Cognitive Behavioral Therapy and Chronic Pain (A Literature Review)
Background
Many dimensions across the biopsychological spectrum are essential in managing nonspecific chronic low back pain (NSCLBP). O’Sullivan, et al (2015) in their research report indicates that NSCLBP is still a costly musculoskeletal syndrome, with real treatment remaining subtle. Albeit the movement traits and body perceptions of individuals with the problem is different from those of pain-free controls, with many physical interventions revealing limited effectiveness. There is increasing proof that psychosocial factors, involving depression, fear, anxiety, catastrophizing, negative beliefs, distress, in addition to maladaptive coping, are related to disabling NSCLBP deficiencies.
Introduction
O’Sullivan, et al (2015) noted that psychosocial or educational interventions have been applied in the treatment of this syndrome with moderate success. It should be further noted that decreased disability after rehabilitation is fundamentally associated to improvements in anxiety, fear, self-efficacy, as well as catastrophizing. Nonetheless, the impact size of psychologically and educational based behavioral therapies is still relatively little, with inadequate long-term effectiveness, and distinct exercise and behavioral treatments seem to be equally effective. Similar sentiments are shared by Trafton, et al (2012) who noted that chronic pain is common and can lead to management challenges for primary care. The authors further state that management of pain might be specifically challenging in patients with HIV and comorbidities. Trafton, et al (2012) discovered that sixty to seventy five percent of HIV-positive patients undergo pain from non-HIV- and HIV-related circumstances. The effect involves psychological distress, increased depression, reduced functional ability, health care operation, and quality of life. Recommending anti-inflammatory and opioid medications is in most cases the preliminary and fundamental response regarding chronic pain reports in medical care.
Delegate your assignment to our experts and they will do the rest.
Analysis
Literature reveals that one latent alternative, cognitive-behavioral therapy-based pain management (CBTPM) has portrayed efficacy in patients with particular pain conditions and in patients manifested with HIV/AIDS. Such patients who completed all sessions revealed essential improvement in pain concentration in addition to pain-related functional distress and interference, nonetheless, over fifty percent of the patients did not attend all sessions. Therefore, prior studies portrayed the efficiency of CBTPM but increase concerns that patients may not receive a full dose of the projected treatment. Cognitive functional therapy (CFT) defined by O’Sullivan, et al (2015) as a novel, individual-centered behavioral intercession that evaluates multiple dimensions in NSCLBP. This treatment combines a functional behavioral method of normalizing stimulating movements and postures whereas discouraging pain traits, with perceptive reconceptualization of the problem. CBTPM might evade problems related with anodynes in the HIV-positive populace.
Research indicates that the same may provide pain reprieve with no risks of drug interactions, medical complications, tolerance, addiction, diversion, and side effects associated with presently applied analgesics. Trafton, et al (2012) hypothesis noted that by assimilating CBTPM into HIV health centers, mental health, pain, and functioning outcomes would improve. CBTPM has seldom been executed outside of comprehensive pain treatment health institutions. Studies reveal that lack of psychology experts in primary care may have limited execution of this low-risk and efficacious treatment.
Materials and Methods
Participants were recruited from 3 local health care consultant clinics, including 2 chronic pain centers and 1 rheumatology center. All members were on the public health service awaiting lists, either awaiting medicinal intervention after their preliminary appointment or those with schedules with the medical staff. The research required legible participants to report NSCLBP of not less than half a year, their NSCLBP must have been present in the prior week and the lower back had to be reported as their fundamental location (Trafton, et al, 2012). Members’ NSCLBP must also have correlated with their function they provided lessened activity levels or medication in the prior year. In the methods section, a multiple case-cohort study involving three phases (A1-B-A2) was performed. The first phase involved a baseline measurement whereby no new interference was conducted. In this phase, individual-reported foundation measurements of functional and pain disability was performed for all members on three separate instances six weeks apart. In phase B, the research section participated in CFT interference. The duration of the intervention phase ranged in a pragmatic manner, founded on the progression of members, but involved a minimum time span of six weeks (O’Sullivan, et al, 2015). The last stage lasted a year, including follow-ups at 3, 6, and 12 months after conclusion of the treatment.
