Psychological Approaches to Pain Management: A Practitioner's Handbook

Psychological Approaches to Pain Management: A Practitioner's Handbook

Psychological Approaches to Pain Management: A Practitioner's Handbook

Psychological Approaches to Pain Management: A Practitioner's Handbook

Synopsis

Designed for maximum clinical utility, this volume shows how to tailor psychological treatment programs to patients suffering from a wide range of pain problems. Conceptual and diagnostic issues are discussed, widely used clinical models reviewed, and a framework presented for integrating psychological treatment with medical and surgical interventions.

Excerpt

In the Preface to the first edition of this volume, we noted that systematic attempts to treat pain have been closely aligned with how pain is conceptualized and evaluated. Traditionally, the focus in health care has been on the cause of the pain reported, with the assumption that there is a physical basis for the pain and that once it is identified, the source can be either eliminated or blocked by medical, surgical, or other physical interventions. Consequently, assessment was focused on identifying the physical basis—the cause—for the pain. In the absence of “adequate” physical pathology to validate the patient's report, psychological causation was often invoked; hence, the term “psychogenic pain.” Thus, the traditional view of persistent pain complaints has been characterized by a simple dichotomy: The pain report had either a physical cause or a psychological one. The psychological causes might be unconscious factors associated with psychopathology, maladaptive personality, or motive in an effort to achieve some type of personal gain.

The dichotomous view of pain has been shown to be incomplete and inadequate. There is no question that physical perturbations contribute to pain symptoms; nor is there any argument anymore that psychological factors may play a part in the symptom reporting of some patients. The weighting or balance between physical and psychological contributors may vary over time and across individuals. These psychosocial factors must be evaluated and treated in conjunction with the physical and predispositional psychological ones in order to ensure therapeutic success. Moreover, research has suggested that the social and familial context in which pain persists can also play a central role in the maintenance of disability.

The observations we outlined underscore the important role of mental health specialists in the assessment and treatment of patients with diverse chronic pain syndromes. A large proliferation of studies, and several meta-analyses, have confirmed the clinical effectiveness and cost-effectiveness of psychological treatments alone and when combined with more traditional methods. In response to the results of this body of research, the role of mental health specialists has been noted in U.S. government publications and initiatives, such as that of the Veterans Administration. Governmental organizations in other countries (e.g., Canada, Australia, United Kingdom, and Sweden), as well as in the United States, have documented the important role of psychological factors and psychologists in the reports of pain and pain management. Private medical certifying agencies such as the Joint Commission on the Accreditation of Healthcare Organizations (JACHO) and the Commission for the Accreditation of Rehabilitation Facilities (CARF), as well as professional organizations that have proposed practice guidelines (e.g., the American Academy of Neurology), also have recognized the importance and complexity of pain and the need to go beyond exclusive reliance on physical modalities to treat pain sufferers. Moreover, the acknowledgment of the importance of psychological factors in pain has resulted in a large number of mental health providers evaluating and treating pain patients in specialized pain clinics, in a variety of medical settings, and in private practices. The American Psychological Association designated psychological treat-

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