Post Mid Assignment 1

Summary & Critical Evaluation of the Article

Submitted to: Miss Rameesha Arif

Submitted by: Emania Fatima Adan

Major course: Health Psychology

Section: 8 (B)

Submission date: May 3, 2023

Kinnaird College for Women, Lahore.

 “Psychological therapies for the management of chronic pain”

Chronic pain is a debilitating condition that affects millions of people worldwide, and

traditional pain management approaches such as medication and physical therapy often have

limited effectiveness. In recent years, psychological therapies have emerged as a promising

approach to chronic pain management, as they address the psychological and emotional factors

that contribute to pain experience and disability. In this article, Sturgeon reviews the literature on

the use of psychological therapies for chronic pain management and highlights their potential

benefits, limitations, and challenges. The article begins with an introduction that provides an

overview of the prevalence and impact of chronic pain, and highlights the need for effective pain

management strategies that go beyond traditional medication and physical therapies.

Furthermore, chronic pain lowers quality of life10 and contributes to higher levels of

disability. Individuals with chronic pain are also more prone to obesity, sleep disturbance and

fatigue have higher rates of medical utilization and are more prone to problematic pain

medication usage. The psychological therapies have gained increasing attention in recent years,

as they have been found to improve pain coping skills, decrease pain intensity and interference,

and reduce psychological distress. A negative cognitive and emotional mental set associated to an

anticipated or actual experience of pain is known as "pain catastrophizing." Numerous forms of

dysfunction have been linked to pain catastrophizing, such as higher rates of depression and

anxiety, greater functional impairment and disability brought on by pain and lower overall

quality of life.

The next section of the article provides a detailed review of the literature on the use of

psychological therapies for chronic pain management. The author discusses some major types of

psychological therapies that have been found to be effective in reducing pain and improving
quality of life for individuals with chronic pain: operant behavioral approaches, cognitive-

behavioral therapy (CBT), relaxation techniques, mindfulness-based interventions, and

acceptance and commitment therapy. The author notes that these therapies share a common focus

on modifying pain-related thoughts, emotions, and behaviors, and that they can be delivered

individually or in group settings.

Operant behavioral approaches are a drive to avoid pain which causes people to avoid

unpleasant behaviors while maintaining their physical and mental health; this avoidance

contributes to the emergence and maintenance of chronic pain, deconditioning, and depression. A

recent application of learning theory is the in vivo treatment. Through gradually increasing

engagement in painful behaviors without severe negative results, in vivo exposure therapy

eliminates threat, fear, and behavioral avoidance. When these behaviors are carried out without

serious negative outcomes, patients may realize that their expectations about the effects of

physical movement and pain are unreal. Cognitive-behavioral therapy (CBT) takes a

biopsychosocial approach to the treatment of chronic pain by focusing on maladaptive behavioral

and cognitive responses to pain as well as social and environmental factors that influence pain

reactions. CBT for pain teaches coping skills to manage pain and improve psychological
functioning, such as structured relaxation, behavioral activation and scheduling of pleasurable

events, assertive communication, and behavior pacing to avoid pain flare-ups.

The goal of mindfulness-based therapies is to foster detached awareness of the physical

and psychological sensations occurring inside the body. It also aims to decouple the sensory parts

of pain from the evaluative and emotional aspects of pain. This dissociation may improve

individual responses to chronic pain since the chronic pain signal is frequently irreversible.

Through mindful awareness and meditation, it is possible to see thoughts about pain as discrete

events rather than as a sign of an underlying issue that calls for quick and potentially unhelpful

reactions. The recognition that these feelings or ideas are typical may help a person to lessen

emotional or unhelpful behavioral reactions to pain. According to the theory of ACT, reactions to

ideas can be adjusted in order to lessen their negative effects rather than targeting or changing

them. By purposefully and impartially acknowledging mental occurrences, ACT therapies

enhance wellbeing. By encouraging intentional awareness and acceptance of discomfort, ACT

lessens the emphasis on lowering pain or mental content and instead focuses on promoting

behavioral functioning.

