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8 - Pain

Published online by Cambridge University Press:  10 January 2025

Stephen Hupp
Affiliation:
Southern Illinois University, Edwardsville
David F. Tolin
Affiliation:
Institute of Living
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Summary

The primary focus of this chapter is chronic pain. Treatment approaches discussed include cognitive-behavioral therapy and acceptance and commitment therapy. Credible components of treatment include behavioral goals, exposure, activity pacing, cognitive skills training, acceptance, relaxation, mindfulness, and psychological flexibility. A sidebar describes somatic symptom disorder.

Type
Chapter
Information
Science-Based Therapy
Raising the Bar for Empirically Supported Treatments
, pp. 122 - 138
Publisher: Cambridge University Press
Print publication year: 2025

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References

Useful Resources

Dahl, J., Lundgren, T., & Hayes, S. C. (2006). Living beyond your pain: Using acceptance and commitment therapy to ease chronic pain. New Harbinger Publications.

Otis, J. D. (2007). Managing chronic pain: A cognitive-behavioral therapy approach, therapist guide. Treatments that Work Series. Oxford University Press.

Thorn, B. (2017). Cognitive therapy for chronic pain, second edition: A step-by-step guide. The Guilford Press.

References

Åkerblom, S., Perrin, S., Rivano Fischer, M., & McCracken, L. M. (2015). The mediating role of acceptance in multidisciplinary cognitive-behavioral therapy for chronic pain. The Journal of Pain, 16(7), 606615. https://doi.org/10.1016/j.jpain.2015.03.007.CrossRefGoogle ScholarPubMed
American Psychological Association. (2022). Diagnostic and statistical manual of mental disorders, 5th edition-text revision. American Psychiatric Publications Inc.Google Scholar
Antcliff, D., Keeley, P., Campbell, M., et al. (2018). Activity pacing: Moving beyond taking breaks and slowing down. Quality of Life Research, 27(7), 19331935.CrossRefGoogle ScholarPubMed
Bahar, N., Bolier, R., Henderson, C. R., et al. (2018). Association between psychological interventions and chronic pain outcomes in older adults: A systematic review and meta-analysis. JAMA Internal Medicine, 178(6), 830839. https://doi.org/jamainternmed.2018.0756.Google Scholar
Banks, S. M., & Kerns, R. D. (1996). Explaining high rates of depression in chronic pain: A diathesis–stress framework. Psychological Bulletin, 119(1), 95110.CrossRefGoogle Scholar
Beissner, K., HendersonJr, C. R., Papaleontiou, M., et al. (2009). Physical therapists’ use of cognitive–behavioral therapy for older adults with chronic pain: A nationwide survey. Physical Therapy, 89(5), 456469.CrossRefGoogle ScholarPubMed
Bishop, S. R., Lau, M., Shapiro, S., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230.Google Scholar
Burns, J. W., Day, M. A., & Thorn, B. E. (2012). Is reduction in pain catastrophizing a therapeutic mechanism specific to cognitive-behavioral therapy for chronic pain? Translational Behavioral Medicine, 2(1), 2229.CrossRefGoogle ScholarPubMed
Burns, J. W., Glenn, B., Bruehl, S., Harden, R. N., & Lofland, K. (2003). Cognitive factors influence outcome following multidisciplinary chronic pain treatment: A replication and extension of a cross-lagged panel analysis. Behaviour Research and Therapy, 41(10), 11631182.CrossRefGoogle ScholarPubMed
Burns, J. W., Kubilus, A., Bruehl, S., Harden, R. N., & Lofland, K. (2003). Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis. Journal of Consulting and Clinical Psychology, 71(1), 81.CrossRefGoogle ScholarPubMed
