Psychological Approaches to Pain Relief: 63 Recent Studies

 

 

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Psychological Interventions for Pain:

63 Studies Published in 2013-2016

Kenneth S. Pope, Ph.D., ABPP


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PLEASE NOTE: Another page of this website provides citations and excerpts of meta-analyses of psychological interventions.

I gathered following citations and excerpts to help therapists, counselors, and other clinicians who wish to keep abreast of research studies investigating psychological interventions for pain.

Here are the studies published in 2013-2016:

Akerblom, S., et al. (2015). "The mediating role of acceptance in multidisciplinary cognitive-behavioral therapy for chronic pain." The Journal of Pain 16(7): 606-615. Excerpt: "Accumulated results like these suggest that acceptance of pain may be a general mechanism by which CBT-based treatments achieve improvements in functioning. More specific targeting of pain-related acceptance in treatment may lead to further improvements in outcome…. The results highlight the role of pain-related acceptance as an important treatment process even when not explicitly targeted during treatment."

Bell & Meadows (2013). "Efficacy of a brief relaxation training intervention for pediatric recurrent abdominal pain." Cognitive and Behavioral Practice 20(1): 81-92.  Excerpt: "The intervention consisted of a single 1-hour session including psychoeducation and coaching of breathing retraining; the length, duration, and content of the intervention were designed with a goal of maximum portability to primary-care settings....  This brief intervention was successful in lessening abdominal pain...  The intervention was also successful in decreasing some children's general somatic symptoms."

Birnie, et al. (2014). "Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents." Journal of Pediatric Psychology 39(8): 783-808. Excerpt: "Findings showed strong support for distraction and hypnosis for reducing pain and distress from needle procedures. The quality of available evidence was low, however."

Bloot, L., et al. (2015). "The process of change in pain during cognitive-behavior therapy for chronic fatigue syndrome." The Clinical Journal of Pain 31(10): 914-921.Excerpt: "Pain reduction can partly be explained by a reduction of symptom focusing and increased physical functioning. Additional, yet unknown cognitive-behavioral factors also play a role in the reduction of pain."

Brown & Jones (2013). "Psychobiological correlates of improved mental health in patients with musculoskeletal pain after a mindfulness-based pain management program." The Clinical Journal of Pain 29(3): 233-244. Excerpt: "Improvements were found in the MBPM group relative to the control group in mental health, which related to greater perceived control of pain, but not to reductions in clinical or experimental pain ratings.  Anticipatory and pain-evoked event-related potentials to acute experimental pain were decreased, but sources of these event-related potentials were estimated to be in regions that modulate emotional responses rather than pain intensity. Mental health and perceived control outcomes correlated with reduced anticipatory deactivations of dorsolateral prefrontal and somatosensory cortices."

Brunner, et al. (2013). "Can cognitive behavioural therapy based strategies be integrated into physiotherapy for the prevention of chronic low back pain? A systematic review." Disability and Rehabilitation: An International, Multidisciplinary Journal 35(1): 1-10. Excerpt: "Operant conditioning can be integrated in ambulant physiotherapy practice and is a promising CBT-based strategy for the prevention of chronic LBP."

Buhrman, et al. (2013). "Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial." Behaviour Research and Therapy 51(6): 307-315. Excerpt: "A six month follow-up showed maintenance of improvements. We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain."

Buhrman, et al. (2013). "Guided internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation treatment: Randomized controlled trial." European Journal of Pain 17(5): 753-765. Excerpt: " We conclude that Internet-delivered treatment can be partly effective for persons with residual problems after completed pain rehabilitation.

Burns, J. W., et al. (2015). "Does change occur for the reasons we think it does? A test of specific therapeutic operations during cognitive-behavioral treatment of chronic pain." Excerpt: "Findings indicated that: (1) participants receiving the Relaxation module improved more than other groups in relaxation skills, and improved substantially on other coping skills, as well; (2) participants receiving Exercise and Cognitive Coping modules showed mixed improvements and did not improve more than other groups on exercise use or cognitive coping, respectively; and (3) measures of patient-therapist working alliance and patient expectations of treatment benefit at session three correlated significantly with some coping skills changes."

