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 Contributors

Rachel V. Aaron, PhD, Seattle Children’s Hospital Research Institute, Seattle, Washington
John G. Arena, PhD, Charlie Norwood VA Medical Center and Department of Psychiatry
and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia
Benjamin H. Balderson, PhD, Kaiser Permanente Washington Health
Research Institute, Seattle, Washington
Pat M. Beaupre, PhD, private practice, Redlands, California
Sophie Bergeron, PhD, Department of Psychology, University of Montreal, Montreal,
Quebec, Canada
Dawn C. Buse, PhD, Department of Neurology, Montefiore Medical Center, Bronx, New York
Annmarie Cano, PhD, Department of Psychology, Wayne State University, Detroit, Michigan
Leanne R. Cianfrini, PhD, The Doleys Clinic, Birmingham, Alabama
Howard Cohen, MD, Progressive Pain and Psychiatry Clinic, Dallas, Texas
Serena Corsini‑Munt, PhD, Department of Psychology and Neuroscience, University of Halifax,
Halifax, Nova Scotia, Canada
Beth D. Darnall, PhD, Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University School of Medicine, Palo Alto, California
Jeroen de Jong, PhD, Department of Rehabilitation, Maastricht University Medical Centre,
Maastricht, The Netherlands
Marlies den Hollander, MSc, Department of Rehabilitation, Maastricht University
Medical Centre, Maastricht, The Netherlands
Jeffrey Dersh, PhD, South Texas Veterans Health Care System, San Antonio, Texas
Daniel M. Doleys, PhD, The Doleys Clinic, Birmingham, Alabama

vii
viii Contributors

Angela Liegey Dougall, PhD, Department of Psychology, University of Texas at Arlington,

Arlington, Texas
Christopher Eccleston, PhD, Department for Health, University of Bath, Bath, United Kingdom;
Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
Emma Fisher, PhD, Seattle Children’s Hospital Research Institute, Seattle, Washington
Noor M. Gajraj, MD, North Texas Center for Pain Management, Plano, Texas
Robert J. Gatchel, PhD, ABPP, Department of Psychology, University of Texas at Arlington,
Arlington, Texas
Thomas Hadjistavropoulos, PhD, ABPP, Department of Psychology and Centre on Aging
and Health, University of Regina, Regina, Saskatchewan, Canada
Ryan Hulla, BA, BS, Department of Psychology, University of Texas at Arlington, Arlington, Texas
Mark A. Ilgen, PhD, VA Center for Clinical Management Research, VA Ann Arbor
Healthcare System, and Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
Mark P. Jensen, PhD, Department of Rehabilitation Medicine, University of Washington,
Seattle, Washington
Francis J. Keefe, PhD, Department of Psychiatry and Behavioral Sciences, Duke University,
Durham, North Carolina
Sarah A. Kelleher, PhD, Department of Psychiatry and Behavioral Sciences, Duke University,
Durham, North Carolina
Edmund Keogh, PhD, Department for Health, University of Bath, Bath, United Kingdom
Robert D. Kerns, PhD, Departments of Psychiatry, Neurology, and Psychology,
Yale University, New Haven, Connecticut; Pain Research, Informatics, Multimorbidities,
and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
Nancy Kishino, OTR/L, West Coast Spine Rehabilitation Center, Riverside, California
Alexander J. Kuka, MA, Department of Psychology, University of Mississippi, Oxford, Mississippi
Steven James Linton, PhD, Center for Health and Medical Psychology, Örebro University,
Örebro, Sweden
Travis I. Lovejoy, PhD, MPH, Center to Improve Veteran Involvement in Care,
VA Portland Health Care System, and Department of Psychiatry, Oregon Health & Science University,
Portland, Oregon
Cindy McGeary, PhD, ABPP, Department of Psychiatry, University of Texas Health Science Center,
San Antonio, Texas
Don McGeary, PhD, ABPP, Department of Psychiatry, University of Texas Health Science Center,
San Antonio, Texas
Lindsey C. McKernan, PhD, Department of Psychiatry and Behavioral Sciences,
Vanderbilt University Medical Center, Nashville, Tennessee
Elena S. Monarch, PhD, Lyme and PANS Treatment Center, Cohasset, Massachusetts
Benjamin J. Morasco, PhD, Center to Improve Veteran Involvement in Care,
VA Portland Health Care System, and Department of Psychiatry, Oregon Health & Science University,
Portland, Oregon
Stephen Morley, PhD (deceased), Leeds Institute of Health Sciences, University of Leeds,
Leeds, United Kingdom
 Contributors ix

