Cognitive Behavioral Therapy and Biofeedback.

Purpose Of Review: This review aims to understand the foundations of cognitive behavioral therapy (CBT) and biofeedback, their indications for therapy, and evidence-based support.

Recent Findings: Both CBT and biofeedback are noninvasive therapy options for patients who are suffering from a variety of chronic pain conditions, including chronic low back pain, headache, fibromyalgia, and temporomandibular disorder (TMD). CBT has been shown to be effective in treating multiple chronic pain conditions.

Pain catastrophizing as a treatment process variable in cognitive behavioural therapy for adults with chronic pain.

Background: Interdisciplinary cognitive behavioural therapy (CBT) for chronic pain is effective at improving function, mood and pain interference among individuals with disabling chronic pain. Traditionally, CBT assumes that cognitive change is an active therapeutic ingredient in the determination of treatment outcome. Pain catastrophizing, a cognitive response style that views the experience of pain as uncontrollable, permanent and destructive, has been identified as an important maladaptive cognition which contributes to difficulties with the management of chronic pain.

Examining the effectiveness of pain rehabilitation on chronic pain and post-traumatic symptoms.

Patients with co-morbid chronic pain and post-traumatic stress disorder (PTSD) pose significant treatment challenges. This study evaluated the effectiveness of an interdisciplinary pain rehabilitation program (IPRP) in improving pain and PTSD outcomes, as well as reducing medication use. In addition, the mediating effect of pain catastrophizing, which is theorized to underlie the pain and PTSD comorbidity, was examined.

Difficult Conversations: Training Medical Students to Assess, Educate, and Treat the Patient with Chronic Pain.

Objective: Chronic pain, along with opioid abuse and misuse, continues to be a prevalent problem across the USA. Medical students have minimal training in biopsychosocial treatment of chronic pain and often lack the knowledge and skill necessary to address chronic pain with their patients. While there are a variety of treatment options available, research repeatedly has demonstrated that biopsychosocial treatment is the most effective option for chronic pain.

Effect of In-Class vs Online Education on Sexual Health Communication Skills in First-Year Medical Students: a Pilot Study.

Objective: Online education is effective for knowledge acquisition, but its effect on clinical skill development is not well characterized. We aimed to compare communication skills of 50 first-year medical students who learned to assess and treat patients through an online learning module vs an in-class lecture.

Methods: Twenty-six students were randomized to learn about antidepressant-induced sexual dysfunction in class and 24 learned the same content through an online module.

Longitudinal Treatment Outcomes for an Interdisciplinary Pain Rehabilitation Program: Comparisons of Subjective and Objective Outcomes on the Basis of Opioid Use Status.

Unlabelled: Chronic pain is a major public health concern, and widespread use of prescription opioids for chronic pain has contributed to the escalating problem of opioid use disorder. Interdisciplinary pain rehabilitation programs (IPRPs) can be highly effective in discontinuing opioids in patients with chronic pain while also improving functional status. This study sought to examine self-report and performance-based functional outcomes of 2 cohorts of patients enrolled in a 3-week IPRP: patients engaged in interdisciplinary pain treatment and physician-supervised opioid taper versus nonopioid users engaged in interdisciplinary treatment.

Impact of Family History of Substance Abuse on Admission Opioid Dose, Depressive Symptoms, and Pain Catastrophizing in Patients with Chronic Pain.

The objectives of this study were to examine association between a family history of substance abuse and admission morphine equivalent dose, depression and pain catastrophizing screening scores, as well as reported personal history of substance use. The retrospective research was completed in an interdisciplinary three-week pain rehabilitation center. The subject cohort included admissions from January through December 2014 with 351 datasets for family history of substance abuse and oral morphine equivalency and 341 for depression, pain catastrophizing and use of substances.

Unique Contributions of Acceptance and Catastrophizing on Chronic Pain Adaptation.

Purpose: Pain catastrophizing and acceptance represent distinct but interrelated constructs that influence adaptation to chronic pain. Clinical and laboratory research suggest that higher levels of catastrophizing and lower levels of acceptance predict worse functioning; however, findings have been mixed regarding which specific outcomes are associated with each construct. The current study evaluates these constructs in relation to pain, affect, and functioning in a treatment-seeking clinical sample.

