Journal CME, August 2023: Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers-Journal CME, August 2023: Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers

Journal CME, August 2023: Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers

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The article "Opening the Black Box of Psychological Treatments for Chronic Pain: A Clinical Perspective for Medical Providers" discusses the importance of incorporating psychological interventions in the treatment of chronic pain alongside medical options. Chronic pain significantly affects physical, psychological, and social functioning and incurs substantial health care costs. The National Pain Strategy calls for better training for providers in the biopsychosocial aspects of chronic pain management. Psychological treatments, though underutilized, have shown effectiveness in reducing pain, enhancing global functioning, and improving the quality of life.<br /><br />The biopsychosocial model integrates biological, psychological, and social factors, offering a comprehensive understanding of chronic pain. Psychological interventions like Cognitive Behavioral Therapy (CBT), Pain Education, Mindfulness, Acceptance and Commitment Therapy (ACT), Clinical Hypnosis, and Biofeedback are highlighted. These interventions variously target pain-related thoughts, behaviors, and physiological responses, emphasizing self-management, skill development, and behavior change to improve patient functioning.<br /><br />Examples provided include:<br />1. **Pain Education**: Educates patients on pain mechanisms and self-management.<br />2. **Cognitive Behavioral Therapy (CBT)**: Focuses on changing maladaptive thoughts and behaviors.<br />3. **Mindfulness**: Promotes a nonjudgmental focus on present experiences.<br />4. **Acceptance and Commitment Therapy (ACT)**: Enhances psychological flexibility and engagement in valued activities.<br />5. **Clinical Hypnosis**: Uses suggestive techniques to alter pain perception.<br />6. **Biofeedback**: Provides real-time physiological feedback to help patients manage stress responses.<br /><br />The article also stresses the importance of the patient-provider relationship and effective communication. Validation of the patient’s pain experience and clear explanations about treatment options can improve satisfaction and adherence. Providers are encouraged to facilitate psychological care by referring patients to mental health professionals and considering comprehensive treatment programs like Functional Restoration Programs (FRPs) for more severe cases. Integrating these practices into standard care can lead to better patient outcomes and more effective pain management.

Keywords

chronic pain

psychological interventions

biopsychosocial model

Cognitive Behavioral Therapy

pain education

Mindfulness

Acceptance and Commitment Therapy

Clinical Hypnosis

Biofeedback

patient-provider relationship