Paul Nabity, PhD, Department of Psychiatry, University of Texas Health Science Center,
San Antonio, Texas
Michael R. Nash, PhD, ABPP, Department of Psychology, University of Tennessee,
Knoxville, Tennessee
Diane Novy, PhD, Department of Pain Medicine, University of Texas MD Anderson Cancer Center,
Houston, Texas
John D. Otis, PhD, Department of Psychiatry, Boston University School of Medicine,
Boston, Massachusetts
Tonya M. Palermo, PhD, Seattle Children’s Hospital Research Institute, Seattle, Washington
David R. Patterson, PhD, ABPP, Department of Rehabilitation Medicine, University of Washington,
Seattle, Washington
Donald B. Penzien, PhD, Departments of Anesthesiology, Neurology, and Psychiatry,
Wake Forest School of Medicine, Winston‑Salem, North Carolina
Peter B. Polatin, MD, private practice, Dallas, Texas
Sheri D. Pruitt, PhD, private practice, Sacramento, California
Chelsea Ratcliff, PhD, Department of Psychology and Philosophy, Sam Houston State University,
Huntsville, Texas
Christopher T. Ray, PhD, College of Nursing and Health Innovations, University of Texas
at Arlington, Arlington, Texas
Natalie O. Rosen, PhD, Department of Psychology and Neuroscience, Dalhousie University,
Halifax, Nova Scotia, Canada
Meredith E. Rumble, PhD, Department of Psychiatry and Psychology,
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Eric Salas, MA, Department of Psychology, University of Texas at Arlington, Arlington, Texas
Steven H. Sanders, PhD, Chronic Headache Management Program, James A. Haley VA Hospital,
Tampa, Florida
Laura Simons, PhD, Department of Anesthesiology, Perioperative, and Pain Medicine,
Stanford University School of Medicine, Palo Alto, California
Todd A. Smitherman, PhD, Departments of Anesthesiology, Neurology, and Psychiatry,
University of Mississippi, Oxford, Mississippi
Michele Sterling, PhD, Recovery Injury Research Centre, University of Queensland,
Herston, Australia
Anna Wright Stowell, PhD, private practice, Dallas, Texas
John A. Sturgeon, PhD, Department of Anesthesiology and Pain Medicine, University
of Washington, Seattle, Washington
Abby Tabor, PhD, Department for Health, University of Bath, Bath, United Kingdom
James D. Tankersley, MS, Charlie Norwood VA Medical Center, Augusta, Georgia
Hallie Tankha, MEd, Department of Psychology, Wayne State University, Detroit, Michigan
Dennis C. Turk, PhD, Department of Anesthesiology and Pain Medicine,
University of Washington School of Medicine, Seattle, Washington
Alyssa N. Van Denburg, MA, Department of Psychology and Neuroscience, Duke University,
Durham, North Carolina
x Contributors

Miranda A. L. van Tilburg, PhD, Department of Medicine, Division of Gastroenterology

and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Johan W. S. Vlaeyen, PhD, Department of Health Psychology, KU Leuven University,
Leuven, Belgium
Michael Von Korff, ScD, Kaiser Permanente Washington Health Research Institute,
Seattle, Washington
Lynette Watts, BS, Department of Psychology, University of Texas at Arlington, Arlington, Texas
William E. Whitehead, PhD, Center for Functional Gastroenterological and Motility Disorders,
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Amanda C. de C. Williams, PhD, Research Department of Clinical, Educational
and Health Psychology, University College London, London, United Kingdom
Laurie D. Wolf, PhD, Orlando VA Medical Center, Orlando, Florida
 Preface
Advances in Psychosocial Approaches
to Treating Patients with Chronic Pain

