Psychological approaches to the management of pain, cognition and emotion

Abstract

Psychological approaches to managing chronic pain have evolved considerably since the 1970s when pioneers like Fordyce first described applications of behaviour change principles to pain and its behavioural manifestations. The settings in which these approaches have been applied have also been greatly extended since Fordyce’s original work in a rehabilitation hospital. This chapter reviews current psychological approaches to the management of persisting pain and associated cognitive, emotional and behavioural changes. This chapter considers primarily cognitive behavioural therapy (CBT) approaches as they have the most empirical support in this field. The theoretical and experimental underpinnings for CBT approaches are described, and this is followed by: (1) a description of the characteristics of CBT methods, (2) the available evidence supporting the use of these approaches in the management of persisting pain and (3) a consideration of the implementation of psychological approaches and their effects on outcomes. There is general agreement in the research literature that the question of ‘does it work?’ has been answered (in the affirmative), and the task now for both clinicians and researchers is to refine our questions. In particular, we need to consider questions like which versions of psychological treatments, for which problems, and how these can be done most effi- ciently and effectively. An emerging issue is to do with the quality of treatment and that, in turn, raises the question of training. This is starting to be addressed but it is likely to become a much larger issue than was the case even 10 years ago.