Handbook of Psychosocial Interventions for Chronic Pain

An Evidence-Based Guide

Andrea Kohn Maikovich-Fong, Bret A. Moore, Andrea Kohn Maikovich-Fong

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351164023
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Handbook of Psychosocial Interventions for Chronic Pain provides a cutting-edge and comprehensive review of interventions for chronic pain grounded in biopsychosocial frameworks.

Each chapter gives readers the opportunity to solidify their knowledge of major approaches to chronic pain in an accessible format. Reflecting national efforts to reduce prescriptions for pain medications and increase access to interdisciplinary treatment approaches, the book also considers a wide range of person-level variables such as age, cultural factors, and comorbid mental health conditions.

In this book, mental health and allied health professionals will find the tools they need to understand the real-world delivery of chronic pain treatments in a wide variety of settings.

1
Introduction

Andrea Kohn Maikovich-Fong

Chronic pain (i.e., pain that lasts beyond normal healing time or more than three to six months) is a public health concern of great significance in the United States, and indeed throughout the world. According to the Centers for Disease Control National Health and Nutrition Examination Survey, nearly one-quarter of Americans are limited by pain at least one day per month, and over 25 million Americans are disabled because of a pain condition (CDC, 2014).

Of patients in the United States seeking medical care, nearly 50% endorse pain as a primary presenting concern (Abbott & Fraser, 1998; Turk & Burwinkle, 2005). Approximately 20% of the population worldwide is estimated to be impacted directly by chronic pain conditions (Gatchel, Peng, Peters, Fuchs, & Turk, 2007; Treede et al., 2015). These estimates do not account for the indirect (and often significant) impact of the pain conditions on family members, work colleagues/employers, and friends. Estimated annual costs of chronic pain in the United States range from $550 to $625 billion (Dansie & Turk, 2013), inclusive of direct healthcare costs and indirect costs such as lost productivity, lost tax revenue, legal services, and disability compensation (Stewart, Ricci, Chee, Morganstein, & Lipton, 2003).

Biomedical models that conceptualize chronic pain as the direct result of tissue damage largely have been replaced by biopsychosocial models that recognize the complex ways in which biological, psychological, and social factors interact to produce and shape the subjective experience of pain (e.g., Gatchel et al., 2007; Novy & Aigner, 2014). Biological components of the biopsychosocial model typically encompass genetic factors, physiological disease states, sleep patterns and disruptions, physical impairments, and other facets of the neuroscience of pain. Psychological factors typically include behaviors, emotions, thought patterns/cognitions, and perceptions that contribute to and are influenced by pain. Finally, social factors encompass cultural variables, family dynamics (especially around pain and pain behaviors), and interpersonal relationships (including within the school or workplace).

As biopsychosocial models evolved away from purely biomedical models, so too did interdisciplinary treatment approaches evolve away from exclusively medical interventions. Today, collaborative care intervention models are frequently recognized as preferable to purely pharmacological or surgical treatment approaches (Becker, Sjogren, Bech, Olsen, & Eriksen, 2000; Dobscha et al., 2009). Depending upon resource limitations, comprehensive pain management teams may include a primary care physician, occupational therapist, physical therapist, pharmacist, medical specialists appropriate for the pain condition (e.g., neurologist for headache conditions; gynecologist for chronic pelvic pain conditions), and psychologist.

Psychologists provide non-pharmacological treatments that may include cognitive-behavioral therapy, mindfulness-based interventions, and group therapy. These treatments target many aspects of the chronic pain experience, including but not necessarily limited to pain intensity, pain interference, comorbid mental health conditions, adherence to and tolerance of medical treatments, and interpersonal effectiveness. Psychologists often also assist with conducting pre-treatment assessments of chronic pain patients, aiming to identify maladaptive behavioral, emotional, coping, and relationship patterns that may be contributing to (and/or emerging from) the chronic pain experience. These psychosocial interventions and approaches are covered extensively throughout this handbook.