In the Preface to the first two editions of this volume, we observed that attempts to
treat individuals experiencing persistent pain were closely aligned with how pain was
conceptualized and evaluated. Traditionally, the focus in health care has been on the
cause of the symptoms reported, with the assumption that there is a physical basis for
each of these and, once identified, the source can be eliminated or blocked by medical,
surgical, or other physical interventions (e.g., physical therapy exercises, transcuta-
neous electric nerve stimulation [TENS], and ultrasound). Consequently, assessment
was focused on identifying the physical mechanisms—the “putative cause(s)”—for the
symptoms. In the absence of specific physical pathology to validate the patient’s self-
report, psychological causation is invoked as an explanation; hence the terms “psycho-
genic,” “psychosomatic,” “secondary gain” (i.e., symptom reports that are assumed
to be consciously or nonconsciously motivated to achieve desired outcomes—such as
attention, disability compensation, to obtain positively reinforcing drugs). In the case
of many of the most prevalent chronic pain conditions (e.g., chronic low back pain,
fibromyalgia, headache, whiplash-associated disorders), there is frequently no, or very
limited, objective evidence substantiating the report of pain and its severity. Hence,
the traditional view of persistent pain complaints has been characterized by a simple
dichotomy: The pain report is either somatogenic or psychogenic.
The dichotomous view of pain has been shown in numerous studies to be in-
complete, inadequate, and, in some situations, simply wrong. There is no question
that physical perturbations contribute to symptoms of pain; nor is there any reason-
able argument that psychological factors do not play a part in the symptom reporting.
Moreover, research has convincingly demonstrated that socioeconomic, familial, and
contextual variables play important roles in patients’ acceptance of recommendations
and response to the treatments prescribed, the development of symptom chronicity,
and the maintenance of disability. The balance among physical, psychosocial, and
xi
xii Preface

contextual contributors may vary across individuals, as well as over time within the
same individual. The limitations of the traditional biomedical model may explain why,
despite advances in knowledge and understanding of the neurophysiological mecha-
nisms involved with nociception and pain, there are still no treatments available that
consistently and permanently alleviate pain for all those afflicted (Turk, Wilson, &
Cahana, 2011).
Predictors of chronicity continue to be a major focus of research, and evidence
has consistently revealed that psychosocial variables are better predictors of disability
and response to treatment than physical ones (e.g., Benyon, Hill, Zadurian, & Mallen,
2010; Carragee, Allamin, Miller, & Carragee, 2005; Jarvik et al., 2005). Identifica-
tion of psychosocial predictors holds promise for prevention and early intervention
in order to prevent chronicity and disability. Comprehensive psychosocial assessment
has become accepted as essential prior to surgery and implementation of spinal cord
stimulators and implantable drug-delivery systems.
Exciting developments that have appeared in the literature demonstrate the di-
rect effects of psychological variables on physiological parameters associated with
pain (e.g., Baranto, Hellstrom, Cederlund, Nyman, & Sward, 2009; Jensen et al., 2012;
Kucyi et al., 2014). Psychosocial factors are no longer secondary phenomena; they play
a mechanistic role in the anatomy and physiology of pain. Moreover, the role of psy-
chosocial factors in predicting pain onset, remission, and disability (e.g., Carragee et
al., 2005; Jarvik et al., 2005; Severeijns, Vlaeyen, Kester, & Knottnerus, 2001), and re-
sponse to treatment (e.g., Benyon et al., 2010; Smeets, Vlaeyen, Kester, & Knottnerus,
2006; Thomee et al., 2008), along with concerns about medication coupled with in-
creasing evidence to support the positive outcomes reported for many psychological
interventions (e.g., Eccleston, Palermo, Williams, Lewandowski, & Morley, 2009;
Henschke et al., 2010; Hoffman, Papas, Chatkoff, & Kerns, 2007; Williams, Eccleston,
& Morley, 2012), all support the importance and timeliness of this current volume.
The results of these research studies have contributed to the growing number of calls
for the use of nonpharmacological treatments as alternatives, if not adjuncts, to drugs
(e.g., Buckhardt et al., 2005; Chou et al., 2007; Institute of Medicine, 2011).
More cost-effective and not just clinically effective interventions are being driven
by changes in health care, with concerns about cost containment. The emphasis in
all treatments is on “streamlining” and efficiency, with cost being a critical driver
and outcome consideration. Greater attention is being devoted to the development and
evaluation of advanced technologies (e.g., Web-based, smartphone-delivered applica-
tions), not only to be efficient and to reduce costs, but also potentially to increase
access and to enhance adherence to treatment recommendations and maintenance of
benefits.
Despite the advances noted here and throughout this volume, the traditional medi-
cal model has not, in general, relinquished its firm grasp on the thinking of medical
providers, the health care system, and payers. We would be remiss if we did not ac-
knowledge what we have labeled the “evidence-based paradox.” Despite the growing
calls for evidence, even though there is more clinical and cost evidence for the effec-
tiveness of psychological treatments, relative to any of the alternatives (e.g., Gatchel
& Okifuji, 2006; Hoffman et al., 2007; McCracken & Turk, 2002; Turk & Theodore,
2011), health care providers tend to be resistant to considering psychosocial interven-
 Preface xiii

