Behavioural Approaches to Pain Management: Difference between revisions
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== Cognitive Behavioural Therapy (CBT)<br> == | == Cognitive Behavioural Therapy (CBT)<br> == | ||
<span style="font-size: 13.28px; line-height: 19.92px;">Whether assessing or treating acute or chronic pain syndromes, management should include a biopsychosocial approach. Assessment may include a focused joint and functional examination including more global areas of impairment (ie, gait, balance, and endurance) and disability.<ref name="2">Steven P. Stanos, James McLean, Lynn Rader. Physical Medicine Rehabilitation Approach to Pain. Medical Clinics of North America, Volume 91, Issue 1, Pages 57-95. 2007</ref></span> | <span style="font-size: 13.28px; line-height: 19.92px;">Whether assessing or treating acute or chronic pain syndromes, pain management should include a biopsychosocial approach. Assessment may include a focused joint and functional examination including more global areas of impairment (ie, gait, balance, and endurance) and disability.<ref name="2">Steven P. Stanos, James McLean, Lynn Rader. Physical Medicine Rehabilitation Approach to Pain. Medical Clinics of North America, Volume 91, Issue 1, Pages 57-95. 2007</ref></span> | ||
Cognitive Behavioral Therapy (CBT) can be described as the "gold standard" psychological treatment for individuals with a wide range of pain problems. It can be used alone or in conjunction with medical or interdisciplinary rehabilitation treatments. | |||
Chronic pain stands out as the most common condition treated with CBT. But why? As Institute of Medicine (2011) explained, chronic pain is a condition influenced by biological, psychological, and social factors and optimally managed by treatments that address not only its biological causes but also its psychological and social influences and consequences.<ref name="1">Dawn M. Ehde, Tiara M. Dillworth, and Judith A. Turner. Cognitive-Behavioral Therapy for Individuals | Chronic pain stands out as the most common condition treated with CBT. But why? As Institute of Medicine (2011) explained, chronic pain is a condition influenced by biological, psychological, and social factors and optimally managed by treatments that address not only its biological causes but also its psychological and social influences and consequences.<ref name="1">Dawn M. Ehde, Tiara M. Dillworth, and Judith A. Turner. Cognitive-Behavioral Therapy for Individuals With Chronic Pain - Efficacy, Innovations, and Directions for Research. University of Washington. February-March 2014</ref> <span style="font-size: 13.28px; line-height: 19.92px;">Since the introduction of the biopsychosocial model, treatment for chronic pain has become multimodal and multidisciplinary, with emphasis on a range of strategies aimed at maximising pain reduction, improving health-related quality of life, independence and mobility, enhancing psychological wellbeing and preventing secondary dysfunction.<ref name="3" /> </span> | ||
As time goes by, patient develops behaviours, such as '''pain catastrophizing''' (magnification of the threat of, rumination about, and perceived inability to cope with pain), as well as '''fear-avoidance''' (activity avoidance due to fear of increased pain or bodily harm), which have consistently been found to be associated with greater physical and psychosocial dysfunction, even after controlling for pain and depression levels (Edwards, Cahalan, Mensing, Smith, & Haythornthwaite, 2011; Quartana,Campbell, & Edwards, 2009; Gatchel et al., 2007; Leeuw et al., 2007). Many individuals with chronic pain have mood, anxiety, and sleep disorders (Alsaadi, McAuley, Hush, & Maher, 2011; Demyttenaere et al., 2007; Gore, Sadosky, Stacey, Tai, & Leslie, 2012; Tsang et al., 2008), and CBT is also used to treat these conditions.<ref name="1" /> | As time goes by, patient with pain develops behaviours, such as '''pain catastrophizing''' (magnification of the threat of, rumination about, and perceived inability to cope with pain), as well as '''fear-avoidance''' (activity avoidance due to fear of increased pain or bodily harm), which have consistently been found to be associated with greater physical and psychosocial dysfunction, even after controlling for pain and depression levels (Edwards, Cahalan, Mensing, Smith, & Haythornthwaite, 2011; Quartana,Campbell, & Edwards, 2009; Gatchel et al., 2007; Leeuw et al., 2007). Many individuals with chronic pain have mood, anxiety, and sleep disorders (Alsaadi, McAuley, Hush, & Maher, 2011; Demyttenaere et al., 2007; Gore, Sadosky, Stacey, Tai, & Leslie, 2012; Tsang et al., 2008), and CBT is also used to treat these conditions.<ref name="1" /> | ||
CBT IN PRACTICE<br | CBT IN PRACTICE<br> | ||