A number of factors coalesced to create a need for this handbook: 1) the ascension of the biopsychosocial model to its current accepted status; 2) the increasing emphasis in pain medicine on interdisciplinary treatment approaches; and 3) the current large-scale societal focus on reducing prescription pain medications during the “opioid crisis.” Herein you will find a comprehensive source of information on the biopsychosocial model as applied to various pain conditions. This need was the impetus for creating this handbook, which provides readers with a thorough and timely review of the literature on evidence-based psychosocial approaches to treating chronic pain.

The handbook is organized as follows: chronic pain assessment (Chapter 2); historical context of psychological approaches to pain (Chapter 3); reviews of two important current theoretical orientations, CBT and mindfulness (Chapters 4–5); modalities of treatment delivery, including group settings and primary care (Chapters 6–7); pharmacology overview (Chapter 8); review of several common chronic pain conditions (Chapters 9–16); discussion of common behavioral health comorbidities (Chapters 17–19); and topics for special consideration, including pediatrics, geriatrics, and culture (Chapters 20–23).

References

Abbott, F. V., & Fraser, M. I. (1998). Use and abuse of over-the-counter analgesic agents. Journal of Psychiatry and Neuroscience, 23, 13–34.

Becker, N., Sjogren, P., Bech, P., Olsen, A. K., & Eriksen, J. (2000). Treatment outcome of chronic non-malignant pain patients managed in a Danish multidisciplinary pain centre compared to general practice: A randomised controlled trial. Pain, 84(2–3), 203–211. doi:10.1016/s0304-3959(99)00209-2.

Centers for Disease Control and Prevention (CDC). (2014). National Center for Health Statistics (NCHS). National health and nutrition examination survey data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Dansie, E. J., & Turk, D. C. (2013). Assessment of patients with chronic pain. British Journal of Anesthesia, 111(1), 19–25.

Dobscha, S. K., Corson, K., Perrin, N. A., Hanson, G. C., Leibowitz, R. Q., Doak, M. N., … Gerrity, M. S. (2009). Collaborative care for chronic pain in primary care. JAMA, 301(12), 1242–1252. doi:10.1001/jama.2009.377.

Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581.

Novy, D. M., & Aigner, C. J. (2014). The biopsychosocial model in cancer pain. Current Opinion in Supportive and Palliative Care, 8(2), 117–123.

Stewart, W. F., Ricci, J. A., Chee, E., Morganstein, D., & Lipton, R. (2003). Lost productive time and cost due to common pain conditions in the US workforce. Journal of the American Medical Association, 290, 2443–2454.

Treede, R-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., … First, M. B. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003.

Turk, D. C., & Burwinkle, T. M. (2005). Clinical outcomes, cost-effectiveness, and the role of psychology in treatments for chronic pain sufferers. Professional Psychology: Research and Practice, 36, 602–610.

2
Assessment of Chronic Pain Patients

Adrianne Sloan

Introduction

Chronic pain affects approximately 20–30% of the population in developed countries, making it a major public health concern (Dansie & Turk, 2013). Pain is one of the most common reasons patients seek care in the United States, with nearly one-half reporting pain as a primary presenting concern (Abbott & Fraser, 1998; Turk & Burwinkle, 2005b). Chronic pain impacts not only the patient but also his or her significant others, family, and society at large. Estimates of annual incremental healthcare costs resulting from pain range from $261 to $300 billion (Bianchini et al., 2017). In addition, there are indirect costs, such as lost productivity, lost tax revenue, legal services, and disability compensation (Stewart, Ricci, Chee, Morganstein, & Lipton, 2003). Although difficult to assess precisely, estimated costs of chronic pain (including indirect costs) in the United States range from $550 billion to $625 billion annually (Dansie & Turk, 2013).