tions, and payers demonstrate a significant lack of willingness to cover these treat-
ments. We believe this is likely to change given the concerns about the inadequacy, if
not outright pernicious effects, of more traditional medical treatments. Mental health
providers need to keep abreast of the growing literature and to use it as supporting evi-
dence for the services they offer. It will be incumbent on them to demonstrate that they
follow the guidelines described throughout this volume as to the standards of care, and
also cite evidence for the clinical effectiveness and cost-effectiveness of the treatments
they provide, because payers may not be familiar with such evidence.
The state of pain management has not changed significantly in the 15 years since
the publication of the previous edition of this volume. Concerns about misuse and
abuse of medications, however, are leading to a call for better assessment to predict
misuse, and for alternatives to drugs with abuse potential. Also, psychosocial treat-
ments are gaining renewed and growing interest as more than just adjuncts of phar-
macological interventions. Even when medications are indicated, the interrelationship
between somatic and psychosocial factors supports more integrated approaches to
treatment. Indeed, although individuals with diverse chronic pain syndromes have
much in common, there are unique characteristics that require attention specific to the
problem associated with the disease or condition. For example, patients with occupa-
tional injuries have concerns about their ability to return to work; those with amputa-
tions must deal with particular limitations associated with the physical impairments
posed by limb loss; individuals with chronic pelvic pain must deal with problems
associated with sexuality and sexual function; individuals with cancer have to cope
with fears of dying, disfigurement, and dependence; and people who have sustained
injuries in automobile collisions must face their fears of driving, reinjury, and legal
ramifications, all in addition to problems created by the presence of persistent pain.
Thus, despite the fact that the psychosocial treatments described have been used for
some time now, they need to be customized to the unique patient populations and, as
always, to each unique patient.
We have presented many workshops and have given numerous lectures describ-
ing psychological approaches to pain management. We have also received many com-
ments on the two previous editions of this volume. What we have learned is that most
providers are interested in going beyond overviews and academic discussions of the-
ory and general principles. They seek specific and practical strategies and methods
as to how to address their specific patients, and the common problems they confront
in treating the patients in their practices. Whereas some spend the majority of their
time providing services to pain patients, others are increasingly receiving referrals
of patients who have diverse chronic pain disorders, especially given the growing
concerns about medication misuse and abuse by those patients. These providers raise
questions about how to motivate patients; how to most effectively and efficiently
evaluate these patients; how to select the most appropriate treatment options among
the variety of available psychosocial treatment approaches; when and how to involve
their patients’ significant others; what are successful strategies to increase adherence
to treatment recommendations; how to design appropriate homework assignments;
how best to address problems of relapse and flare-ups; and what are good strategies
regarding follow-up; among many others. Essentially, they are seeking not only what
to do but also how to do it. Thus, in planning this edition, as well as the previous
xiv Preface