Burns, J. W., et al. (2015). "Specific and general therapeutic mechanisms in cognitive behavioral treatment of chronic pain." Journal of Consulting and Clinical Psychology 83(1): 1-11. Excerpt: "Because the CBT conditions produced comparable improvements, we combined them. Precontemplation and action attitudes toward pain self-management showed significant quadratic trends over assessments such that 67% and 94.1% (respectively) of total pre–post changes occurred in the first 4 weeks. Outcomes showed only significant linear trends. Cross-lagged regressions revealed that pretreatment-to-4-week changes in action attitudes and 4-week levels of working alliance were related significantly with 4-week-to-posttreatment changes in pain intensity and interference but not vice versa and that 3-week patient expectations were related to 4-week-to-posttreatment changes in interference. Analyses in which mechanism factors were entered simultaneously revealed nonsignificant unique effects on outcomes…. Adopting an action attitude early in treatment may represent a specific CBT mechanism but with effects held largely in common with 2 general mechanisms. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

Bushnell, et al. (2013). "Cognitive and emotional control of pain and its disruption in chronic pain." Nature Reviews Neuroscience 14(7): 502-511. Excerpt: "Chronic pain is one of the most prevalent health problems in our modern world, with millions of people debilitated by conditions such as back pain, headache and arthritis. To address this growing problem, many people are turning to mind–body therapies, including meditation, yoga and cognitive behavioural therapy.... Neural mechanisms [underlie] the modulation of pain by cognitive and emotional states—important components of mind–body therapies. [There is] accumulating evidence that chronic pain itself alters brain circuitry, including that involved in endogenous pain control, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic."

Carmody, et al. (2013). "Telephone-delivered cognitive–behavioral therapy for pain management among older military veterans: A randomized trial." Psychological Services 10(3): 265-275. Excerpt: "This study investigated the effectiveness of telephone-delivered cognitive–behavioral therapy (T-CBT) in the management of chronic pain with older military veterans enrolled in VA primary-care clinics. We conducted a randomized clinical trial comparing T-CBT with telephone-delivered pain education (T-EDU)....  No significant differences were found between the two treatment groups on any of the outcome measures. Both treatment groups reported small but significant increases in level of physical and mental health, and reductions in pain and depressive symptoms. Improvements in all primary outcome measures were mediated by reductions in catastrophizing."

Cederberg, J. T., et al. (2015). "Acceptance as a mediator for change in acceptance and commitment therapy for persons with chronic pain?" International Journal of Behavioral Medicine (Published online in advance of print publication). Excerpt: "In summary, the results suggest that acceptance may have a mediating effect on change in physical functioning in ACT for persons with chronic pain."

Cherkin, Daniel C., et al. "Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial." JAMA 315.12 (2016): 1240-1249.   Excerpt: "Among adults with chronic low back pain, both MBSR and CBT resulted in greater improvement in back pain and functional limitations at 26 and 52 weeks when compared with usual care. There were no meaningful differences in outcomes between MBSR and CBT. The effects were moderate in size, which has been typical of evidence-based treatments recommended for chronic low back pain.4 These benefits are remarkable given that only 51% of those randomized to receive MBSR and 57% of those randomized to receive CBT attended at least 6 of the 8 sessions.  The findings of this study are consistent with the conclusions of a 2011 systematic review,35 which reported that "acceptance-based" interventions such as MBSR have beneficial effects on the physical and mental health of patients with chronic pain, comparable to those of CBT."

Costa & Pinto-Gouveia (2013). "Experiential avoidance and self-compassion in chronic pain." Journal of Applied Social Psychology 43(8): 1578-1591. Excerpt: "Our results suggest that when people with chronic pain are willing to remain in contact with particular private experiences without attempting to control them, they reported less depression, anxiety, and stress,...suggesting the importance of helping people with chronic pain to increase their willingness to pain rather than avoiding it."