Burns, J. W., Nielson, W. R., Jensen, M. P., et al. (2015). Does change occur for the reasons we think it does? A test of specific therapeutic operations during cognitive-behavioral treatment of chronic pain. The Clinical Journal of Pain, 31(7), 603611.CrossRefGoogle ScholarPubMed
Cederberg, J. T., Cernvall, M., Dahl, J., von Essen, L., & Ljungman, G. (2016). Acceptance as a mediator for change in acceptance and commitment therapy for persons with chronic pain? International Journal of Behavioral Medicine, 23(1), 2129. https://doi.org/10.1007/s12529-015-9494-y.CrossRefGoogle ScholarPubMed
Crombez, G., Vlaeyen, J. W., Heuts, P. H., & Lysens, R. (1999). Pain–related fear is more disabling than pain itself: evidence on the role of pain–related fear in chronic back pain disability. Pain, 80(1–2), 329339.CrossRefGoogle ScholarPubMed
Day, M. A. (2017). Mindfulness-based cognitive therapy for chronic pain: A clinical manual and guide. Wiley-Blackwell.CrossRefGoogle Scholar
Deary, V., Chalder, T., & Sharpe, M. (2007). The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review. Clinical Psychology Review, 27(7), 781797.CrossRefGoogle ScholarPubMed
den Hollander, M., Goossens, M., de Jong, J., et al. (2016). Expose or protect? A randomized controlled trial of exposure in vivo vs pain-contingent treatment as usual in patients with complex regional pain syndrome type 1. Pain, 157(10), 23182329.CrossRefGoogle ScholarPubMed
Du, S., Dong, J., Jin, S., Zhang, H., & Zhang, Y. (2021). Acceptance and Commitment Therapy for chronic pain on functioning: A systematic review of randomized controlled trials. Neuroscience & Biobehavioral Reviews, 131, 5976.CrossRefGoogle ScholarPubMed
Dunford, E., & Thompson, M. (2010). Relaxation and mindfulness in pain: A review. Reviews in Pain, 4(1), 1822.CrossRefGoogle ScholarPubMed
Eccleston, C., Morley, S., Williams, A., Yorke, L., & Mastroyannopoulou, K. (2002). Systematic review of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief. Pain, 99(1–2), 157165.CrossRefGoogle ScholarPubMed
Elliott, T. E., Renier, C. M. & Palcher, J. A. (2003). Chronic pain, depression, and quality of life: correlations and predictive value of the SF–36. Pain Medicine 4(4), 331339.CrossRefGoogle ScholarPubMed
Feldmann, M., Hein, H. J., Voderholzer, U., et al. (2021). Cognitive change and relaxation as key mechanisms of treatment outcome in chronic pain: Evidence from routine care. Frontiers in Psychiatry, 12, 617871. https://doi.org/10.3389/fpsyt.2021.617871.CrossRefGoogle ScholarPubMed
Gatchel, R. J. (2004). Comorbidity of chronic pain and mental health disorders: The biopsychosocial perspective. American Psychologist, 59(8), 795805.CrossRefGoogle ScholarPubMed
Gatchel, R. J., & Howard, K. (2008). The biopsychosocial approach. Practical Pain Management, 8(4), 98104.Google Scholar
Gatchel, R. J., & Maddrey, A. M. (2004). The biopsychosocial perspective of pain. In Raczynski, J. and Leviton, L. (Eds.). Healthcare Psychology Handbook. Vol II (pp. 357378). American Psychological Association Press.Google Scholar
Geneen, L. J., Moore, R. A., Clarke, C., et al. (2017). Physical activity and exercise for chronic pain in adults: An overview of Cochrane Reviews. The Cochrane Database of Systematic Reviews, 4(4), CD011279. https://doi.org/10.1002/14651858.CD011279.pub3.Google ScholarPubMed
Gentili, C., Rickardsson, J., Zetterqvist, V., et al. (2019). Psychological flexibility as a resilience factor in individuals with chronic pain. Frontiers in Psychology, 10, 2016. https://doi.org/10.3389/fpsyg.2019.02016.CrossRefGoogle ScholarPubMed
Hann, K. E., & McCracken, L. M. (2014). A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. Journal of Contextual Behavioral Science, 3(4), 217227.CrossRefGoogle Scholar
Harris, R. (2009). ACT made simple: A quick-start guide to ACT basics and beyond. New Harbinger.Google Scholar