editions, we had had two driving considerations: (1) to bring together experts and
masterful clinicians who have direct clinical experience with the most common and
difficult chronic pain diagnoses; and (2) to instruct all contributors about the need
to provide specific and practical information and guidance to practitioners who will
be treating patients with these various conditions, regardless of these practitioners’
levels of experience.
In order to facilitate the second consideration and to provide unique value to
readers of this edition, we requested that contributors include in each chapter a text
box that presents practical “Clinical Highlights” of the material covered in a succinct
fashion. Specifically, these boxes address what a provider should keep in mind when
treating patients with the diagnosis covered in the chapter, and when applying any of
the psychosocial treatments described. We directed authors to write these “Clinical
Highlights” boxes to provide a quick review for practitioners, assuming that the chap-
ter may have been read some time prior to actually treating their patients. We hope this
addition will prove to be a particular benefit to readers, and we welcome your com-
ments to improve our future efforts.
Since the publication of the second edition of this volume, there have been as-
tronomical advances in many important areas, such as better understanding of the
genetics and neurophysiology of pain and the experience of living with persistent pain;
the roles and nature of a range of psychosocial, behavioral, and contextual factors in
the onset, maintenance, and exacerbation of pain; responses to, and acceptance of,
treatment; adherence to treatment recommendations; and retention of benefits of treat-
ment over time. Moreover, there is mounting evidence of the clinical effectiveness and
cost-effectiveness of various nonpharmacological treatments as monotherapies and
when combined with more traditional medical interventions. Inertia continues to be
a constraint, and significant challenges remain despite the advances to which we al-
lude here. Few patients are “cured” by the available treatments, and the majority of
patients, regardless of the treatment sophistication, continue to experience some level
of pain and related symptoms with which they will have to learn to live, and to better
“manage.” Thus, we need to move away from an overly simplistic “curative” model of
treatment, toward a more realistic “management” model. This requires courage, self-
control, and a considerable degree of resilience. Psychological approaches may help in
this process of working with patients to enhance their ability to better manage their
lives as effectively as possible, despite the residual symptoms. We focus in this volume
on how to help patients achieve such management outcomes.
Health care is evolving at a dizzying pace. There is greater and greater reliance on
empirically based outcomes that focus not only on cost but also on patient satisfaction
and efficiency, as well as clinical effectiveness. As a consequence, it is no longer pos-
sible to justify treatment based solely on beliefs and assertions. The plural of anecdote
is not accepted as data or evidence anymore. We hope the information presented in this
volume may serve as “antidotes” to these limited and non-data-based anecdotes. But,
as noted earlier, even evidence may not be sufficient without taking into consideration
cost and availability of providers of treatments with demonstrated efficacy.
We have attempted to cover the topics outlined in this edition, with an emphasis
on innovations, expanded knowledge, and opportunities created, all with an eye to-
ward practical clinical utility and efficiency. In an effort to balance “what to do” and
 Preface xv

