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Pain Management: Cognitive Therapy for Chronic Pain & Fibromyalgia-Abb10
Self-help is typically more cost efficient and can be made available to a greater number of patients than traditional individual therapy. Research has investigated the application of self-help to chronic illnesses in which chronic pain, depressive symptoms, and disability are common. Much of this work has focused on the application of cognitive-behavioral treatment (CBT), which promotes skill development, problem solving, and self-management by using behavioral and cognitive therapies and principles, delivered through a self-help format. Self-help delivered via group formats, workbooks, books, audiotapes, minimal contact formats, telephone delivery systems, and Internet-based delivery systems has been effectively used to reduce pain, pain-related disability, depression, and anxiety in arthritis (Lorig & Holman, 1993; Lorig, Ritter, Laurent, & Fries, 2004), low back pain (Buhrman, Faltenhag, Strom, & Andersson, 2004; Moore, Von Korff, Cherkin, Saunders, & Lorig, 2000; Von Korff et al., 1998), headache (Andersson, Lundstrom, & Strom, 2003; Blanchard et al., 1985; Devineni & Blanchard, 2005; Haddock et al., 1997; Jurish et al., 1983; Strom, Pettersson, &Andersson, 2000), and temporomandibular joint disorder (TMD) (Dworkin et al., 1994; Townsend, Nicholson, Buenaver, Bush, & Gramling, 2001). Self-help appears to achieve reductions in pain and disability primarily through increases in self-efficacy, and these changes can be maintained over long periods. Further, the efficacy of self-help in the form of minimal contact treatment (MCT) has been examined in greatest detail within the headache literature. A metaanalysis of 20 controlled clinical trials concluded that home-based behavioral treatment of headache yields treatment effects that are equivalent or superior to clinic-based treatments (Haddock et al., 1997).
In this article we present a rationale for self-help and focus on a particular type of self-help—minimal contact treatment—that we used to deliver CBT.
Minimal Contact Treatment
Minimal contact interventions have been used as a viable, cost-effective alternative for many chronic headache sufferers, averaging a fivefold increment in cost-effectiveness (Haddock et al., 1997). Therefore, MCT may be more affordable than individual or group therapy for many individuals seeking care. Additionally, MCT produces gains that appear to be as well maintained as an intensive individual protocol (Blanchard et al., 1988). For patients who have limited resources, travel a long distance for specialty care, or are resistant to seeking mental health care, MCT may be particularly useful. We have also found that many of our medical colleagues are interested in having these resources available to their patients who are unable or unwilling to pursue a referral to our outpatient clinic. Overall, the development of brief, self-help-oriented, minimal contact interventions has the potential to increase vastly the number of patients who can successfully access and benefit from these interventions.
Cognitive-Behavioral Therapy for Patients with Chronic Pain
- Lim, J. A., Choi, S. H., Lee, W. J., Jang, J. H., Moon, J. Y., Kim, Y. C., & Kang, D. H. Cognitive-behavioral therapy for patients with chronic pain: Implications of gender differences in empathy. Medicine, (2018), 97(23), e10867. doi:10.1097/MD.0000000000010867
Reflection Exercise #4
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