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 125. https://doi.org/10.1016/j.brat.2005.06.006CrossRefGoogle ScholarPubMed
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.Google Scholar
Hedman-Lagerlöf, M., Hedman-Lagerlöf, E., Axelsson, E., et al. (2018). Internet-delivered exposure therapy for fibromyalgia. The Clinical Journal of Pain, 34(6), 532542.CrossRefGoogle ScholarPubMed
Hilton, L., Hempel, S., Ewing, B. A., et al. (2017). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 51(2), 199213.CrossRefGoogle ScholarPubMed
Hoffman, B. M., Papas, R. K., Chatkoff, D. K., & Kerns, R. D. (2007). Meta-analysis of psychological interventions for chronic low back pain. Health Psychology, 26(1), 19.CrossRefGoogle ScholarPubMed
Holroyd, K. A., O’Donnell, F. J., Stensland, M., et al. (2001). Management of chronic tension-type headache with tricyclic antidepressant medication, stress-management therapy, and their combination: A randomized controlled trial. JAMA, 285, 22082215.CrossRefGoogle ScholarPubMed
Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and commitment therapy (ACT) for chronic pain. The Clinical Journal of Pain, 33(6), 552568.CrossRefGoogle ScholarPubMed
Jamison, R. N., & Mao, J. (2015). Opioid Analgesics. Mayo Clinic Proceedings, 90(7), 957968. https://doi.org/10.1016/j.mayocp.2015.04.010.CrossRefGoogle ScholarPubMed
Kabat-Zinn, J. (2003). Mindfulness-based stress reduction (MBSR). Constructivism in the Human Sciences, 8(2), 73107.Google Scholar
Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163190. https://doi.org/10.1007/BF00845519.CrossRefGoogle ScholarPubMed
Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865878.CrossRefGoogle ScholarPubMed
Kerns, R. D., & Haythornthwaite, J. A. (1988). Depression among chronic pain patients: cognitive–behavioral analysis and effect on rehabilitation outcome. Journal of Consulting and Clinical Psychology, 56(6), 870876.CrossRefGoogle ScholarPubMed
Kratz, A. L., Davis, M. C., & Zautra, A. J. (2007). Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients. Annals of Behavioral Medicine, 33(3), 291301.CrossRefGoogle ScholarPubMed
Kroenke, K., Outcalt, S., Krebs, E., et al. (2013). Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain. General Hospital Psychiatry, 35(4), 359365.CrossRefGoogle ScholarPubMed
Leeuw, M., Goossens, M. E., van Breukelen, G. J., et al. (2008). Exposure in vivo versus operant graded activity in chronic low back pain patients: Results of a randomized controlled trial. Pain, 138(1), 192207.CrossRefGoogle ScholarPubMed
Linton, S. J., & Ryberg, M. (2001). A cognitive-behavioral group intervention as prevention for persistent neck and back pain in a non-patient population: A randomized controlled trial. Pain, 90, 8390.CrossRefGoogle Scholar
Ljótsson, B., Hesser, H., Andersson, E., et al. (2014). Provoking symptoms to relieve symptoms: A randomized controlled dismantling study of exposure therapy in irritable bowel syndrome. Behaviour Research and Therapy, 55, 2739.CrossRefGoogle ScholarPubMed
López-de-Uralde-Villanueva, I., Munoz-Garcia, D., Gil-Martinez, A., et al. (2016). A systematic review and meta-analysis on the effectiveness of graded activity and graded exposure for chronic nonspecific low back pain. Pain Medicine, 17(1), 172188.Google ScholarPubMed
Macedo, L. G., Smeets, R. J., Maher, C. G., Latimer, J., & McAuley, J. H. (2010). Graded activity and graded exposure for persistent nonspecific low back pain: A systematic review. Physical Therapy, 90(6), 860879.CrossRefGoogle ScholarPubMed
McCracken, L. M. (2024). Psychological flexibility, chronic pain, and health. Annual Review of Psychology, 75, 601624.CrossRefGoogle ScholarPubMed