Czamanski-Cohen, et al. (2014). "CB-ART—The use of a hybrid cognitive behavioral and art based protocol for treating pain and symptoms accompanying coping with chronic illness." The Arts in Psychotherapy 41(4): 320-328. Excerpt: "We found that the CB-ART protocol is beneficial in reducing distress of women coping with pain, anxiety and depressive symptoms. We also found that the protocol is equally efficacious in individual and group modalities. Art making provides an opportunity to externalize distressing experiences. The concrete nature of the art product provides a platform for examining mental imagery, practicing coping skills, examining and changing maladaptive cognitions and behaviors."

Czamanski-Cohen, J., et al. (2014). "CB-ART—The use of a hybrid cognitive behavioral and art based protocol for treating pain and symptoms accompanying coping with chronic illness." The Arts in Psychotherapy 41(4): 320-328. Excerpt: "We found that the CB-ART protocol is beneficial in reducing distress of women coping with pain, anxiety and depressive symptoms. We also found that the protocol is equally efficacious in individual and group modalities. Art making provides an opportunity to externalize distressing experiences. The concrete nature of the art product provides a platform for examining mental imagery, practicing coping skills, examining and changing maladaptive cognitions and behaviors."

DasMahapatra, P., et al. (2015). "Mediators and moderators of chronic pain outcomes in an online self-management program." The Clinical Journal of Pain 31(5): 404-413. Excerpt: "Compared with controls, experimental participants evidenced significant improvement in pain, emotional functioning, and coping strategies from baseline to follow-up."

Davis, M. C., et al. (2015). "Mindfulness and cognitive–behavioral interventions for chronic pain: Differential effects on daily pain reactivity and stress reactivity." Journal of Consulting and Clinical Psychology 83(1): 24-35. Excerpt: "For individuals with RA, M produces the broadest improvements in daily pain and stress reactivity relative to CBT-P and E. These findings also highlight the utility of a diary-based approach to evaluating the treatment-related changes in responses to daily life."

Donatone (2013). "Focused suggestion with somatic anchoring technique: Rapid self-hypnosis for pain management." American Journal of Clinical Hypnosis 55(4): 325-342. Excerpt: "The focused suggestion with somatic anchoring technique has been used with various types of pain, including somatic pain (arthritis, post-injury pain from bone breaks, or muscle tears), visceral pain (related to irritable bowel disease), and neuropathic pain (related to multiple sclerosis). This technique combines cognitive restructuring and mindfulness meditation with indirect and direct suggestions during hypnosis.... Focused suggestion with somatic anchoring technique is used with both acute and chronic pain conditions when use of long-term medication has been relatively ineffective."

Dysvik, et al. (2013). "Evaluating physical functioning as part of a Cognitive Behavioural Therapy approach in treatment of people suffering from chronic pain." Journal of Clinical Nursing 22(5-6): 806-816. Excerpt: "Findings suggest that our pain management intervention, that includes physical activity designed to help patients to live a healthier life, can have a clinically assessable impact on reducing PI and PS, improving physical functioning and HRQL. Relevance to clinical practice: Training in CBT approaches and inter-professional working in chronic pain may extend the skills of nurses and physiotherapists to improve physical functioning among a group of patients for whom traditional medicine has little to offer."

Ehde, D. M., et al. (2014). "Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research." American Psychologist 69(2): 153-166. Excerpt: "Over the past three decades, cognitive-behavioral therapy (CBT) has become a first-line psychosocial treatment for individuals with chronic pain. Evidence for efficacy in improving pain and pain-related problems across a wide spectrum of chronic pain syndromes has come from multiple randomized controlled trials. CBT has been tailored to, and found beneficial for, special populations with chronic pain, including children and older adults. Innovations in CBT delivery formats (e.g., Web-based, telephone-delivered) and treatments based on CBT principles that are delivered by health professionals other than psychologists show promise for chronic pain problems."

Fales, J., et al. (2015). "Sleep outcomes in youth with chronic pain participating in a randomized controlled trial of online cognitive-behavioral therapy for pain management." Behavioral Sleep Medicine 13(2): 107-123. Excerpt: "Although pain improved with online-CBT, no changes were observed in sleep outcomes. Shorter pretreatment sleep duration was associated with less improvement in posttreatment functioning."

