Behavioural-Cognition Approach ?

[emad]

Hi all

As i read i meet those words always , i am sure this is related to our work i tried to search pubmed , those abstracts attracted me , however those since 1980s:

Pain. 1986 Feb;24(2):125-41.
Behavioral remediation of chronic pain: a status report.Linton SJ.

The literature concerning the behavioral treatment of chronic pain other than headache was reviewed with particular emphasis on those studies being published since the most recent reviews from 1982. In general, the quality of these studies is much better than those included in the previous reviews. Several studies used broad outcome measures and many studies employed control conditions. The critical examination indicates that the operant program is effective in increasing activity levels and in decreasing medication consumption, and probably also in improving reported levels of pain and mood. Relaxation, in the form of biofeedback, showed mixed results. However, progressive relaxation and relaxation used as a coping strategy, proved to be useful especially in controlling pain ratings. No additional studies of pure 'cognitive' methods were found and the multimodal studies continued to be methodologically problematic. It was concluded that there is substantial evidence for the efficacy of some behavioral treatments for chronic pain. The comparative work suggests that relaxation may be a particularly valuable tool in remediating reported pain intensity. One question is which methods are most effective and economical and it remains for future research to find an answer. The data also suggest that treatment gains tend to be maintained and that patients continue to use assigned techniques although at a lower rate than recommended. Finally, it was pointed out that rehabilitation seldom leads to 100% improvement. Consequently, the need for prevention was stressed.

Soc Sci Med. 1984;19(12):1339-45
Cognitive dimensions of chronic pain.Ciccone DS, Grzesiak RC.

Behavioral interventions have now found widespread acceptance in the treatment of chronic benign pain. Among those with demonstrated therapeutic efficacy are operant conditioning, biofeedback and cognitive-behavior therapy. Since these interventions are based on different assumptions about the etiology of chronic pain, behavioral clinicians are often in the position of using different causal models to justify the use of different treatment procedures. In an effort to address this problem, the present paper proposes an explanatory framework based on the principles of cognitive psychology. Such a framework is parsimonious, empirically-based and offers an internally-consistent approach to understanding the development and maintenance of chronic pain symptoms. An important implication of this approach is that all behavioral interventions may exert an influence on chronic pain through a common mechanism, namely by changing the way clients think about their pain. Specific patterns of dysfunctional thinking are proposed to account for each of the major symptoms of chronic pain. These cognitive patterns include: awfulizing; low frustration tolerance; self-downing; and overgeneralizing. A conceptual analysis of biofeedback and operant conditioning found no evidence to suggest that either modality can effect changes in clients through noncognitive means. It was concluded that behavioral interventions are effective because they facilitate the development of new thinking skills that explicitly challenge the cognitive causes of chronic pain.

Int J Clin Exp Hypn. 1998 Jan;46(1):44-61.
Cognitive aspects of pain and pain control.

Weisenberg M.

Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.

The cognitive and cognitive-behavioral approaches have been shown to be very effective in controlling pain and its sequelae both in the laboratory and in the clinical setting. As used in most research and treatment, cognitive approaches are concerned with the way the person perceives, interprets, and relates to his or her pain rather than with the elimination of the pain per se. This article reviews some of the origins of cognitive theory and pain theory, as well as examples of the techniques used and the research support for the approach. Special emphasis is given to self-efficacy, perceived control, and stress inoculation therapy. There is also discussion of some of the limitations of the cognitive approach. The overall conclusion is that the cognitive approach is a powerful and effective one for pain control despite its limitations.


Is thus has a meaning for us ? :idea:



cheers
emad :lol:

[nari]

emad -

CBT (Cognitive Behaviour Therapy) has been recognised, (as your articles show) for many years as effective for pain management.

The problems are:

We are not trained in basics of CBT.

It really is the territory of the psychologists.

However, for us to manage chronic pain well, we must attend to the patient's attitude, beliefs, mood and so on, or we cannot be as effective as we would like to be. We cannot expect consistent compliance if we only discuss pain physiology and encourage mobility/activity.
I did talk to a psychologist about this, and she did not see it as a problem; she asked if we should obtain basic training first. I agreed the basics should be taught at undergrad level.
But she knew what I meant, and did not feel threatened.

if we all understood the impact of yellow flags on pain, and developed understanding of useful rapport with a patient;
and if we move aside from just the physical assessment only (we need to give physical and emotional input!);

we would, in David Butler's words, become the primary carer/mover/shaker in the management of chronic pain. Not only in the late stages of sensitisation, but also be able to 'pick up' the danger signals in sub-acute stages.

A long way away yet.


Nari :(

[emad]

Hi Nari & Bernard :

Nari

thank you for asking the psychologist you know , all what i feel from dealing with patients , being a patient/sick is no more than attitude firstly (mainly) , if we succed in geeting out with the patient from that cycle , this will make our missionb for easy .

yes we are not trained basiclly to be psychologists , but at least we could discuss with the patient his thinking problems , as this has great direct effect on the physical domian we are treating .

In the town where i live :

Ther is an orthopedist , who refuse to treat fractures , treat only patients with pains , he does no more than speaking ,his private clinic is full with consumers , particularly females , as we this is our continous joke .

cheers
emad :lol:

[emad]

Hi Nari:

I am not trying to take the role of the psychologist , just i want to say it is our mission ,responsibility to speak,explain for the consumer the nature of his problem thus from biliogical,physical point of view , this is have great effect ,particularly if the consumer have wrong ,mis knowledge about his disease .

cheers
emad :lol: :D

[nari]

emad

I agree with you.

Unless we use this biological approach, mixed with that understanding of what can perpetuate the pain, we will be denying our patients the full benefit of our treatment.

It would be good if doctors also did that, but at present they do not, so we should pick up the job.


Nari

[emad]

you are right Nari

cheers
emad :D