McCracken, L. M., & Eccleston, C. (2005). A prospective study of acceptance of pain and patient functioning with chronic pain. Pain, 118(1–2), 164169.CrossRefGoogle ScholarPubMed
McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain, 15(3), 221234.CrossRefGoogle Scholar
McCracken, L. M., & Vowles, K. E. (2007). Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument. The Journal of Pain, 8(9), 700707.CrossRefGoogle ScholarPubMed
McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. American Psychologist, 69(2), 178187.CrossRefGoogle ScholarPubMed
McCracken, L. M., & Yang, S.-Y. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain, 123(1–2), 137145. https://doi.org/10.1016/j.pain.2006.02.021.CrossRefGoogle Scholar
Meints, S. M., Cortes, A., Morais, C. A., Edwards, R. R. (2019). Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Manag. 9(3), 317334. https://doi.org/10.2217/pmt-2018-0030. Epub 2019 May 29. PMID: 31140916; PMCID: PMC6587104.CrossRefGoogle ScholarPubMed
Merskey, H., Bogduk, N. (1994). Classification of chronic pain. 2nd ed. IASP PressGoogle Scholar
Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80(1–2), 113.CrossRefGoogle ScholarPubMed
Nielson, W. R., Jensen, M. P., Karsdorp, P. A., & Vlaeyen, J. W. (2013). Activity pacing in chronic pain: Concepts, evidence, and future directions. The Clinical Journal of Pain, 29(5), 461468.CrossRefGoogle ScholarPubMed
Otis, J. D., Sanderson, K., Hardway, C., et al. (2013). A randomized controlled pilot study of a cognitive behavioral therapy approach for painful diabetic peripheral neuropathy. Journal of Pain, 14(5), 475482.CrossRefGoogle ScholarPubMed
Palermo, T. M., Eccleston, C., Lewandowski, A. S., Williams, A. C. D. C., & Morley, S. (2010). Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: An updated meta-analytic review. Pain, 148(3), 387397.CrossRefGoogle ScholarPubMed
Pardos-Gascón, E. M., Narambuena, L., Leal-Costa, C., & van-der Hofstadt-Román, C. J. (2021). Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review. International Journal of Clinical and Health Psychology, 21(1), 100197. https://doi.org/10.1016/j.ijchp.2020.08.001.CrossRefGoogle ScholarPubMed
Parrish, J. M., Jenkins, N. W., Parrish, M. S., et al. (2021) The influence of cognitive behavioral therapy on lumbar spine surgery outcomes: A systematic review and meta-analysis. European Spine Journal, 30, 13651379.CrossRefGoogle ScholarPubMed
Philips, H. C. (1987). Avoidance behaviour and its role in sustaining chronic pain. Behaviour Research and Therapy, 25(4), 273279.CrossRefGoogle ScholarPubMed
Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain catastrophizing: A critical review. Expert Review of Neurotherapeutics, 9(5), 745758.CrossRefGoogle ScholarPubMed
Racine, M., Jensen, M. P., Harth, M., Morley-Forster, P., & Nielson, W. R. (2019). Operant learning versus energy conservation activity pacing treatments in a sample of patients with fibromyalgia syndrome: A pilot randomized controlled trial. The Journal of Pain, 20(4), 420439.CrossRefGoogle Scholar
Roditi, D., & Robinson, M. E. (2011). The role of psychological interventions in the management of patients with chronic pain. Psychology Research and Behavior Management, 4, 4149.CrossRefGoogle ScholarPubMed
Schütze, R., Rees, C., Preece, M., & Schütze, M. (2010). Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain, 148(1), 120127.CrossRefGoogle Scholar
Scott, W., & McCracken, L. M. (2015). Psychological flexibility, acceptance and commitment therapy, and chronic pain. Current Opinion in Psychology, 2, 9196.CrossRefGoogle Scholar
Segal, Z., Williams, M., & Teasdale, J. (2018). Mindfulness-based cognitive therapy for depression. Guilford Publications.Google Scholar
