Chronic pain is commonly defined as pain that endures past three months. It can result from injury or illness or unknown causes and often leads to significant emotional distress and interference in activities of daily life. The Centers for Disease Control and Prevention estimate that approximately 20% of US adults have chronic pain. Various conditions are characterized by and associated with chronic pain, such as back pain (e.g., low, mid, neck, etc.), arthritis (e.g., rheumatoid, psoriatic, osteoarthritis, etc.), fibromyalgia, complex regional pain syndrome, headaches (e.g., migraine, cluster, tension), and many others.
From a treatment perspective, chronic pain is best conceptualized as 1) a complex exchange among biological, psychological, and social factors and 2) a condition to be managed rather than a symptom to be eliminated. Current practice in the management of chronic pain is based on a biopsychosocial model, and a multidisciplinary approach is often the most effective. The federal Pain Management Best Practices Inter-Agency Task Force emphasizes that behavioral health approaches are fundamental to any interdisciplinary approach to chronic pain management. They list evidence-based behavioral health approaches to chronic pain management as including (but not limited to):
Cognitive-behavioral therapy (CBT): CBT for chronic pain focuses on helping patients understand the interrelationships among thoughts, behaviors, emotions, and their pain experience. It aims to identify and challenge unhelpful beliefs about pain, decrease behaviors that increase pain perception and develop behaviors that reduce or prevent it from worsening, establish social support, and cultivate self-efficacy for pain management. CBT for chronic pain also includes relaxation training and, if indicated, addresses sleep disturbances caused by chronic pain. The overall goal is to reduce the negative impact of chronic pain on daily life by identifying unhelpful patterns and establishing healthier ones.
Acceptance and commitment therapy (ACT): An ACT approach to chronic pain management is acceptance- and mindfulness-based. It emphasizes that a patient's struggle with chronic pain, rather than the physical pain itself, is what causes their suffering (Dahl & Lundgren, 2006). ACT for chronic pain aims to increase psychological flexibility around pain-related thoughts, emotions, and behaviors. Patients learn to act according to their core values despite physical pain. The goal is to experience life more fully by changing how one relates to one's pain.
Self-regulatory or psychophysiological approaches such as biofeedback and relaxation training: Biofeedback provides a patient with information about physiological responses to pain (e.g., increases in heart rate, muscle tension, or skin conductance) in real-time. Relaxation training is often part of a biofeedback training protocol and teaches patients how to elicit the body's parasympathetic ("relaxation") nervous system response. The overall goal of these approaches is to utilize the mind-body connection to increase awareness and control over physiological processes that impact both physical pain and psychological distress.
In summary, chronic pain significantly affects an individual's quality of life, impacting physical, psychological, and social factors. Behavioral health interventions are effective in improving the quality of life for individuals suffering from chronic pain. As mentioned above, these are a crucial part of any multidisciplinary approach to chronic pain management.
-Megan L. Wagner, Ph.D., BCB, & Biofeedback Program Director