Fisher, et al. (2014). "Systematic review and meta-analysis of psychological therapies for children with chronic pain." Journal of Pediatric Psychology 39(8): 763-782. Excerpt: "35 included studies revealed that across all chronic pain conditions, psychological interventions reduced pain symptoms and disability posttreatment. Individual pain conditions were analyzed separately…. For headache pain, higher treatment dose led to greater reductions in pain. No effect of dosage was found for other chronic pain conditions."

Flor, H. (2014). "Psychological pain interventions and neurophysiology: Implications for a mechanism-based approach." American Psychologist 69(2): 188-196. Excerpt: "A number of psychological pain treatments have been examined with respect to their effects on brain activity, ranging from cognitive- and operant behavioral interventions, meditation and hypnosis, to neuro- and biofeedback, discrimination training, imagery and mirror treatment, as well as virtual reality and placebo applications. These treatments affect both ascending and descending aspects of pain processing and act through brain mechanisms that involve sensorimotor areas as well as those involved in affective-motivational and cognitive-evaluative aspects. The analysis of neurophysiological changes related to effective psychological pain treatment can help to identify subgroups of patients with chronic pain who might profit from different interventions, can aid in predicting treatment outcome, and can assist in identifying responders and nonresponders, thus enhancing the efficacy and efficiency of psychological interventions."

Gardner-Nix, et al. (2014). "Exploring the effectiveness of a mindfulness-based chronic pain management course delivered simultaneously to on-site and off-site patients using telemedicine." Mindfulness 5(3): 223-231. Excerpt: "Program participants showed significant improvements in mental health, pain catastrophizing, and suffering levels, while the controls remained relatively unchanged. Neither group showed significant changes in the physical quality of life measures or usual pain levels. The present study lends support for the effectiveness of mind–body interventions in improving mental health and suffering in chronic pain sufferers seeking help in tertiary pain clinic settings. It also provides evidence for the usefulness of a mindfulness-based program modified specifically for the chronic pain population, and supports its delivery through telemedicine."

Garland, et al. (2014). "Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: Results from an early-stage randomized controlled trial." Journal of Consulting and Clinical Psychology 82(3): 448-459. Excerpt: "Compared with SG participants, participants in MORE evidenced significantly less stress arousal…and desire for opioids…, and were significantly more likely to no longer meet criteria for opioid use disorder immediately following treatment (p = .05); however, these effects were not sustained at follow-up."

Igna, R., et al. (2014). "Mindfulness-based cognitive-behavior therapy (MCBT versus virtual reality (VR) enhanced CBT, versus treatment as usual for chronic back pain. A clinical trial." Journal of Evidence-Based Psychotherapies 14(2): 229-247. Excerpt: "Results show that only the level of pain was significantly lower in the MCBT group than in the PHM group, but the results were not different from the CBT group. Effects were not mediated by the hypothesized variables."

Jegindo, et al. (2013). "Expectations contribute to reduced pain levels during prayer in highly religious participants." Journal of Behavioral Medicine 36(4): 413-426. Excerpt: "Prayer reduced pain intensity by 34 % and pain unpleasantness by 38 % for religious participants, but not for non-religious participants. For religious participants, expectancy and desire predicted 56–64 % of the variance in pain intensity scores, but for non-religious participants, only expectancy was significantly predictive of pain intensity (65–73 %). Conversely, prayer-induced reduction in pain intensity and pain unpleasantness were not followed by autonomic and cardiovascular changes."

Jensen, et al. (2013). "Effects of non-pharmacological pain treatments on brain states." Clinical Neurophysiology.  Excerpt: "Individuals with spinal cord injury and chronic pain were given an EEG and administered measures of pain before and after five procedures (hypnosis, meditation, transcranial direct current stimulation [tDCS], neurofeedback, and a control sham tDCS procedure)....  Each procedure was associated with a different pattern of changes in brain activity, and all active procedures were significantly different from the control procedure in at least three bandwidths.  Very weak and mostly non-significant associations were found between changes in EEG-assessed brain activity and pain.... Different non-pharmacological pain treatments have distinctive effects on brain oscillation patterns. However, changes in EEG-assessed brain oscillations are not significantly associated with changes in pain, and therefore such changes do not appear useful for explaining the benefits of these treatments."