Impact of a Psychological Opioid-Risk Evaluation on Opioid Prescribing in Primary Care.

Background And Objectives: The misuse and abuse of opioids has increased across the United States in recent years, associated with a rise in opioid-related overdose deaths. Physicians report having difficulty discerning substance abuse or drug diversion, which can lead to over- or under-prescribing of opioids and poor pain management. Additionally, research suggests that patient characteristics (eg, sex, ethnicity/race, age) may unduly influence the pain management decisions of health care providers.

The Mediating Effects of the Different Dimensions of Pain Catastrophizing on Outcomes in an Interdisciplinary Pain Rehabilitation Program.

Objective: Although reducing pain catastrophizing has been shown to contribute to functional improvement in patients receiving interdisciplinary pain care, little is known about how changes in the different dimensions of pain catastrophizing uniquely contribute to improvement in outcome. The study examined the unique relationship between changes in the 3 distinct factors of pain catastrophizing-helplessness, rumination, and magnification-and changes in pain outcomes.

Materials And Methods: In this nonrandomized study, 641 patients who completed treatment in a 3-week interdisciplinary pain rehabilitation program between the years 2013 and 2014 completed a battery of psychometrically validated measures of pain catastrophizing, pain severity, pain interference, mental and physical health-related quality of life, and depressive symptoms at pretreatment and posttreatment.

Impact of weight status on physical and psychological outcomes of a comprehensive pain rehabilitation programme.

Objective: To examine the impact of weight status on physical and psychological outcomes of patients enrolled in a comprehensive pain rehabilitation programme.

Methods: Participants (n = 314; mean body mass index 30.34) were administered measures of pain perception, depression, and physical functioning.

The Relationship Between Pain Catastrophizing and Outcomes of a 3-Week Comprehensive Pain Rehabilitation Program.

OBJECTIVE : Pain catastrophizing is an important predictor of functioning and disability among individuals with chronic pain, and modification of catastrophic interpretations of pain is a proposed treatment mechanism of pain rehabilitation. The purpose of the current study is to examine the relationship between changes in catastrophic thinking and treatment outcomes for a large sample of patients with chronic pain. METHODS : 648 adult patients with chronic pain completed a 3-week intensive outpatient comprehensive pain rehabilitation program.

Patients' perceptions of a chronic pain rehabilitation program: changing the conversation.

Objective Research supports the effectiveness of comprehensive approaches to chronic pain treatment, including behavioral management and physical reconditioning. However, less is known about patients' perceptions of this treatment approach. The current study evaluated patient perceptions and treatment outcomes utilizing both qualitative and quantitative data collection.

Rumination, Magnification, and Helplessness: How do Different Aspects of Pain Catastrophizing Relate to Pain Severity and Functioning?

Objectives: Although there is a large body of research on the relationship between pain catastrophizing and functioning among individuals with chronic pain, little is known about the potential differential impact of specific aspects of pain catastrophizing. The current study evaluates the relationship between the Rumination, Helplessness, and Magnification subscales of the Pain Catastrophizing Scale and pain-related outcomes.

Materials And Methods: In total, 844 patients who were admitted to a chronic pain rehabilitation program completed survey measures of pain, catastrophizing, quality of life (QOL), and depression.

Impact of opioid use on outcomes of functional restoration.

Objectives: To examine the effect of opioid use on psychological function, physical functioning, and return-to-work outcomes of a multidisciplinary rehabilitation program (MRP) for chronic pain.

Methods: The participants were 127 patients with on-the-job injuries who had completed an MRP between 2001 and 2003. Opioid use was controlled by the patients' treating physicians (who were not affiliated with the MRP) and was assessed via patient self-report at the time of admission to the program and discharge.

Pain-related anxiety in the prediction of chronic low-back pain distress.

This study evaluated the relation of particular aspects of pain-related anxiety to characteristics of chronic pain distress in a sample of 76 individuals with low-back pain. Consistent with contemporary cognitive-behavioral models of chronic pain, the cognitive dimension of the Pain Anxiety Symptoms Scale (PASS; McCracken, Zayfert, and Gross, 1992, Pain 50:67-73) was uniquely predictive of cognitive-affective aspects of chronic pain, including affective distress, perceived lack of control, and pain severity. In contrast, the escape and avoidance dimension of the PASS was more predictive of behavioral interference in life activities.