Biopsychosocial Approaches to Pain Management
Pain experience depends on a complex interaction between various biological, environmental, psychological, and societal factors.
ORLANDO — The 2017 annual meeting of the American Academy of Pain Medicine (AAPM) included a presentation on biopsychosocial approaches for functional pain syndromes.1 It was led by Martin D. Cheatle, PhD, associate professor of psychology at the University of Pennsylvania Perelman School of Medicine, and director of pain and chemical dependency research at the Center for Studies of Addiction there.
According to the biopsychosocial model, pain originates in the nervous system in response to a physiologic stimulus, but an individual's pain experience depends on a complex interaction between various biological, environmental, psychological, and societal factors.2 Studies have shown that pain management programs rooted in this approach, which often include cognitive behavioral therapy (CBT), physical exercise, and medication management, led to reduced pain, increased activity, and improved daily functioning in patients with chronic pain.3,4
The biopsychosocial treatment program for functional pain syndromes covered by Dr Cheatle includes the following components:
· CBT and Acceptance and Commitment Therapy. CBT aims to correct maladaptive cognitive and behavioral patterns that commonly occur in patients with chronic noncancer pain, such as catastrophizing and kinesiophobia. It encourages patients to take a proactive vs passive role in their healing process. The goal of acceptance and commitment therapy (ACT), which is a form of CBT, is to “experience life mindfully and reinforce psychological flexibility” through engagement with its core process, such as defusion, acceptance, and committed action.1 CBT and ACT have been found to improve mood, function, and pain in people with chronic pain.5,6
· Functional restoration includes occupational and physical therapy to help desensitize and reset altered central processing in the brain. In addition, aquatic therapy provides mild compressive force that can reduce edema and assist in weight-bearing of the affected extremity.
Social support has been shown to affect pain intensity and mood in patients with chronic pain.7
· Graded motor imagery (GMI). Dr Cheatle discussed structural and functional changes that occur in the CNS as a result of chronic pain and covered GMI, which is based on these concepts of neuroplasticity. The approach originated 20 years ago and is currently growing in popularity. GMI retrains the way the brain processes pain using specific techniques across 3 phases: laterality training, explicit motor imagery, and mirror therapy. GMI can be tailored to patients with a range of conditions, including chronic regional pain syndromes, amputations, arthritis, and fibromyalgia.
- Cheatle MD. Biopsychosocial approach to assessing and managing patients with functional pain syndromes. Presented at: the American Academy of Pain Medicine 33rd Annual Meeting; March 16-19, 2017; Orlando, Florida.
- Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: The National Academies Press; 2011.
- Cheatle MD, Gallagher RM. Chronic pain and comorbid mood and substance use disorders: a biopsychosocial treatment approach. Curr Psychiatry Rep. 2006;8(5):371-376.
- McCracken LM, Turk DC. Behavioral and cognitive-behavioral treatment for chronic pain: outcome, predictors of outcome, and treatment process. Spine (Phila Pa 1976). 2002;27(22):2564-2573. doi: 10.1097/01.BRS.0000032130.45175.66
- Bernardy K, Klose P, Busch AJ, Choy EH, Häuser W. Cognitive behavioural therapies for fibromyalgia. Cochrane Database Syst Rev. 2013;(9):CD009796. doi: 10.1002/14651858.CD009796.pub2
- Vowles KE, McCracken LM, O'Brien JZ. Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process. Behav Res Ther. 2011;49(11):748-755. doi: 10.1016/j.brat.2011.08.002
- López-Martínez AE, Esteve-Zarazaga R, Ramírez-Maestre C. Perceived social support and coping responses are independent variables explaining pain adjustment among chronic pain patients. J Pain. 2008;9(4):373-379. doi: 10.1016/j.jpain.2007.12.002