Jensen, M. P. and D. R. Patterson (2014). "Hypnotic approaches for chronic pain management: Clinical implications of recent research findings." American Psychologist 69(2): 167-177. Excerpt: "Clinical trials show that hypnosis is effective for reducing chronic pain, although outcomes vary between individuals.... Neurophysiological studies reveal that hypnotic analgesia has clear effects on brain and spinal-cord functioning that differ as a function of the specific hypnotic suggestions made, providing further evidence for the specific effects of hypnosis."

Kashikar-Zuck, et al. (2013). "Changes in pain coping, catastrophizing, and coping efficacy after cognitive-behavioral therapy in children and adolescents with juvenile fibromyalgia." The Journal of Pain 14(5): 492-501. Excerpt: "A recent randomized multisite clinical trial found that cognitive-behavioral therapy (CBT) was significantly more effective than fibromyalgia education (FE) in reducing functional disability in adolescents with juvenile fibromyalgia (JFM). The primary objective of this study was to examine the psychological processes of CBT effectiveness by evaluating changes in pain coping, catastrophizing, and coping efficacy and to test these changes as mediators of continued improvements in functional disability and depressive symptoms at 6-month follow-up.... Participants in both conditions showeds ignificant improvement in coping, catastrophizing, and efficacy by the end of the study, but significantly greater improvements were found immediately following treatment for those who received CBT. Treatment gains were maintained at follow-up. Baseline to posttreatment changes in coping, catastrophizing, and efficacy were not found to mediate improvements in functional disability or depressive symptoms from posttreatment to follow-up."

Kerns, et al. (2014). "Can we improve cognitive–behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy." Health Psychology 33(9): 938-947. Excerpt: "Participants in this study evidenced a high degree of participation and adherence, but treatment tailored to take into account participant preferences, and that employed motivational enhancement strategies, failed to increase treatment participation over and above SCBT for chronic back pain. Evidence that participation and adherence were associated with positive outcomes supports continued clinical and research efforts focusing on these therapeutic processes"

Kerns, R. D., et al. (2014). "Can we improve cognitive–behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy." Health Psychology 33(9): 938-947. Excerpt: "Participants in this study evidenced a high degree of participation and adherence, but treatment tailored to take into account participant preferences, and that employed motivational enhancement strategies, failed to increase treatment participation over and above SCBT for chronic back pain. Evidence that participation and adherence were associated with positive outcomes supports continued clinical and research efforts focusing on these therapeutic processes."

Kohl, et al. (2013). "Acceptance, cognitive restructuring, and distraction as coping strategies for acute pain." The Journal of Pain 14(3): 305-315. Excerpt: "Acceptance led to a higher increase in pain tolerance than did cognitive restructuring of pain-related thoughts. No differences were detected between either acceptance and distraction or distraction and cognitive restructuring with respect to pain tolerance. Distraction led to lower pain intensity compared to acceptance. Cognitive restructuring did not differ from either acceptance or distraction with respect to pain intensity. As a short-term strategy, cognitive restructuring was not as useful as acceptance in increasing pain tolerance."

Kong, et al. (2013). "Functional connectivity of the frontoparietal network predicts cognitive modulation of pain." Pain 154(3): 459-467. Excerpt: "The experience of pain can be significantly influenced by expectancy (predictive cues). This ability to modulate pain has the potential to affect therapeutic analgesia substantially and constitutes a foundation for nonpharmacological pain relief....  After cue conditioning, visual cues can significantly modulate subjective pain ratings. Functional magnetic resonance imaging results suggested that brain regions pertaining to the frontoparietal network (prefrontal and parietal cortex) and a pain/emotion modulatory region (rostral anterior cingulate cortex) are involved in cue modulation during both pain anticipation and administration stage. Most interestingly...pretest resting state functional connectivity between the frontoparietal network (as identified by independent component analysis) and the rostral anterior cingulate cortex/medial prefrontal cortex was positively associated with cue effects on pain rating changes."