The lack of a one-to-one relationship between physical damage and the experience of pain makes managing chronic pain difficult. As stated by Dansie and Turk (2013), “patient reports of pain severity often demonstrate modest associations with objective physical and laboratory findings: there is no direct linear relationship between the amount of detectable physical pathology and the reported pain intensity” (p. 13). Multiple sources note that many common pain conditions (both acute and chronic) like headache, fibromyalgia, and back pain have largely unknown causes (Robbins & Lipton, 2010; Shuer, 2003; Abeles, Solitar, Pillinger, & Abeles, 2008), whereas asymptomatic patients may show significant findings on imaging, such as herniated discs, that clearly would explain pain if it were present (Borenstein et al., 2001; Jensen et al., 1994).

Furthermore, agreement among providers regarding diagnoses and etiologies of pain in the routine clinical assessment of chronic pain patients is surprisingly low (Gladman et al., 2004; de Winter et al., 2004), and the treatment of chronic pain often remains challenging due to its multifactorial nature. However, research over the past four decades has begun to uncover a multi-layered answer to the question of why some patients seem to suffer more than others from potentially debilitating chronic pain symptoms, making it essential to thoroughly assess the contributing factors to each patient’s individual pain experience so as to inform the most effective intervention approaches.

The biopsychosocial model provides an effective framework for understanding what contributes to, and stems from, chronic pain. This model purports that the pain experience is a product of multiple cognitive, emotional, and behavioral constructs and processes, in addition to physical, biological, and medical factors that interact in complex ways (Turk, Fillingim, Ohrback, & Patel, 2016). The interaction of the physical domain with psychosocial factors contributes to variation in disability and responses to treatment over time (Edwards, Dworkin, Sullivan, Turk, & Wasan, 2016). This model shifts focus from exclusive pathophysiology to the involvement of the patient’s cognitions, emotional state, and past pain history, which influence his/her pain experiences and subsequent behavior. Therefore, diagnosing and treating chronic pain requires consideration of multiple factors, including but not limited to the following: a history and physical examination; pain intensity, quality, and location; functional abilities and quality of life; beliefs, appraisals, and expectations; emotional functioning; overt expressions of pain/pain behaviors; and sleep quality.

Additionally, due to the escalation in opioid-related deaths and overdoses stemming in part from increased prescribing of these medications for the management of chronic pain, the topics of assessing aberrant behaviors and potential malingering also are important. This chapter examines the common variables that have been identified as relevant and significant for assessing, understanding, and treating chronic pain.

Medical Assessment Overview

Dansie and Turk (2013) describe the primary goals of medical history taking and evaluation as follows: 1) determine the necessity of additional diagnostic testing; 2) determine if the medical data can explain the patient’s symptoms, symptom severity, and functional limitations; 3) make a medical d...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Contents
• List of Contributors
• Series Editor’s Foreword
• 1 Introduction
• 2 Assessment of Chronic Pain Patients
• 3 Historical Context: Psychological Mislabeling and the Emergence of the Biopsychosocial Model
• 4 Cognitive-Behavioral Interventions for Chronic Pain
• 5 Mindfulness-Based Interventions for Chronic Pain
• 6 Group Interventions for Chronic Pain
• 7 Brief Treatment Approaches for Addressing Chronic Pain in Primary Care Settings
• 8 Pharmacological Treatment Approaches: Strengths, Risks, and the Role for Interdisciplinary Care
• 9 Chronic Back Pain
• 10 Cancer-Related Pain
• 11 Chronic GI Disorders
• 12 Fibromyalgia and Related Conditions
• 13 Chronic Headache Pain
• 14 Rheumatoid Arthritic Pain
• 15 Urological Chronic Pelvic Pain Syndromes
• 16 Orofacial Pain
• 17 Treating Chronic Pain in Personality-Disordered Patients
• 18 Co-occurring Depression, Anxiety, and Chronic Pain
• 19 Co-occurring PTSD and Chronic Pain
• 20 Psychological Treatment of Chronic Pain in Pediatric Populations
• 21 Psychiatric Treatment Approaches for Pediatric Pain
• 22 Psychological and Psychiatric Treatment of Chronic Pain in Geriatric Populations
• 23 Pain and Culture: Differences in Experience and Treatment, Challenges of Measurement and Some Recommendations
• Index