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Psychological Therapy for Centralized Pain: An Integrative Assessment and Treatment Model.

Psychosomatic medicine
January 1, 2019
Mark A Lumley et al. (2 authors)
Journal ArticleResearch Support, N.I.H., ExtramuralReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate an integrative psychological treatment model for chronic pain, incorporating mindfulness-based therapies alongside other interventions to address cognitive, behavioral, emotional, and interpersonal factors.

Results Summary

The study suggests that integrating mindfulness skills with tailored pain neuroscience education, emotional processing, and interpersonal changes can substantially reduce or eliminate centralized pain by altering the processes that maintain it. The approach showed potential for greater efficacy when distinguishing centralized pain from peripheral pain and addressing psychological conflicts.

Population

Patients with chronic pain, particularly those with centralized (somatoform or nociplastic) pain.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (7)
InterventionDirectionEndpointPopulationDosageImpactClaim #
cognitive-behavioral and acceptance/mindfulness-based therapies
decrease
chronic pain
patients with chronic pain
-
evidence-based psychological therapies
#1
integrative assessment and treatment model
decrease
centralized pain
patients with centralized pain
-
has the potential to substantially reduce and sometimes eliminate
#2
tailored pain neuroscience education
decrease
pain
patients with centralized pain
-
to achieve pain reduction
#3
cognitive and mindfulness skills
decrease
pain danger alarm mechanism
patients with centralized pain
-
to decrease
#4
behavioral engagement in avoided painful and other feared activities
decrease
pain
patients with centralized pain
-
to achieve pain reduction
#5
emotional awareness and expression
decrease
centralized pain
patients with centralized pain
-
to reverse emotional avoidance and overcome trauma or psychological conflict
#6
adaptive communication
decrease
interpersonal stress
patients with centralized pain
-
to decrease
#7
Abstract

OBJECTIVE: Chronic pain is a significant health problem that is increasing in prevalence, and advances in treatment are needed. METHODS: We briefly review the leading evidence-based psychological therapies for chronic pain-cognitive-behavioral and acceptance/mindfulness-based therapies-and examine several limitations and missing perspectives of these approaches. We review six lesser-known interventions that address these limitations, and we describe our integrative model for psychological assessment and treatment of centralized pain. We present a typical patient and describe how we apply this approach, along with challenges to its implementation and possible solutions to these challenges. RESULTS: Greater pain treatment efficacy may be possible if clinicians: (a) distinguish patients with primarily centralized (i.e., somatoform or nociplastic) pain from those with primarily peripheral (nociceptive, inflammatory, or neuropathic) pain; (b) acknowledge the capacity of the brain not only to modulate pain but also generate as well as attenuate or eliminate centralized pain; (c) consider the powerful role that adverse life experiences and psychological conflicts play in centralized pain; and (d) integrate emotional processing and interpersonal changes into treatment. Our integrative treatment involves delivering a progression of interventions, as needed, to achieve pain reduction: tailored pain neuroscience education, cognitive and mindfulness skills to decrease the pain danger alarm mechanism, behavioral engagement in avoided painful and other feared activities, emotional awareness and expression to reverse emotional avoidance and overcome trauma or psychological conflict, and adaptive communication to decrease interpersonal stress. CONCLUSIONS: This integrative assessment and treatment model has the potential to substantially reduce and sometimes eliminate centralized pain by changing the cognitive, behavioral, emotional, and interpersonal processes that trigger and maintain centralized pain.

Medical Subject Headings (MeSH)
Chronic PainHumansPsychotherapy
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality80/10
Citation Metrics
Total Citations63
Citations/Year10.5
Relative Citation Ratio4.58
NIH Percentile92%
Research Impact Scores
APT Score0.95
Weight Score2.47
Normalized Score0.66
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