Kratz, et al. (2013). Acceptance of pain in neurological disorders: Associations with functioning and psychosocial well-being. US, American Psychological Association. 58: 1-9. Excerpt: "Chronic pain acceptance has been shown to be related to positive adjustment to chronic pain in patients presenting with pain as a primary problem....  Activity engagement predicted lower pain interference and depression, and greater quality of life and social role satisfaction. Pain willingness predicted less pain interference and depression. Together, the two pain acceptance subscales accounted for more variance in outcomes than did self-reported pain intensity....Findings correspond with the broader pain acceptance literature, although activity engagement appears to be a more robust predictor of adjustment than does pain willingness."

Kristjansdottir, et al. (2013). "A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: Randomized controlled trial." Journal of Medical Internet Research 15(1): 125-146. Excerpt: "A total of 140 women with chronic widespread pain who participated in a 4-week inpatient rehabilitation program were randomized into 2 groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of 1 face-to-face session and 4 weeks of written communication via a smartphone. Participants received 3 smartphone diary entries daily to support their awareness of and reflection on pain-related thoughts, feelings, and activities. The registered diaries were immediately available to a therapist who submitted personalized written feedback daily based on cognitive behavioral principles. Both groups were given access to a noninteractive website after discharge to promote constructive self-management. Outcomes were measured with self-reported questionnaires.... Immediately after the intervention period, the intervention group reported less catastrophizing (mean 9.20, SD 5.85) than the control group (mean 15.71, SD 9.11...), yielding a large effect size.... At 5-month follow-up, the between-group effect sizes remained moderate for catastrophizing..., acceptance of pain..., and functioning and symptom levels....  The results suggest that a smartphone-delivered intervention with diaries and personalized feedback can reduce catastrophizing and prevent increases in functional impairment and symptom levels in women with chronic widespread pain following inpatient rehabilitation."

Liu, et al. (2013). "Effect of brief mindfulness intervention on tolerance and distress of pain induced by cold-pressor task." Stress and Health: Journal of the International Society for the Investigation of Stress 29(3): 199-204. Excerpt: "A number of studies have demonstrated that short-term meditation intervention can lead to greater tolerance and lower pain or distress ratings of experimentally induced pain.... Compared with using spontaneous strategies, the mindfulness intervention significantly improved the participants' pain tolerance and reduced their immersion distress. The distraction strategy also significantly improved the participants' pain tolerance. However, it did not have a significant effect on the participants' level of distress during the immersion period. Our results suggest that brief mindfulness intervention without a therapist's personal involvement is capable of helping people cope with pain induced by the cold-pressor task."

Loreto-Quijada, et al. (2014). "Differential effects of two virtual reality interventions: Distraction versus pain control." Cyberpsychology, Behavior, and Social Networking 17(6): 353-358. Excerpt: "in comparison with the control condition, the VRC intervention significantly increased pain tolerance, the pain sensitivity range, and the degree of time underestimation. It also increased self-efficacy in tolerating pain and led to a reduction in reported helplessness.

Lynch-Jordan, A. M., et al. (2014). "Differential changes in functional disability and pain intensity over the course of psychological treatment for children with chronic pain." Pain 155(10): 1955-1961. Excerpt: "Results showed an overall significant decline in functional disability over time. Although pain scores reduced slightly from pretreatment to posttreatment, the longitudinal decline over treatment was not statistically significant. As expected, the rate of change of disability was significantly more rapid than pain."

McCracken, et al. (2013). ""Decentering" reflects psychological flexibility in people with chronic pain and correlates with their quality of functioning." Health Psychology 32(7): 820-823. Excerpt: "Acceptance and mindfulness-based treatments for chronic pain attempts to alter the impact of pain-related thoughts and feelings on behavior without necessarily changing the thoughts and feelings themselves. A process called 'decentering' appears relevant to these treatments because it includes the capacity to observe thoughts and feelings from a detached perspective, as transient events in the mind, that do not necessarily reflect reality or the self....  Decentering significantly correlated with anxiety, depression, and psychosocial disability. In multiple regression analyses it added a significant increment to explained variance in the prediction of depression and psychosocial disability. Across all measures of functioning, pain acceptance and decentering combined accounted for an average of 23.6% of variance while pain accounted for 2.5%....  People with chronic pain may benefit from the capacity to contact their thoughts and feelings from a perspective as a 'separate observer,' to see them as transient, and to experience them as cognitively 'defused.'"

