Group treatment for pain and discomfort

doi:10.1016/0738-3991(93)90130-O

Patient Education and Counseling

Volume 20, Issues 2–3, May 1993, Pages 167-175

https://doi.org/10.1016/0738-3991(93)90130-O Get rights and content

Abstract

Rheumatic patients very often suffer from chronic pain and impairment and show psychological reactions as a consequence of their physical condition. These reactions may vary from psychophysiological symptoms to anger, anxiety, or depression. We developed a cognitive-behavioral treatment programme in a group setting format with components of relaxation, cognitive restructuring, and the promotion of well-being. Subjects included in the study were given diagnoses of low back pain, tension headache, rheumatoid arthritis, and ankylosing spondylitis. Treatment effects in different diagnostic groups were compared to each other, supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis. Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being.

References (46)

K.A. Appelbaum et al.
Cognitive behavioral treatment of a veteran population with moderate to severe rheumatoid arthritis
Behavior Therapy
(1988)
H.D. Basler et al.
Cognitive behavioural treatment in patients with ankylosing spondylitis in a German self-help group
Journal of Psychosomatic Research
(1991)
H. Flor et al.
Efficacy of multidisciplinary pain treatment centers: a meta-analytic review
Pain
(1992)
F.J. Keefe et al.
Behavioral approaches in the multidisciplinary management of pain: Programs and issues
Clinical Psychology Review
(1986)
F.J. Keefe et al.
Coping with rheumatoid arthritis pain: catastrophizing as a maladaptive strategy
Pain
(1989)
M.D. Malone et al.
Meta-analyis of non-medical treatments for chronic pain
Pain
(1988)
T.E. Rudy et al.
Chronic pain and depression: towards a cognitive-behavioral mediation model
Pain
(1988)
M.A. Shearn et al.
Stress management and mutual support groups in rheumatoid arthritis
The American Journal of Medicine
(1985)
J. Achterberg et al.
Rheumatoid arthritis: a study of relaxation and temperature biofeedback as an adjunctive therapy
Biofeedback and Self-Regulation
(1981)
K.O. Anderson et al.
Rheumatoid arthritis: review of psychological factors related to etiology, effects, and treatment
Psychological Bulletin
(1985)

H.D. Basler et al.

Psychologische Schmerztherapie in Rheuma-Liga-Selbsthilfegruppen

Zeitschrift fur Klinische Psychologie

(1989)

H.D. Basler et al.

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Psychology and Health

(1990)

L.A. Bradley

Psychological evaluation of the low back pain patient

L.A. Bradley et al.

Effects of cognitive-behavioral therapy on pain behavior of rheumatoid arthritis (RA) patients: preliminary outcomes

Scandinavian Journal of Behaviour Therapy

(1985)

L.A. Bradley et al.

Effects of psychological therapy on pain behaviour of rheumatoid arthritis patients

Arthritis and Rheumatism

(1987)

L.A. Bradley et al.

Effects of cognitive-behavioral therapy on rheumatoid arthritis pain behavior: one year follow-up

E. Brähler et al.

Der Giessener Beschwerdebogen (GBB)

(1983)

G.K. Brown

A causal analysis of chronic pain and depression

Journal of Abnormal Psychology

(1990)

M.A. Chamberlain

Socioeconomic effects of ankylosing spondylitis

International Journal of Rehabilitation Medicine

(1981)

P.G. Cornelissen et al.

