pain reactivity (d = 0.70). Improvements were also seen in adolescents' depressive symptoms and insomnia severity. The preliminary results of internet-delivered ACT are promising with regards to improvements in adolescent and parent outcome. Measures to improve feasibility are needed prior to conducting a larger randomized trial.

Necessary components of psychological treatment for chronic pain: More packages for groups or process-based therapy for individuals?

This journal recently published a paper by Sharpe et al., entitled "Necessary components of psychological treatments in chronic pain management programs: A Delphi study" (Sharpe, Jones, Ashton-James, Nicholas, & Refshauge, 2020). These researcher sought the views of authors of relevant RCTs published up to September 2016 and supplemented these with input from psychologists working in pain management programs in Australia.

Psychological therapists' judgments of pain and treatment decisions: The impact of ‘medically unexplained symptoms’

BackgroundClinical judgments of pain are influenced by patient and observer factors, and affect their treatment decisions. This study investigated the factors of a lack of a medical explanation for pain, ‘medically unexplained’ comorbid conditions, and ethnicity, on CBT therapists' judgments of pain and treatment. MethodAn online experimental study was conducted in which participants viewed computer-generated faces expressing pain with a brief written patient history, then estimated the severity and likely exaggeration of pain, and likelihood of pain being caused by a mental or physical health problem. Participants ranked a number of treatment options for priority. Results107 CBT therapists were recruited as participants. Estimates of pain were lower, and of likely exaggeration higher, for patients with pain presented without a medical explanation or with a comorbid ‘medically unexplained’ condition. They were also more likely to be recommended CBT for depression over referral to a specialist service or psychological treatment for pain. Contrary to expectations, ethnicity produced no effect on pain judgments, only on treatment decisions. Participants' training also affected their treatment decisions. ConclusionsLack of medical explanation for pain and other long-term conditions biases assessment and treatment decisions by CBT therapists. As CBT therapists are increasingly referred people with ‘medically unexplained’ symptoms in primary care, these biases need to be addressed for better treatment.

Measuring and reporting adverse events in clinical trials of psychological treatments for chronic pain.

Measuring and reporting adverse events in clinical trials of psychological treatments for chronic pain.

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial.

Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02). Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Perceptual Decision Parameters and Their Relation to Self-Reported Pain: A Drift Diffusion Account

Pain intensity ratings are subject to various cognitive modulations – yet the mechanisms underlying this influence are still not understood. In a conditioning protocol, pain-related expectations were induced through pairing predefined movements with a noxious or innocuous stimulus in either a predictable or unpredictable fashion. Healthy volunteers (N = 37) categorized the stimuli as either painful or nonpainful and rated its perceived intensity. Using a Hierarchical Drift Diffusion model based on the categorization data, we found that an a priori decision-making bias evolved toward the expected sensations (P < .001). In particular, our findings suggest that differences in both the amount of decision-making bias (P = .004) and the speed of sensory processing predict pain intensity ratings (P < .001). As such, changes in pain ratings could be based in either of these processes, which may require a different approach when targeted as part of psychological pain treatment. PerspectiveChanges in reported pain levels were linked to two distinct mechanisms, suggesting that increased pain reports could be attributed to either enhanced sensory processing or biased inferences. Our results might contribute to the development of person-tailored treatments based on the identification of latent mechanisms using computational models.