McCracken, L. M. and K. E. Vowles (2014). "Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress." American Psychologist 69(2): 178-187. Excerpt: "This article reviews the progress of CBT in the treatment of chronic pain and the challenges now faced by researchers and clinicians interested in meeting this need for development. It then focuses in greater detail on areas of development within CBT, namely acceptance and commitment therapy (ACT) and mindfulness-based approaches, areas that may hold potential for future progress."

Miller, Cano, & Wurm (2013). A motivational therapeutic assessment improves pain, mood, and relationship satisfaction in couples with chronic pain. Journal of Pain 14(5): 525-537.  Excerpt: "The current study tested whether a therapeutic assessment improved pain and well-being in couples facing chronic pain.... Couples (N = 47) in which 1 spouse had chronic pain completed surveys about pain, mood, marital satisfaction, and empathy, followed by an interview and an assessment session to which they were randomly assigned: a tailored assessment of their marriage and pain coping that incorporated motivational interviewing strategies, or a control condition that included education about the gate control theory of pain. Multilevel modeling revealed that couples in the motivational assessment group experienced significant decreases in pain severity and negative mood, and increases in marital satisfaction and positive mood from baseline to postassessment, relative to the education control group. All participants experienced increases in empathy toward their partner except for spouses in the control group, who experienced declines in spousal empathy. The motivational assessment and control groups did not experience differential change in any of the variables at 1-month follow-up.... The results provide preliminary evidence for the short-term benefits of a brief motivational assessment to improve psychosocial functioning in both patients and spouses."

Nash, V. R., et al. (2013). "Cognitive behavioral therapy, self-efficacy, and depression in persons with chronic pain." Pain Management Nursing 14(4): e236-e243. Excerpt: "There was a significant increase in self-efficacy after participation in the intensive pain rehabilitation program including CBT-focused groups. Patient groups both before and after introduction of CBT-focused groups showed the same rate of improvement on the depression scores, suggesting that persons who participated in CBT-focused groups improved equally compared with persons who did not participate in these groups. Ninety-three percent of the participants expressed satisfaction with the CBT groups."

Ng & Wong (2013). "The differential effects of gratitude and sleep on psychological distress in patients with chronic pain." Journal of Health Psychology 18(2): 263-271. Excerpt: "These data show much of the effect of gratitude on depression was direct whereas sleep exerted a stronger mediating effect on the gratitude–anxiety link."

Poleshuck, E. L., et al. (2014). "Randomized controlled trial of interpersonal psychotherapy versus enhanced treatment as usual for women with co-occurring depression and pelvic pain." Journal of Psychosomatic Research 77(4): 264-272. Excerpt: "ITT analyses were not significant. In causal modeling analyses, participants assigned to IPT showed significantly more improvement for depression and social interactions, but not for pain….  IPT may be a viable option as part of a comprehensive treatment program for women in medical practices with depression and chronic pain.

Rejeh, N., et al. (2013). "Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery." International Journal of Nursing Practice 19(5): 462-470. Excerpt: "Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control."

Schatz, J., et al. (2015). "Changes in coping, pain, and activity after cognitive-behavioral training: A randomized clinical trial for pediatric sickle cell disease using smartphones." The Clinical Journal of Pain 31(6): 536-547. Excerpt: "CBT coping skills training supported using smartphones can increase coping and reduce pain intensity for children with SCD…"

Seminowicz, D. A., et al. (2013). "Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain." The Journal of Pain 14(12): 1573-1584. Excerpt: "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."

