Treating the Psychological Factors in Pain

The three treatments that have been studied the most, and have pretty good evidence to support them, are biofeedback, cognitive behavioral treatment, and acceptance and mindfulness-based treatments. We’re starting to think a lot about subgroups of patients that may benefit more from one or another approach.

One of the things that I promote is the early use of these treatments. Traditionally, they are kind of the end-stage, left to the end when everything else has failed. At that point, getting anything to work is really challenging so I advocate the idea that psychological treatment should be considered very early. Even when there’s no access to a specialized mental health provider who has experience working with pain, there are many self-help materials that are out and available both in terms of booklets as well as websites that can promote the person’s self-management of pain.

A lot of what we talk about in the pain field now is a model that is similar to what has evolved in diabetes. That is the idea that diabetes is a 24/7 condition that requires a lot of work on the part of the patients and not just taking medications. That same model is probably a very useful model for people who have chronic pain. Any practitioner should be encouraging their patients to be looking for strategies that they can use on a day-to-day basis to self-manage their pain symptoms.