Chronic pain is a prevalent and costly problem that eludes adequate treatment. Persistent pain affects all domains of people's lives and in the absence of cure, success greatly depends on adaptation to symptoms and self-management. Dennis Turk and his coworkers reviewed the psychological models that have been used to conceptualize chronic pain--psychodynamic, behavioral (respondent and operant), and cognitive-behavioral. Treatments based on these models, including insight, external reinforcement, motivational interviewing, relaxation, meditation, biofeedback, guided imagery, and hypnosis were described. The cognitive-behavioral perspective has the greatest amount of research that supports the effectiveness of this approach with chronic pain patients. The authors were able to differentiate the cognitive-behavioral perspective from cognitive and behavioral techniques, and suggested that the perspective on the role of patients' beliefs, attitudes, and expectations in the maintenance and exacerbation of symptoms are more important than the specific techniques. The techniques are all geared to fostering self-control and self-management that encourage a patient to replace their feelings of passivity, dependence, and hopelessness with activity, independence, and resourcefulness.

WHAT THE STUDY MAY MEAN TO YOU: Dennis and his colleagues found that psychosocial and behavioral factors play a significant role in the experience, maintenance, and exacerbation of pain. Self-management is an important complement to biomedical approaches. Cognitive-behavioral therapy alone or within the context of an interdisciplinary pain rehabilitation program has the greatest empirical evidence for success. As none of the most commonly prescribed treatment regimens are sufficient to eliminate pain, a more realistic approach will likely combine pharmacological, physical, and psychological components tailored to each patient's needs. The integration of these components has occurred in the self-management of other chronic disorders, e.g., asthma, arthritis, with good success. It is likely that a cognitive-behavioral model integrating the components would be successful in the self-management of chronic pain.

DC Turk et al. Psychological approaches in the treatment of chronic pain patients--when pills, scalpels, and needles are not enough. Canadian Journal of Psychiatry, 2008;53:213-223.