Abstract
The article focuses on cognitive-behavioral approach in the form of long-term case study of chronic non-malignant pain patient with specific phobia (pain-related fear and fear of movement). In the first part the article describes specific phobias, their clinical symptoms, epidemiology, ethiopathology, differential diagnostic approach and specific issues in chronic pain patients.
Next part of the article focuses on specific phobias typical of chronic pain patients: pain-related fear, fear of movement and fear of potential injury, describes them using cognitive-behavioral model. The article also explains cognitive-behavioral therapy (CBT) methods in management of specific phobia (reassurance, education, exposure in vivo, problem solving, relaxation, pacing of activity and cognitive restructuralization) in chronic pain patients.
The articles describes a case study, emphasizing all the initial steps of cognitive-behavioral therapy from psychological evaluation to behavioral, cognitive and functional analyses of the problem, formulation and definition of the problem; goals setting and plan of therapy with evaluation of recent knowledge and techniques for coping with pain (therapy included teaching of new methods for coping with pain and relaps); with next two-years' psychotherapy and follow-up. The case study shows clearly that three years after treatment the patient had consistently much less fear of pain and was able to do acitivities he wished to do, though the level of pain was more or less stable.
In the end the article emphasizes that pain-related fear and fear of movement in chronic pain is a specific problem, and possibly a major obstacle to successful treatment, but with including the cognitive-behavioral approach into the complex care of chronic pain patients this problem can be solved.