Results and Discussion
Participants were self-referred in response to clinical handouts. 31 treatment-ineligible and 70 CBTPM patients registered. One treatment-ineligible and one CBTPM succumbed to non-study-related grounds. Nine CBTPM participants withdrew from the research, and therefore, their information could not be recorded. Four withdrew because they had no time, two lost contact before baseline interview, one moved, and two became extremely sick to take part. Trafton, et al (2012) discovered that CBTPM portrayed efficiency for improving pain and functioning in HIV patients that concluded the program. The results further revealed that a little percentage of patients concluded the program leading to questions about the helpfulness of CBTPM into primary treatment in HIV medicine. This was a study aimed at exploring the impact and feasibility of executing CBTPM into principal treatment in three public HIV clinics. On the other hand, studies conducted by O’Sullivan, et al (2015) involved a multiple cohort study revealing that CFT, a novel, individual-centered multidimensional involvement, highly lessened functional pain and disability among persons with disabling NSCLBP.
Therapeutic Improvement
Providing CBTPM was associated with momentous improvements in pain-related functioning, pain, negative effect, pain acceptance, and illegal drug use in CBTPM patients. Studies further revealed that both treatment-ineligible and CBTPM participants’ portrayed improvements in pain-allied anxiety which might have been the result of repetitive administration of the valuation instrument or effects related to clinic-level impacts of implementation executing the intervention. Trafton, et al (2012) noted that treatment-ineligible participants portrayed significant alterations in pain acceptance and intensity from baseline despite the inconsistency of the changes over time. Perceived effect sixes for pain results were of greater or similar magnitude as those indicated in literature for short term care with opioid or some other anesthetics.
Causes of Changes
Regardless of incomplete care attendance, all participants received exposure to CBTPM thanks to the CD-ROM and manual for self-study provided. Some poor participants briefly reported using CD and manual on a frequent basis. Treatment-ineligible participants might have indirectly undergone some impacts of the CBTPM ( Turner, Holtzman & Mancl, 2007). Researchers noted albeit the assessments do not provide care and treatment, the instruments contain information on distinct methods to perceive mental health conditions or pain that are the objective for cognitive therapies. Therefore, individual-study activities, assessment activities, clinic practice modifications, and not just group attendance, might have been the cause for the experienced improvements in both groups as time elapsed. In support that the impacts were associated with CBTPM, the design of changes noted in the CBTPM category was significantly and greatly correlated with expert expectations. O’Sullivan, et, al (2015) had earlier predicted the probable impacts at twelve weeks, and associations between expected and actual alterations in the CBTPM category were the greatest at this juncture. In addition, impacts were experienced at all participating clinics, and clinical performance noted in treatment-ineligible participants over a similar period was minimal.
Limitations
The shortcoming for Trafton, et al (2012) research includes the fact that it cannot provide that this process led to the observed alterations in results due to application of a pre-post design. This design selection was intentional and picked to permit the clinics to offer care to all eligible participants in addition to maximizing real-world validity of the interpretations on global patient impact and clinical feasibility. Whereas internal validity may be adversely impacted because of this framework, external validity is improved to reveal real-world impact of this form of program. Conversely, rehabilitation with CBT can be improved to accentuate psychological or physical factors according to their relative dominance in all individuals ( Wetherell , et al, 2011). For instance, CBT has previously been applied with a heightened accentuation on addressing physical traits when indicated. This method limits generalizability, in spite of the fact that it lessens the risks of contradictory advice provided by distinct health care experts.
References
O'Sullivan, K., Dankaerts, W., O'Sullivan, L., & O'Sullivan, P. B. (2015). Cognitive functional
therapy for disabling nonspecific chronic low back pain: multiple case-cohort study. Physical therapy , 95 (11), 1478-1488.
Trafton, J. A., Sorrell, J. T., Holodniy, M., Pierson, H., Link, P., Combs, A., & Israelski, D.
(2012). Outcomes associated with a cognitive-behavioral chronic pain management program implemented in three public HIV primary care clinics. The journal of behavioral health services & research , 39 (2), 158-173.
Turner, J. A., Holtzman, S., & Mancl, L. (2007). Mediators, moderators, and predictors of
therapeutic change in cognitive–behavioral therapy for chronic pain. Pain , 127 (3), 276-286.
Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., Petkus, A. J., ... &
Atkinson, J. H. (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain , 152 (9), 2098-2107.