“how to do it” of various treatment approaches with different painful conditions, and
the need for a rational conceptual basis and demonstrated evidentiary base, we have
organized the volume into three sections.
Part I, Conceptual, Diagnostic, and Methodological Issues (Chapters 1–3), sets
the foundation for the various treatment approaches described. Chapter 1 presents an
integrated biopsychosocial perspective that is critical to understanding chronic pain,
individuals experiencing pain, and the impact of pain, regardless of the specific condi-
tion or treatment. The second chapter establishes the interrelationship among psycho-
logical disorders and chronic pain, considering the causal connections between physi-
cal and mental health. Chapter 3 provides important insights into outcomes research
and offers suggestions for how to conduct, critically evaluate, and interpret published
reports of treatment outcome studies and communicate these results to policy and
payer decision makers.
Part II, Treatment Approaches and Methods (Chapters 4–14), focuses on impor-
tant topics and models that transcend specific pain conditions. There is no question
that patient motivation is essential, regardless of the treatment approach adopted.
Chapter 4 describes a model for facilitating patient motivation. Chapters 5 and 6 de-
scribe the rationale and detailed methods of two of the most common psychologi-
cal perspectives and approaches, namely, behavioral (e.g., operant conditioning) and
cognitive-­behavioral, to treating individuals with chronic pain. Chapters 7–9 describe
several specific psychological techniques—biofeedback, hypnosis, exposure-based
desensitization—that can be adapted for use in patients with any number of different
pain conditions described in Part III. Chapters 10 and 11 address particular modes of
treatment delivery—­group and family involvement. There are unique benefits to treat-
ing patients in groups, both in terms of efficiency and the power of group dynamics.
But there are logistical trade-offs that need to be overcome in organizing groups. Indi-
viduals with chronic pain, like most people, do not live in isolation but in a social con-
text. Moreover, the vast majority of chronic pain patients—by definition, people with
conditions that extend over long periods of time—will continue to experience pain
long after the conclusion of formal treatment. Consequently, significant others play
important roles in maintaining the benefits derived during treatment, and in generaliz-
ing the positive outcomes beyond the clinical setting. Involvement of significant others
can enhance long-term maintenance; however, one cannot forget that significant oth-
ers can also be potential impediments and undermine treatment. Thus, it is important
to educate them about their potential impact. Greater attention is being given to the
additive, if not synergistic, potential of such combinations. Chapter 12, a new chapter
in this volume, addresses a concept that has been neglected but has aroused growing
interest, “resilience”—an individual’s ability to function and even thrive despite the
presence of circumstances (i.e., chronic pain) that unquestionably create significant
problems in all domains of life (physical, emotional, behavioral, and social). Facilita-
tion and enhancement of a patient’s sense of resilience can result from psychosocial
treatments that, in general, can transcend any specific modality. Recently, two particu-
lar treatment approaches have centered on the concept of resilience—mindfulness-
based stress reduction (MBSR) and acceptance and commitment therapy (ACT). Both
of these approaches, variants of cognitive-behavioral therapy (CBT), are described in
this new chapter. There is growing evidence that monotherapies, whether pharmaco-
xvi Preface