<span style="font-size: 13.28px; line-height: 19.92px;">There is no standard protocol for Cognitive Behavioral Therapy. It varies in number of sessions and specific techniques that often include relaxation training, setting and working toward behavioral goals (typically including systematic increases in exercise and other activities), behavioral activation, guidance in activity pacing, problem-solving training, and cognitive restructuring (Thorn, 2004; Turner & Romano, 2001).<ref name="1" /> </span> | |||
< | <span style="font-size: 13.28px; line-height: 19.92px;" /><span style="font-size: 13.28px; line-height: 19.92px;">Currently, CBT is the prevailing psychological treatment for individuals with chronic pain conditions such as low back pain, headaches, arthritis, orofacial pain, and fibromyalgia. CBT has also been applied to pain associated with cancer and its treatment.<ref name="1" /> </span>Although there are no cures, a combination of psychological and physical therapies appears to provide significant benefits. When pain persists in spite of medical treatment, as is the case in chronic pain syndromes, the issues become even more complex. A person who has pain, especially on movement, tends to avoid doing things that provoke their symptoms. They rest but unfortunately this is not a helpful treatment as it leads to secondary stiffness and weakness, causing worsening of the symptom that the individual is trying to avoid. Inability to function leads to a loss of role and self-esteem with the progressive intrusion of other problems such as financial hardship and strained relationships. In essence, cognitive behavioural approaches aim to improve the way that an individual manages and copes with their pain, rather than finding a biological solution to the putative pathology. With appropriate instruction in a range of pacing techniques, cognitive therapy to help identify negative thinking patterns and the development of effective challenges, stretching and exercising to improve physical function, careful planning of tasks and daily activities, and the judicious use of relaxation training, many people find the treatment enables them to take back control of their lives, to do more and feel better.<ref name="4" /> | ||
While the cognitive elements of the programme are usually the province of psychologists, other staff working alongside them, such as physiotherapists, occupational therapists, nurses and doctors, are required to improve their psychological understanding and skills to enable them to contribute to the treatment package. For example, an exercise programme run by a physiotherapist will adopt a cognitive approach by ascertaining the person's fears and beliefs about the movement or activity they are undertaking. Frequently this will demonstrate that the person's caution relates to fear of damage. Such an approach will move the person on both physically and psychologically in a way that coercion alone will never achieve.<ref name="4">C.Pither. Cognitive Behavioral Approaches to Chronic Pain. Available at www.wellcome.ac.uk/en/pain/microsite/medicine3.html</ref><span style="font-size: 13.28px; line-height: 19.92px;" /> | |||
<span style="font-size: 13.28px; line-height: 19.92px;">Importantly, a multidisciplinary approach to pain management provides benefits to patients, healthcare providers and society as a whole. The integration of multiple treatment modalities, including behavioural modification therapy, has resulted in considerable improvements for patients suffering from chronic pain in terms of a reduction in the use of medications, improved functional ability, increased likelihood of returning to work, improved quality of patient care and patient satisfaction, as well as reducing healthcare costs [Cassisi et al. 1989; Deardorff et al. 1991; Kames et al. 1990; Flor et al. 1992; Chen 1996; Luk et al. 2010].</span><ref name="3">J.Pergolizzi. Towards a Multidisciplinary Team Approach in Chronic Pain Management. PDF book available at www.pae-eu.eu</ref><br> | |||
== Cognitive Functional Therapy (CFT) == | == Cognitive Functional Therapy (CFT) == | ||
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Cognitive Behavioural Therapy (CBT)
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Whether assessing or treating acute or chronic pain syndromes, pain management should include a biopsychosocial approach. Assessment may include a focused joint and functional examination including more global areas of impairment (ie, gait, balance, and endurance) and disability.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Cognitive Behavioral Therapy (CBT) can be described as the "gold standard" psychological treatment for individuals with a wide range of pain problems. It can be used alone or in conjunction with medical or interdisciplinary rehabilitation treatments.
