We often see psychological approaches in the treatment of pain pitted against each other.
What’s better?
Cognitive Behavioural Therapy?
Mindfulness Based Stress Reduction?
Cognitive Functional Therapy?
Pain Reprocessing Therapy?
Acceptance and Commitment Therapy?
The reality is that while there may be variation in terms of the focus and philosophy across these approaches, there is also quite a bit of overlap in terms of the treatment used within them. A Delphi study published in the European Journal of Pain sought to identify the critical components of effective psychological interventions for chronic pain management programs.
What’s better?
Cognitive Behavioural Therapy?
Mindfulness Based Stress Reduction?
Cognitive Functional Therapy?
Pain Reprocessing Therapy?
Acceptance and Commitment Therapy?
The reality is that while there may be variation in terms of the focus and philosophy across these approaches, there is also quite a bit of overlap in terms of the treatment used within them. A Delphi study published in the European Journal of Pain sought to identify the critical components of effective psychological interventions for chronic pain management programs.
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Necessary Components of Psychological Treatment in Pain Management Programs: A Delphi Study
Methods:
This Delphi study led by Louise Sharpe at the University of Sydney aimed to reach a consensus among experts on the essential psychological components of chronic pain management programs. A Delphi approach is often used for exploring complex issues where evidence has been inconsistent. These authors took the following approach:
- Literature Review: A systematic review of randomized controlled trials (RCTs) on psychological interventions for chronic pain was performed to identify a comprehensive list of 49 treatment components. These components formed the basis for the Delphi process.
- Selection of Participants: Participants included 74 researchers who had conducted RCTs on chronic pain and clinicians from pain management programs. In total, 42 participants, representing diverse geographic and professional backgrounds, completed the process.
- Rounds of Surveys: Round 1: Experts rated each treatment component as "necessary," "desirable," "unnecessary," "potentially harmful," or "unsure." Open-ended responses allowed participants to suggest additional strategies. Round 2: Components reaching a consensus threshold of 70% as "necessary" were retained. Feedback from Round 1 guided additional refinement and discussion.
- Consensus Determination: The process aimed to establish agreement on core strategies for psychological pain management while capturing insights from both research and clinical expertise.
What Are the Most Critical Components of Psychological Approaches?
Findings: Experts (clinicians & researchers) from across Australia, identified the following components as essential for effective psychological interventions in the treatment of pain:
#1 Psycho-Education
Educating patients about pain mechanisms and the cognitive role in chronic pain was deemed essential. Understanding these connections empowers patients to shift harmful thought patterns.
#2 Increasing Activity
Strategies such as graded activity exposure, pacing, and goal-setting encourage patients to engage in activities incrementally, reducing avoidance behaviors that perpetuate pain.
#3 Cognitive Approaches
Strategies to address beliefs about pain and recovery were highlighted for their ability to help patients address negative beliefs and emotions associated with pain.
Other desirable strategies included Relaxation Strategies (mindfulness & stress management) as well as conversations about Managing Set Backs. However, the three components above were universally deemed necessary for effective interventions.
Clinical Implications for Rehabilitation Professional
These findings emphasize a tailored approach to pain management that considers...
- Unified Principles: While various psychologically informed approaches exist, the components of psycho-education, facilitating activity engagement, and integrating cognitive strategies are often included across approaches.
- Individualized Plans: Each patient’s pain experience is unique. Interventions and combinations of approaches used should align with the client’s goals, preferences, and readiness to engage with these components.
- Skills Development: Clinicians from all backgrounds would benefit from training in evidence-based techniques such as CBT, Graded Exposure, and Pain Neuroscience Education to effectively address the psychological components of the pain experience.
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