The arthritis sufferer and the community: a comparison of arthritis sufferers in rural and urban areas

Annals Rheumatic Diseases

(1988)

R. Cziske et al.

Effekt eines Kurzzeitprogramms zur Schmerzbewältigung bei Rheumapatienten während der Rehabilitation

Zeitschrift fur Klinische Psychologie

(1987)

P. Elst et al.

Sexual problems in rheumatoid arthritis and ankylosing spondylitis

Arthritis and Rheumatism

(1984)

H. Flor

Empirical evaluation of a diathesis — stress — model of chronic pain

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Several studies have reported reduced cerebral gray matter (GM) volume or density in chronic pain conditions, but there is limited research on the plasticity of the human cortex in response to psychological interventions. We investigated GM changes after cognitive-behavioral therapy (CBT) in patients with chronic pain. We used voxel-based morphometry to compare anatomic magnetic resonance imaging scans of 13 patients with mixed chronic pain types before and after an 11-week CBT treatment and to 13 healthy control participants. CBT led to significant improvements in clinical measures. Patients did not differ from healthy controls in GM anywhere in the brain. After treatment, patients had increased GM in the bilateral dorsolateral prefrontal, posterior parietal, subgenual anterior cingulate/orbitofrontal, and sensorimotor cortices, as well as hippocampus, and reduced GM in supplementary motor area. In most of these areas showing GM increases, GM became significantly higher than in controls. Decreased pain catastrophizing was associated with increased GM in the left dorsolateral prefrontal and ventrolateral prefrontal cortices, right posterior parietal cortex, somatosensory cortex, and pregenual anterior cingulate cortex. Although future studies with additional control groups will be needed to determine the specific roles of CBT on GM and brain function, we propose that increased GM in the prefrontal and posterior parietal cortices reflects greater top-down control over pain and cognitive reappraisal of pain, and that changes in somatosensory cortices reflect alterations in the perception of noxious signals.
An 11-week CBT intervention for coping with chronic pain resulted in increased GM volume in prefrontal and somatosensory brain regions, as well as increased dorsolateral prefrontal volume associated with reduced pain catastrophizing. These results add to mounting evidence that CBT can be a valuable treatment option for chronic pain.
Prevalence of symptoms of anxiety and depression in patients with psoriatic arthritis attending rheumatology clinics
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Las alteraciones psicológicas son frecuentes entre pacientes con enfermedades reumáticas. El objetivo del estudio fue conocer la prevalencia de los síntomas de ansiedad y depresión en pacientes con artritis psoriásica que acuden a consultas de reumatología.
Estudio transversal multicéntrico en consultas de reumatología. Se seleccionaron pacientes con artritis psoriásica; se recogieron variables sociodemográficas, clínicas y centradas en el paciente (Escala Hospitalaria de Ansiedad y Depresión o HADs, cuestionario EQ-5D, etc.).
Se calculó la prevalencia de síntomas de ansiedad y depresión en esta población según una puntuación ≥11 en HADs o estar recibiendo tratamiento farmacológico. Se utilizó un modelo de regresión logística para conocer las variables relacionadas con la presencia de síntomas de ansiedad o depresión.
Se incluyeron 495 pacientes, 42,8% mujeres y edad media (DE) de 50,4 (12,7) años.
La prevalencia de síntomas de ansiedad fue 29,7% y 17,6% de depresión. Los pacientes con síntomas de ansiedad o depresión presentaron mayor afectación en todas las dimensiones del EQ-5D (p<0,01).
La mayor prevalencia en la población de estudio de ansiedad se relacionó con ser mujeres, patrón de debut mixto respecto al periférico y en tratamiento con FAME en monoterapia respecto a FAME+AINES o biológico en monoterapia. La mayor prevalencia de depresión se relacionó con ser mujeres y patrón de debut mixto respecto al periférico.
La prevalencia de síntomas de ansiedad y de depresión es elevada en pacientes con artritis psoriásica en la población de este estudio.
Psychological impairment is frequent in patients with rheumatic diseases. The aim of the study was to assess the prevalence of symptoms of anxiety and depression in patients with psoriatic arthritis attending rheumatology clinics.
Multicentre cross-sectional study conducted in rheumatology clinics. Patients with psoriatic arthritis were recruited; variables retrieved were sociodemographic, clinical and patient centered (Hospital Anxiety and Depression scale o HADs, EQ-5D questionnaire, etc.).
Prevalence in the study population was calculated as anxiety or depression symptoms by an HADs score ≥11 or those receiving pharmacological treatment. A logistics regression model was used to know which variables were related to symptoms of anxiety or depression.
A total of 495 patients were included, 42.8% were women and median (SD) age was 50.4 (12.7) years.
Prevalence of symptoms of anxiety were 29.7% and prevalence of symptoms of depression was 17,6%. Patients with anxiety or depression symptoms had all EQ-5D dimensions affected (p<0.01).
Higher prevalence of anxiety was related to being a woman, a mixed onset pattern with respect to peripheral joints and those treated with DMARD alone with respect to DMARD+NSAID or biologic alone. A higher depression prevalence was related to being a woman and a mixed onset pattern with respect to peripheral joints.
The prevalence of anxiety symptoms and the prevalence of depression symptoms are high among patients suffering psoriatic arthritis in the studied population.
Therapeutic interactive voice response (TIVR) to reduce analgesic medication use for chronic pain management
2010, Journal of Pain