Sephton, S. E., Salmon, P., Weissbecker, I., et al. (2007). Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: Results of a randomized clinical trial. Arthritis and Rheumatism, 57(1), 7785. https://doi.org/10.1002/art.22478.CrossRefGoogle ScholarPubMed
St Sauver, J. L., Warner, D. O., Yawn, B. P., et al. (2013). Why patients visit their doctors: Assessing the most prevalent conditions in a defined American population. Mayo Clinical Proceedings, 88, 5667.CrossRefGoogle Scholar
Staerkle, R., Mannion, A. F., Elfering, A., et al. (2004). Longitudinal validation of the fear-avoidance beliefs questionnaire (FABQ) in a Swiss-German sample of low back pain patients. European Spine Journal, 13(4), 332340.CrossRefGoogle Scholar
Sullivan, M. J., Thorn, B., Haythornthwaite, J. A., et al. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain, 17(1), 5264.CrossRefGoogle ScholarPubMed
Tolin, D. F., McKay, D., Forman, E. M., Klonsky, E. D., & Thombs, B. D. (2015). Empirically supported treatment: Recommendations for a new model. Clinical Psychology: Science and Practice, 22(4), 317338. https://doi.org/10.1111/cpsp.12122.Google Scholar
Turner, J. A. (1982). Comparison of group progressive-relaxation training and cognitive-behavioral group therapy for chronic low back pain. Journal of Consulting and Clinical Psychology, 50(5), 757.CrossRefGoogle ScholarPubMed
Urits, I., Hubble, A., Peterson, E., et al. (2019). An update on cognitive therapy for the management of chronic pain: A comprehensive review. Current Pain and Headache Reports, 23(8), 17.Google ScholarPubMed
Veehof, M. M., Oskam, M. J., Schreurs, K. M., & Bohlmeijer, E. T. (2011). Acceptance–based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152(3), 533542.CrossRefGoogle ScholarPubMed
Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. (2016). Acceptance–and mindfulness–based interventions for the treatment of chronic pain: A meta–analytic review. Cognitive Behaviour Therapy, 45(1), 531CrossRefGoogle ScholarPubMed
Vlaeyen, J. W., & Crombez, G. (2020). Behavioral conceptualization and treatment of chronic pain. Annual Review of Clinical Psychology, 16, 187212.CrossRefGoogle ScholarPubMed
Vlaeyen, J. W., & Linton, S. J. (2000). Fear–avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317332.CrossRefGoogle ScholarPubMed
Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76(3), 397407.CrossRefGoogle ScholarPubMed
Vowles, K. E., & McCracken, L. M. (2010). Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes. Behaviour Research and Therapy, 48(2), 141146.CrossRefGoogle ScholarPubMed
Vowles, K. E., McNeil, D. W., Gross, R. T., et al. (2007). Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behavior Therapy, 38(4), 412425.CrossRefGoogle ScholarPubMed
Vowles, K. E., Sowden, G., Hickman, J., & Ashworth, J. (2019). An analysis of within-treatment change trajectories in valued activity in relation to treatment outcomes following interdisciplinary Acceptance and Commitment Therapy for adults with chronic pain. Behaviour Research and Therapy, 115, 4654.CrossRefGoogle ScholarPubMed
Williams, A. C., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane Database of Systematic Reviews, 11(11), CD007407. https://doi.org/10.1002/14651858.CD007407.pub3.Google ScholarPubMed
Williams, A. C., Fisher, E., Hearn, L., & Eccleston, C. (2020). Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews, 8(8). CD007407. https://doi.org/10.1002/14651858.CD007407.pub4.Google ScholarPubMed
Woods, M. P., & Asmundson, G. J. (2008). Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: A randomized controlled clinical trial. Pain, 136(3), 271280.CrossRefGoogle ScholarPubMed

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