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Assessment

Psychological assessment for chronic pain focuses not only on pain, but also on the patient’s beliefs about pain, pain fearfulness, self-efficacy, pattern of activity, usual coping strategies, and co-morbid conditions.

It is important for patients to be examined by their medical practitioners to ensure there is no malignant disease underlying the pain they experience or that they are suitable for surgery.

Treatment

Cognitive behaviour therapy (CBT) is the gold standard approach in the management of chronic pain and has the strongest evidence base. This approach includes a combination of:

• Psycho-education of chronic pain
  
• Graded goal setting (ie. pacing and exercises)
  
• Relaxation techniques
  
• Attentional strategies
  
• Cognitive restructuring
  
• Problem solving
  
• Assertiveness
  
• Communication

There is research conducted on acceptance and commitment therapy (n=3), and mindfulness-based therapy (n=7), but they have methodological issues, and they have not been found to be superior to CBT.

Thus, CBT should be the first line of treatment for the management of chronic pain.

Evidence-Based Self-Help Books

• Explain pain
  Butler, D. S., & Moseley, G. L. (2013). Adelaide: Noigroup Publications.
  
  
• Manage your pain: Practical and positive ways to adapt to chronic pain
  Nicholas, M., Molloy, A., Tonkin, L., & Beeston., L. (2012). Sydney: Souvenir Press.
  
  
• The pain book: Finding hope when it hurts.
  Siddal, P., McCabe, R., & Murray R. (2013). Sydney: Hammond Press.

References

• Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. American Psychologist, 69(2), 153-166.
  
  
• Sharpe, L., Nicholas, M., & Nicholson Perry, K. (2015). A Clinician’s quick guide of evidence-based approaches: Chronic Pain. Clinical Psychologist, 19, 105-106.

Evidence-Based Treatment Manuals

• Flor, H., & Turk, D. C. (2011). Chronic pain: An integrated biobehavioral approach. Seattle, WA:IASP Press.

Tags: cognitive behaviour therapy, CBT, chronic pain management