logical, interventional, or psychological, do not eliminate the problem of pain for many
patients and that combinations of treatment with different emphases may be necessary.
Chapter 13 describes an approach to integrating pharmacological and psychological
treatment.
As noted previously, there are rapid technological developments in forms of com-
munication with the advent of the Internet and smartphones. These technologies are
providing tremendous clinical opportunities, and they will unquestionably escalate in
the coming years. Closing out this section, another new chapter in this edition, Chapter
14, describes some of the advances made possible by technologies in treating patients
directly, facilitating adherence, and enhancing maintenance.
Part III, Specific Pain Conditions and Populations (Chapters 15–30), covers sec-
ondary assessment, prevention, and treatment of populations at the extremes of the
lifespan (i.e., children and the growing number of elderly adults), and with many of
the most common pain syndromes and comorbidities. Awareness of, and methods to
address, the complexities involved in treating the diversity of chronic patients are cov-
ered in depth throughout Part III. The authors of the chapters provide insights and
make suggestions to increase the likelihood of achieving the best outcomes with these
unique groups.
There is growing evidence demonstrating the importance of patient selection
when implementing interventional modalities (i.e., surgery, spinal cord stimulators,
implantable drug delivery systems). Chapter 15 describes the expanding role that men-
tal health professionals may play, and the methods they may use in assessing chronic
pain patients for whom these interventions are being considered. Chapters 16–26 pro-
vide detailed discussion and case examples describing the treatment of patients with
specific and prevalent chronic pain syndromes (i.e., back pain, headaches, fibromyal-
gia, whiplash-associated disorders, temporomanidbular disorders, pelvic pain, func-
tional gastrointestinal disorders, cancer, and unexplained somatic symptoms). As we
noted earlier, there are commonalities among patients with different pain conditions,
yet there are unique problems that must be addressed for each specific syndrome.
These chapters address both the commonalities and the specific features that must be
targeted to successfully treat patients with each particular pain condition.
Chapters 27 and 28, also new to this volume, cover the treatment of patients with
comorbid psychological disorders and chronic pain (i.e., posttraumatic stress disor-
der and substance use disorders). There is a growing number and awareness of these
comorbid and challenging patients. Treatment of these groups requires particular sen-
sitivities and approaches. Concluding this section, Chapters 29 and 30 describe the
treatment needs of children and elderly adults. Although the same psychological prin-
ciples apply across the span of life, the methods used to treat elderly adults and very
young patients create unique challenges, and require special skills and sensitivity for
presentation and delivery.
It is our intention that this volume bridge the gap between clinical research and di-
rect application to the clinical environment. In addition to completely updating topics
and treatment approaches described in the previous editions, as previously noted, we
have added a new chapter regarding the potential of advanced technologies to improve
efficiency, treatment outcomes, and associated costs, as well as chapters covering
emerging problems related to comorbidity among patients with chronic pain. These
 Preface xvii

topic areas adhere to the National Institutes of Health’s emphasis on the importance
of the “transfer of technology” from basic research to clinical populations in the “real
world.” In a complementary way, the Institute of Medicine’s (2011) report on reliev-
ing pain in America has called for a “cultural transformation” that addresses societal,
educational, and patient needs related to pain and its treatment. We hope this volume
will contribute to these cultural and clinical transformation themes regarding pain
treatment.
Each of the contributors to this volume is a seasoned clinician who is widely
regarded as an expert in his or her field. Chapter authors were carefully selected in
an effort to assist in the dissemination of information for use in the “real world” of
the management of patients with chronic pain, and the health care environment more
broadly. We believe this handbook will be of particular relevance and value to clini-
cians, whether they treat only a small number of pain patients or the majority of their
practices are centered on this population. The specificity of this shared clinical wis-
dom should also make the text valuable to students and those new to the field of chron-
ic pain. Each chapter also provides evocative and practical guidelines. We believe the
content will help practitioners, regardless of their experience or training, to better un-
derstand the most appropriate and heuristic ways of thinking about, and working with,
their patients, and interfacing with the health care and payer environment. Careful
attention to the insights provided should facilitate clinical interactions and contribute
to better outcomes. Moreover, the specific elements of treatments presented should
inform clinical investigators, and also potentially suggest avenues of future clinical
research to ultimately improve treatment options, and, thereby, the lives of the millions
of individuals who experience chronic pain.
As always, we welcome your comments and suggestions for improving our ef-
forts.

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 Contents

PART I. CONCEPTUAL, DIAGNOSTIC, AND METHODOLOGICAL ISSUES

1. Biopsychosocial Perspective on Chronic Pain 3

Dennis C. Turk and Elena S. Monarch

2. Psychological Disorders and Chronic Pain: 25

Are There Cause-and-Effect Relationships?
Eric Salas, Nancy Kishino, Jeffrey Dersh, and Robert J. Gatchel