It also mentions the findings from randomized controlled trials and other studies on the

effectiveness of psychological therapies for chronic pain management. The researcher identifies

that while the evidence base is still limited, there is growing support for the effectiveness of

psychological therapies in reducing pain and improving physical and psychological functioning.

The challenges associated with the use of psychological therapies for chronic pain management,

such as limited access to trained providers, high dropout rates and lack of insurance coverage are

also discussed. There is a lack of empirical information about the risks of psychological

treatments since it is assumed that psychological therapies for pain have a minimal chance of
having negative effects on the patient. However, when psychological therapies are administered

properly, these concerns are addressed by proper clinical and ethical training of practitioners and

are not typically regarded as significant risks.

Practitioners should be careful of assuming that patients with pain disorders are all the

same, since a range of characteristics might predict therapy response. Some of the factors

include:

Patient
characteriscit
cs

Health care
Pain related
system
factors
related
Factors affecting
the outcomes of
psychological
interventions.

Provider
Psychological
related

Treatment
related

 The patient's demographic characteristics, including age, gender, and cultural

background, can impact the effectiveness of psychological interventions. For example,

younger patients may be more receptive to interventions that involve technology or

online delivery, while older patients may prefer in-person interventions.

 The type and severity of pain, as well as the duration of pain, can influence the

effectiveness of psychological interventions. Patients with more severe pain may require
 more intensive interventions, while patients with chronic pain may benefit from

interventions that focus on acceptance and coping skills.

 The patient's psychological status, including depression, anxiety, and stress, can impact

the effectiveness of psychological interventions. Patients with comorbid psychological

disorders may require additional interventions to address these conditions.

 The type and intensity of psychological intervention, as well as the duration of treatment,

can impact its effectiveness. Patients may respond differently to individual versus group

interventions, or to interventions delivered in person versus online.

 The provider's training and experience, as well as their communication style and ability to

establish rapport with the patient, can impact the effectiveness of psychological

interventions. Patients may feel more comfortable with providers who share their cultural

background or who have personal experience with chronic pain.

 The availability and accessibility of psychological interventions, as well as insurance

coverage and reimbursement policies, can impact their effectiveness. Patients may face

barriers to accessing interventions due to geographic location, transportation, or financial

constraints.

Overall, these factors highlight the importance of individualizing psychological interventions

for chronic pain management and taking into account the unique needs and preferences of each

patient. By considering these factors, healthcare providers can optimize the effectiveness of

psychological interventions and improve outcomes for patients with chronic pain.

In conclusion, the article highlights the potential benefits of psychological therapies for

chronic pain management and emphasizes the importance of a multidisciplinary approach that

includes psychological interventions. The author notes that further research is needed to optimize
the effectiveness of these therapies and address the challenges associated with their

implementation. Overall, the article provides a comprehensive review of the literature on

psychological therapies for chronic pain management and highlights their potential to improve

the lives of individuals with chronic pain.

Strengths

 The article gives a thorough overview of psychological interventions for chronic pain

management, including various types of interventions and factors that can impact their

effectiveness.

 The article draws on a range of studies and meta-analyses to support its conclusions and

recommendations.

 The article provides practical recommendations for healthcare providers and patients,

such as individualizing interventions based on patient characteristics and preferences.

Weaknesses

 This article does not provide an in-depth analysis of any single intervention or approach.

 The article has a particular emphasis on cognitive-behavioral therapy and mindfulness-

based interventions, which may not be the best fit for all patients and shows biasness

towards other interventions.

 The article primarily draws on secondary sources such as meta-analyses and literature

reviews, rather than original research studies.

 References

Sturgeon, J. (2014) “Psychological therapies for the management of chronic pain,” Psychology

Research and Behavior Management, p. 115. https://doi.org/10.2147/prbm.s44762