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Behavioral and Cognitive–Behavioral Approaches to Treating Patients with Chronic Pain: Thinking Outside the Pill Box

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Abstract

Chronic pain is a prevalent and disabling problem. It is a complex, multifactorial disorder that requires a comprehensive biopsychosocial conceptualization. In this paper we provide an update on research implicating the importance of the behavioral and cognitive factors in chronic pain. In addition to the significant co-variations among self-reported symptoms, recent advancement in the imaging technology provides a better understanding of the neurophysiological basis of those psychosocial factors in chronic pain. Additionally, we discuss several variations of behavioral and cognitive–behavioral approaches to chronic pain, including operant–behavioral and cognitive–behavioral (including Acceptance and Commitment Therapy, internet-adapted, exposure based on the Fear Avoidance model) and review the evidence for their efficacy. Overall, the psychologically oriented programs based upon the biopsychosocial concept of pain are efficacious in reducing pain, disability, and mood disturbance. The accumulated evidence supports our contention that the conventional unidimensional, sensory perspective of pain based upon the biomedical model is, although ubiquitous and persistent, incomplete and inadequate to understand and effectively treat people with chronic pain. We must go beyond the convention of that pain is solely a neurophysiological phenomenon and start thinking outside the pill box if we hope to provide more effective treatment for people experiencing chronic pain.

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Authors and Affiliations

  1. University of Utah, Salt Lake City, UT, USA

    Akiko Okifuji

  2. Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, Seattle, WA, 98195, USA

    Dennis C. Turk

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  1. Akiko Okifuji
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  2. Dennis C. Turk
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Okifuji, A., Turk, D.C. Behavioral and Cognitive–Behavioral Approaches to Treating Patients with Chronic Pain: Thinking Outside the Pill Box. J Rat-Emo Cognitive-Behav Ther 33, 218–238 (2015). https://doi.org/10.1007/s10942-015-0215-x

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