Model of cognitive-behavioral therapy in adult patients with chronic pain states of nonmalignant etiology
Abstract
Pain, from its origin through its treatment and in its subsequent maintenance, is influenced by psychosocial factors. For this reason, psychotheraphy is also used in pain treatment.
The use of cognitive-behavioral therapy (CBT) is dominant. The paper describes the history of CBT and its three basic approaches: behavioral, (operant), cognitive, and cognitive-behavioral.
The indications to CBT and the most frequent problems in treatment are isolated. Basic CBT techniques in chronic pain treatment, namely the cognitive restructuration and the practice of skills for pain and stress management (education, adaptive positive self-instruction, relaxation and imagination, increasing activity, exposition, structured problem solving, and relapse coping) are specified.
Particular fields of chronic pain which represent the goal of multidisciplinary program of pain treatment including CBT are examined. The author structures basic assumptions of successful program: direct and indirect positive reinforcement of pain behavior, positive reinforcement of required behavior, improvement of physical condition, cognitive reframing, education, training in CBT in pain treatment, and conforming to the CBT principles.
The paper sumarizes the efficiency of CBT in chronic pain treatment in adult patients, describes problems in its monitoring and suggests some innovations for increasing its use.