3. Conducting and Evaluating Treatment Outcome Studies 51

Amanda C. de C. Williams and Stephen Morley

PART II. TREATMENT APPROACHES AND METHODS

4. Enhancing Motivation to Change in Pain Treatment 71

Mark P. Jensen

5. Operant and Related Conditioning with Chronic Pain: Back to Basics 96

Steven H. Sanders

6. A Cognitive-Behavioral Perspective on the Treatment 115

of Individuals Experiencing Chronic Pain
Dennis C. Turk

7. Introduction to Biofeedback Training for Chronic Pain Disorders 138

John G. Arena and James D. Tankersley

xix
xx Contents

8. Clinical Hypnosis in the Treatment of Chronic and Acute Pain 160

Lindsey C. McKernan, Michael R. Nash, and David R. Patterson

9. Exposure In Vivo for Pain-Related Fear 177

Johan W. S. Vlaeyen, Marlies den Hollander, Jeroen de Jong,
and Laura Simons

10. Group Therapy for Patients with Chronic Pain 205

Francis J. Keefe, Pat M. Beaupre, Meredith E. Rumble,
Sarah A. Kelleher, and Alyssa N. Van Denburg

11. Treating Adults with Chronic Pain and Their Families: 230
Application of an Enhanced Cognitive-Behavioral Transactional Model
Hallie Tankha, Robert D. Kerns, and Annmarie Cano

12. Facilitating Patient Resilience: Mindfulness-Based Stress Reduction, 250

Acceptance, and Positive Social and Emotional Interventions
John A. Sturgeon and Beth D. Darnall

13. Integration of Pharmacotherapy with Psychological Treatment 264

of Chronic Pain
Peter B. Polatin, Noor M. Gajraj, and Howard Cohen

14. Using Advanced Technologies to Improve Access to Treatment, 289

to Improve Treatment, and to Directly Alter Experience
Christopher Eccleston, Abby Tabor, and Edmund Keogh

PART III. SPECIFIC SYNDROMES AND POPULATIONS

15. Evaluating Patients for Neuromodulation Procedures 303

Daniel M. Doleys and Leanne R. Cianfrini

16. Strengthening Self-Management of Low Back Pain in Primary Care: 319

An Evolving Paradigm
Benjamin H. Balderson, Sheri D. Pruitt, and Michael Von Korff

17. A Cognitive-Behavioral Approach to Early Interventions 340

to Prevent Chronic Pain-Related Disability
Steven James Linton

18. Occupational Musculoskeletal Pain and Disability 357

Christopher T. Ray, Robert J. Gatchel, Ryan Hulla, and Anna Wright Stowell

19. Recurrent Headache Disorders 377

Todd A. Smitherman, Alexander J. Kuka, Dawn C. Buse,
and Donald B. Penzien
 Contents xxi

20. Treatment of Patients with Fibromyalgia 398

Dennis C. Turk

21. Treatment of Patients with Whiplash-Associated Disorders 425

Michele Sterling

22. Treatment of Patients with Temporomandibular Disorders 439

Angela Liegey Dougall, Lynette Watts, and Robert J. Gatchel

23. Treating the Patient with Genito-Pelvic Pain 458

Sophie Bergeron, Natalie O. Rosen, and Serena Corsini-Munt

24. Treating Patients with Functional Gastrointestinal Pain Disorders 473

Miranda A. L. van Tilburg and William E. Whitehead

25. Treating Cancer Patients with Persistent Pain 485

Chelsea Ratcliff and Diane Novy

26. Treating Patients with Somatic Symptom and Related Disorders 499
Don McGeary, Cindy McGeary, and Paul Nabity

27. Treating Patients with Posttraumatic Stress Disorder and Chronic Pain 515
Laurie D. Wolf and John D. Otis

28. Management of Chronic Pain in Patients with a Comorbid 530

Substance Use Disorder
Benjamin J. Morasco, Travis I. Lovejoy, and Mark A. Ilgen

29. Treating Children and Adolescents with Chronic Pain 541

Emma Fisher, Rachel V. Aaron, and Tonya M. Palermo

30. Treating Older Patients with Persistent Pain 556

Thomas Hadjistavropoulos

Index 569
 PA RT I

CONCEPTUAL, DIAGNOSTIC,
AND METHODOLOGICAL ISSUES
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