Academic journal article Journal of Cognitive Psychotherapy

The Continuing Evolution of Biopsychosocial Interventions for Chronic Pain

Academic journal article Journal of Cognitive Psychotherapy

The Continuing Evolution of Biopsychosocial Interventions for Chronic Pain

Article excerpt

In the last several decades, great strides have been made in the treatment of persistent painful conditions. The scope of treatment has shifted from purely biomedical, including approaches built upon cognitive, behavioral, and social psychological principles. This article reports and discusses several key paradigm shifts that fueled this revolutionary change in the management of chronic pain. The progressive development of theoretical metamodels and treatment conceptualizations is presented. Cognitive behavioral therapy (CBT) is the most widely accepted biopsychosocial treatment for chronic pain and is founded upon a rich theoretical tradition. The CBT rationale, and empirical evidence to support its efficacy, is presented. The emergence and promise of mindfulness-based and acceptance-based interventions is also discussed. The article concludes with the assertion that future treatment outcome research should focus on understanding the treatment-specific and common factors associated with efficacy.

Keywords: chronic pain; intervention; biopsychosocial; mechanism

Chronic pain is a pervasive and costly healthcare concern. Recent estimates suggest that approximately 116 million Americans are affected by chronic pain (Tsang et al., 2008), and this translates into a staggering annual cost of over $61 billion in lost workdays, medical expenses, and other benefit costs (American Academy of Pain Medicine, 2012). Chronic pain is among the most common presenting complaints seen in medical settings; headache pain alone accounts for 18 million physician visits per year (Schwartz, Stewart, Simon, & Lipton, 1998). While the frontline treatment approach for chronic pain has been biomedical in nature, biopsychosocial treatments have evolved that are at least as efficacious as medically based treatments and are cost effective relative to surgery and medication management (Eccleston, Palermo, et al., 2009).

Biopsychosocial treatments for chronic pain emerged in the mid 1960s and continued to develop and take hold in the 1970s and 1980s. During this time, several paradigm shifts occurred and ultimately led to an understanding of pain as multidimensional in nature. This new understanding of pain expanded the points of intervention beyond an exclusive focus on biomedical pathophysiology. This article highlights the historical roots from which grew an expansive body of psychological research, which shaped today's biopsychosocial treatment conceptualization for chronic pain. The development of biopsychosocial treatments has been, and will continue to be, a dynamic progression. The article concludes by suggesting some possible future directions for the continued development of biopsychosocial interventions for chronic pain. This article is conceptual in nature and not intended to cover all extant biopsychosocial treatments, nor provide an exhaustive documentation of the huge volume of research dedicated to this topic.

HISTORICAL ROOTS OF BIOPSYCHOSOCIAL INTERVENTIONS FOR CHRONIC PAIN

Over the past 50 years, groundbreaking metatheoretical models emerged and converged to create today's conceptualization of biopsychosocial treatments for chronic pain. Some of these models were pain-specific, whereas others were broader in nature. It could be argued that the initial impetus for these developments stemmed from a growing awareness of the shortcomings inherent in the biomedical approach to health care.

Mounting dissatisfaction with the biomedical model eventually led to Engel's (1977) biopsychosocial conceptualization of illness. Engel proposed that the illness itself was not an entity independent of social, psychological, and behavioral influences. Rather, he suggested that each of these dimensions form a complex interaction, which under certain conditions may culminate in active disease or manifest illness. Thus, to provide both a basis for understanding the determinants of disease and a framework for guiding medical treatment and health care, Engel proposed the biopsychosocial model of disease conceptualization. …

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