Psychological therapies for the management of chronic pain

Figures & data

Table 1 Descriptions of psychological therapies for pain

Therapeutic modality	Description of treatment
Operant-behavioral therapy	Treatment focuses on extinguishing maladaptive behavioral responses and fostering of adaptive behavioral responses to pain. Behavioral responses are altered through reinforcement and punishment contingencies and extinction of associations between threat value of pain and physical behavior.
Cognitive-behavioral therapy (CBT)	Treatment applies biopsychosocial approach to pain that targets behavioral and cognitive responses to pain. CBT protocols involve psychoeducation about pain, behavior, and mood, strategies for relaxation, behavioral pacing, behavioral activation, positive event scheduling, effective communication, and cognitive restructuring for distorted and maladaptive thoughts about pain.
Mindfulness-based stress reduction	Treatment promotes a nonjudgmental approach to pain and uncoupling of physical and psychological aspects of pain; teaches “nonstriving” responses to pain through experiential meditations and daily mindfulness practice intended to increase awareness of the body and proprioceptive signals, awareness of the breath, and development of mindful activities.
Acceptance and commitment therapy	Based on psychological flexibility model, treatment focuses on development of acceptance of mental events and pain and ceasing of maladaptive attempts to eliminate and control pain through avoidance and other problematic behaviors; emphasizes awareness, defusion, and acceptance of thoughts and emotions as well as behavioral engagement in pursuit of personal goals.

Table 2 Demonstrated efficacy of psychological interventions by pain population

Therapeutic modality	Pain disorder
Operant-behavioral therapy	Complex regional pain syndromes, lower back pain, mixed chronic pain, whiplash-associated disorders
Cognitive-behavioral therapy	Cancer, chronic lower back pain, chronic headaches, chronic migraines, chronic orofacial pain, complex regional pain syndromes, fibromyalgia, HIV/AIDS, irritable bowel syndrome, mixed chronic pain, nonspecific heart pain, multiple sclerosis, nonspecific musculoskeletal pain, osteoarthritis, rheumatoid arthritis, spinal cord injury, systemic lupus erythematosus, whiplash-associated disorders
Mindfulness-based stress reduction	Arthritis, cancer, chronic lower back pain, chronic headache, chronic migraine, complex regional pain syndromes, fibromyalgia, irritable bowel syndrome, rheumatoid arthritis, chronic neck pain
Acceptance and commitment therapy	Musculoskeletal pain (full body, lower back, lower limb, neck, upper limb), whiplash-associated disorders

Abbreviation: HIV/AIDS, human immunodeficiency virus/acquired immunodeficiency syndrome.