This paper examines whether a telephone-based, automated maintenance enhancement program can help to reduce opioid and nonsteroidal anti-inflamatory drugs (NSAID) analgesic use in patients with chronic pain. Following 11 weeks of group cognitive-behavioral therapy (CBT), 51 subjects with chronic musculoskeletal pain were randomized to 1 of 2 study groups. Twenty-six subjects participated in 4 months of a Therapeutic Interactive Voice Response (TIVR) program in addition to standard follow-up care, while a control group of 25 subjects received standard follow-up care only. TIVR is an automated, telephone-based tool developed for the maintenance and enhancement of CBT skills. Opioid analgesic use decreased in the experimental group in both follow-ups: 4 and 8 months postCBT. In addition, at 8-month follow-up, 21% of the TIVR subjects had discontinued the use of opioid analgesics, 23% had discontinued NSAIDS, and 10% had discontinued antidepressant medications. In contrast, the control group showed increases in opioid and NSAIDS use. Analysis of covariance (ANCOVA) revealed significant between-group differences in opioid analgesic use at 8-month follow up (P = .004). We have previously demonstrated the efficacy of TIVR to decrease pain and improve coping; this analysis demonstrates that the use of TIVR may also result in concurrent reductions in opioid analgesic and NSAID medications use.
This article demonstrates that the Therapeutic Interactive Voice Response maintenance enhancement program can help to reduce opioid analgesic use in patients with chronic pain. This automated maintenance enhancement program could potentially assist patients not only to decrease pain and improve coping, but also to diminish the likelihood of opioid dependence.
Therapeutic Interactive Voice Response for chronic pain reduction and relapse prevention
2008, Pain
Citation Excerpt :
When cure is not possible and pain becomes chronic, self-management of pain is a valuable treatment option. There is considerable evidence that a course of 8–12 weekly group cognitive–behavioral therapy (CBT) offers significant therapeutic benefit to patients with persistent pain [2,3,5,37]. In their review of the behavioral and cognitive–behavioral therapy (BT-CBT) literature, McCracken and Turk [23] conclude that “BT-CBT for chronic pain reduces patients’ pain, distress, and pain behavior, and improves their daily functioning”.
We developed Therapeutic Interactive Voice Response (TIVR) as an automated, telephone-based tool for maintenance enhancement following group cognitive–behavioral therapy (CBT) for chronic pain. TIVR has four components: a daily self-monitoring questionnaire, a didactic review of coping skills, pre-recorded behavioral rehearsals of coping skills, and monthly personalized feedback messages from the CBT therapist based on a review of the patient’s daily reports. The first three components are pre-recorded and all four can be accessed remotely by patients via touch-tone telephone on demand. Following 11 weeks of group CBT, 51 subjects with chronic musculoskeletal pain were randomized to one of two study groups. Twenty-six subjects participated in 4 months of TIVR, while a control group of 25 subjects received standard care only. The TIVR group showed maximum improvement over baseline at the 8-month follow-up for seven of the eight outcome measures; improvement was found to be significant for all outcomes (p ⩽ .001). Between-group analysis of covariance (ANCOVA) revealed significantly greater improvement for the experimental group at both 4- and 8-month follow-ups for most of the outcomes. Results demonstrate that TIVR can be used to decrease pain, improve coping and decrease likelihood of relapse into pain behavior. Preliminary analysis of medication usage suggests that the superior outcome of the TIVR group was unlikely to be a consequence of differential medication use.
Biopsychosocial management of chronic low back pain patients with psychological assessment and management tools
2003, Physiotherapy
The volume of evidence questioning the efficacy of traditional treatment methods for chronic low back pain sufferers is equalled only by that condoning a more biopsychosocial approach to assessment and treatment. Unfortunately literature on this subject is often academic and does little to offer practical advice to clinicians on how they can apply psychosocial principles to practice. This paper briefly explores the reasons behind the increasing number of chronic back pain patients, reviews the psychological models relevant to understanding this client group, and offers basic practical advice on psychosocial assessment and treatment methods.
Automated telephone as an adjunct for the treatment of chronic pain: A pilot study
2002, Journal of Pain
Abstract: The objective of this study was to test whether Interactive Voice Response (IVR) can be used to enhance the therapeutic outcome of patients receiving group cognitive behavioral therapy (CBT) for chronic pain. Ten subjects with chronic pain syndromes participated in 10 weeks of group CBT followed by 4 months of Therapeutic Interactive Voice Response (TIVR). Our specially designed TIVR is based on a computerized telephone system in which callers are asked questions and respond by using the telephone keypad. It was created to reinforce pain coping skills and to provide messages for relaxation, sleep induction, and emotional support that can be accessed by patients on demand. Within-subject analysis showed that maximum positive change for nearly all outcome measures was observed at the post-TIVR point. For some measures, improvement compared to baseline was significant after TIVR despite the fact it had not been significant after CBT. Measures showing this pattern included SF-36 Mental Health Composite Score (P [lt ] .0004), McGill Pain Questionnaire pain (P [lt ] .01), Coping Strategies Questionnaire Catastrophizing (P [lt ] .0006), Treatment Outcomes in Pain Survey Total Pain Experience (P [lt ] .03), and Perceived Family/Social Disability (P [lt ] .02). Our preliminary results suggest that TIVR can be used to improve coping skills adherence and to prevent relapse into pain behavior. [copy ] 2002 by the American Pain Society