Chronic pain stands out as the most common condition treated with CBT. But why? As Institute of Medicine (2011) explained, chronic pain is a condition influenced by biological, psychological, and social factors and optimally managed by treatments that address not only its biological causes but also its psychological and social influences and consequences.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Since the introduction of the biopsychosocial model, treatment for chronic pain has become multimodal and multidisciplinary, with emphasis on a range of strategies aimed at maximising pain reduction, improving health-related quality of life, independence and mobility, enhancing psychological wellbeing and preventing secondary dysfunction.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
As time goes by, patient with pain develops behaviours, such as pain catastrophizing (magnification of the threat of, rumination about, and perceived inability to cope with pain), as well as fear-avoidance (activity avoidance due to fear of increased pain or bodily harm), which have consistently been found to be associated with greater physical and psychosocial dysfunction, even after controlling for pain and depression levels (Edwards, Cahalan, Mensing, Smith, & Haythornthwaite, 2011; Quartana,Campbell, & Edwards, 2009; Gatchel et al., 2007; Leeuw et al., 2007). Many individuals with chronic pain have mood, anxiety, and sleep disorders (Alsaadi, McAuley, Hush, & Maher, 2011; Demyttenaere et al., 2007; Gore, Sadosky, Stacey, Tai, & Leslie, 2012; Tsang et al., 2008), and CBT is also used to treat these conditions.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
CBT IN PRACTICE
There is no standard protocol for Cognitive Behavioral Therapy. It varies in number of sessions and specific techniques that often include relaxation training, setting and working toward behavioral goals (typically including systematic increases in exercise and other activities), behavioral activation, guidance in activity pacing, problem-solving training, and cognitive restructuring (Thorn, 2004; Turner & Romano, 2001).Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Currently, CBT is the prevailing psychological treatment for individuals with chronic pain conditions such as low back pain, headaches, arthritis, orofacial pain, and fibromyalgia. CBT has also been applied to pain associated with cancer and its treatment.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Although there are no cures, a combination of psychological and physical therapies appears to provide significant benefits. When pain persists in spite of medical treatment, as is the case in chronic pain syndromes, the issues become even more complex. A person who has pain, especially on movement, tends to avoid doing things that provoke their symptoms. They rest but unfortunately this is not a helpful treatment as it leads to secondary stiffness and weakness, causing worsening of the symptom that the individual is trying to avoid. Inability to function leads to a loss of role and self-esteem with the progressive intrusion of other problems such as financial hardship and strained relationships. In essence, cognitive behavioural approaches aim to improve the way that an individual manages and copes with their pain, rather than finding a biological solution to the putative pathology. With appropriate instruction in a range of pacing techniques, cognitive therapy to help identify negative thinking patterns and the development of effective challenges, stretching and exercising to improve physical function, careful planning of tasks and daily activities, and the judicious use of relaxation training, many people find the treatment enables them to take back control of their lives, to do more and feel better.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
While the cognitive elements of the programme are usually the province of psychologists, other staff working alongside them, such as physiotherapists, occupational therapists, nurses and doctors, are required to improve their psychological understanding and skills to enable them to contribute to the treatment package. For example, an exercise programme run by a physiotherapist will adopt a cognitive approach by ascertaining the person's fears and beliefs about the movement or activity they are undertaking. Frequently this will demonstrate that the person's caution relates to fear of damage. Such an approach will move the person on both physically and psychologically in a way that coercion alone will never achieve.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Importantly, a multidisciplinary approach to pain management provides benefits to patients, healthcare providers and society as a whole. The integration of multiple treatment modalities, including behavioural modification therapy, has resulted in considerable improvements for patients suffering from chronic pain in terms of a reduction in the use of medications, improved functional ability, increased likelihood of returning to work, improved quality of patient care and patient satisfaction, as well as reducing healthcare costs [Cassisi et al. 1989; Deardorff et al. 1991; Kames et al. 1990; Flor et al. 1992; Chen 1996; Luk et al. 2010].Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Cognitive Functional Therapy (CFT)[edit | edit source]
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Therapeutic Neuroscience Education (TNE)[edit | edit source]
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