Psychological and Behavioral Therapy

Numerous effective psychological and behavioral therapies have been developed that can bring the treatment to the patient rather than bringing the patient to treatment.

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These therapy techniques can provide effective treatment across the spectrum of severity of pain, neuropathy, alcohol abuse disorders and individual therapies,. New methods of delivery and successful adjuncts to existing behavioral treatments also have been introduced, including computerized cognitive–behavioral treatments, guided self improvements techniques and mindfulness based approaches.

With the availability of a wide variety of psychological and behavioral approaches have been shown to have good efficacy, choosing the treatment most appropriate for a given patient is the most significant.

Psychological Approach:

1. Biofeedback

Biofeedback is a learning technique through which patients learn to interpret feedback (in the form of physiological data) regarding certain physiological functions.

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Feedback is provided by a variety of measurement instruments that can yield information about brain electrical activity, blood pressure, blood flow, muscle tone, electro-dermal activity, heart rate, and skin temperature, among other physiological functions in a rapid manner.

The goal of biofeedback approach is for the patient to learn how to initiate physiological self-regulatory processes by achieving voluntary control over certain physiological responses to ultimately increase physiological flexibility through greater awareness and specific training.

2. Relaxation Techniques

It is generally accepted that stress is a key factor involved in the emergence and maintenance of chronic pain. 

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The focus of relaxation training is to reduce tension levels (physical and mental) through activation of the parasympathetic nervous system and through attainment of greater awareness of physiological and psychological states, thereby achieving reductions in pain and increasing control over pain.

Patients can be taught several relaxation techniques and practice them individually or in conjunction with one another, as well as adjuvant components to other behavioral and cognitive pain management techniques.

3. Fear Avoidance Technique

The fear-avoidance technique is most frequently applied in the context of chronic low back pain (LBP).

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Treatments are aimed at breaking the fear-avoidance cycle by employing systematic graded exposure to feared activities to disconfirm the feared, often catastrophic, consequences of engaging in activities.

Cognitive Behavioral Approaches

Cognitive-behavioral therapy (CBT) interventions for chronic pain utilize psychological principles to effect adaptive changes in the patient’s behaviors, cognitions or evaluations, and emotions.

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These interventions are generally comprised of basic education about pain and the patient’s particular pain syndrome, several behavioral components, coping skills training, problem-solving approaches, and a cognitive restructuring component, though the exact treatment components vary according to the clinician. Behavioral components may include a variety of relaxation skills and behavioral activation strategies.

Acceptance Based Approaches

Acceptance-based approaches are frequently identified as third-wave cognitive-behavioral therapies. Acceptance and commitment therapy (ACT) is the most common of the acceptance-based psychotherapies. ACT emphasizes the importance of facilitating the client’s progress toward attaining a more valued and fulfilling life by increasing psychological flexibility.

In the context of chronic pain, ACT targets ineffective control strategies and experiential avoidance by fostering techniques that establish psychological flexibility.

Why Psychological and Behavioral Therapy?

Benefits of including psychological treatments in multidisciplinary approaches to the management of chronic pain are abundant. These include, but are not limited to, increased self-management of pain, improved pain-coping resources, reduced pain-related disability, and reduced emotional distress-improvements that are affected via a variety of effective self-regulatory, behavioral, and cognitive techniques.

Through implementation of these changes, patients can effectively command their pain control and enable them to live as normal a life as possible despite pain. Moreover, the skills learned through psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives.

Additional benefits of an integrated and holistic approach to the management of chronic pain may include increased rates of return to work, reductions in health care costs, and increased health-related quality of life.