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Rheumatoid arthritis: a study of relaxation and temperature biofeedback as an adjunctive therapy

Biofeedback and Self-Regulation

Rheumatoid arthritis: review of psychological factors related to etiology, effects, and treatment

Psychological Bulletin

Psychologische Schmerztherapie in Rheuma-Liga-Selbsthilfegruppen

Zeitschrift fur Klinische Psychologie

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Psychology and Health

Psychological evaluation of the low back pain patient

Effects of cognitive-behavioral therapy on pain behavior of rheumatoid arthritis (RA) patients: preliminary outcomes

Scandinavian Journal of Behaviour Therapy

Effects of psychological therapy on pain behaviour of rheumatoid arthritis patients

Arthritis and Rheumatism

Effects of cognitive-behavioral therapy on rheumatoid arthritis pain behavior: one year follow-up

Der Giessener Beschwerdebogen (GBB)

A causal analysis of chronic pain and depression

Journal of Abnormal Psychology

Socioeconomic effects of ankylosing spondylitis

International Journal of Rehabilitation Medicine

The arthritis sufferer and the community: a comparison of arthritis sufferers in rural and urban areas

Annals Rheumatic Diseases

Effekt eines Kurzzeitprogramms zur Schmerzbewältigung bei Rheumapatienten während der Rehabilitation

Zeitschrift fur Klinische Psychologie

Sexual problems in rheumatoid arthritis and ankylosing spondylitis

Arthritis and Rheumatism

Empirical evaluation of a diathesis — stress — model of chronic pain

Development and evaluation of psychosocial intervention programs
Group treatment for pain and discomfort