Sharpe, et al. (2013). "A comparison of the effect of mindfulness and relaxation on responses to acute experimental pain." European Journal of Pain 17(5): 742-752. Excerpt: "Analyses confirmed that the threat manipulation was effective in increasing worry, fear of harm and expectations of pain, and reducing coping efficacy. Interaction effects revealed that mindfulness was effective in increasing curiosity and reducing decentring under conditions of high threat but not low threat. Other interactions on cognitive variables (attentional bias to pain and self-focus) confirmed that mindfulness and relaxation appeared to exert influences under different conditions (i.e. mindfulness: high threat; and relaxation: low threat). Despite these cognitive effects being discerned under different conditions, there were no differences between mindfulness and relaxation on pain, tolerance or threshold in either threat group.... These results show that a single, brief session of mindfulness based on body scanning is not sufficient to change the way in which individuals approach an experimental pain task in comparison with relaxation, which has previously been shown to be ineffective."

Silvestrini, N. and P. Rainville (2013, September). "After-effects of cognitive control on pain."  European Journal of Pain, 8. 17.  Excerpt: "The higher order processes involved in self-regulation are generally thought to depend on cognitive (attentional/executive) functions with limited resources. Experimental studies further show that exerting self-control in a first taskresults in decreased performance in other following self-control tasks, which may be interpreted as the consequence of either effective or perceived resource depletion outlasting the first task.... Results revealed that pain was rated higher following the condition requiring higher cognitive control....  These findings suggest that pain regulation mechanisms including the descending pain modulatory system may be less efficient after the performance of tasks requiring high cognitive control resulting in stronger pain experience."

Stewart, M. O., et al. (2015). "National dissemination of cognitive-behavioral therapy for chronic pain in Veterans: Therapist and patient-level outcomes." The Clinical Journal of Pain 31(8): 722-729. Excerpt: "Training in and implementation of CBT-CP in the VA health care system were associated with significant increases in therapist competencies to deliver CBT-CP and improvements in several domains for Veteran patients. Results support the feasibility and effectiveness of broad dissemination of CBT-CP in routine, nonpain specialty settings."

Trost & Parsons (2014). "Beyond distraction: Virtual reality graded exposure therapy as treatment for pain-related fear and disability in chronic pain." Journal of Applied Biobehavioral Research 19(2): 106-126. Excerpt: "In addition to mitigating costs associated with traditional exposure protocols, the VRGET platform facilitates patient treatment engagement, provides real-time assessment of valuable outcome variables such as affective response and kinematic adaptation, and promotes generalizability of treatment gains across clinical and home environments." Ussher, M., et al. (2014). "Immediate effects of a brief mindfulness-based body scan on patients with chronic pain." Journal of Behavioral Medicine 37(1): 127-134. Excerpt: "These data suggest that, in a clinic setting, a brief body scan has immediate benefits for those experiencing chronic pain."

Valentini, et al. (2013). "Hypnotic modulation of pain perception and of brain activity triggered by nociceptive laser stimuli." Cortex: A Journal Devoted to the Study of the Nervous System and Behavior 49(2): 446-462. Excerpt: "Hypnotic suggestions exerted a top−down modulatory effect on both evoked and induced-cortical brain responses triggered by selective nociceptive laser inputs. Furthermore, correlation analyses indicated that gamma power modulation and suggestions of hyperalgesia may reflect the process of allocating control resources to salient and threatening sensory-affective dimensions of pain."

Vallabh, P. K., et al. (2014). "The effect of a cognitive-behavioral therapy chronic pain management program on perceived stigma: A clinical controlled trial." Journal of Pain Management 7(4): 291-299. Excerpt: "Stigmatization was high in our patients. While treatment was successful in reducing anxiety and pain-related disability, CBT had no effect on perceived stigma across groups. Including a family member or friend early in treatment reduced perceived stigma from physicians. Our findings of level of stigmatization in our clinical sample were highly similar to data collected in a clinically and geographically different population. Our outcomes confirmed that stigma is prevalent in chronic pain. Pain-focused CBT, while effective in its declared objectives, did not mitigate the perception of stigma. While helping reduce perceived stigma may be valuable, it appears that a primary focus should also be to educate and change public views toward chronic pain. "

Vowles, K. E., et al. (2014). "Acceptance and commitment therapy for chronic pain: Evidence of mediation and clinically significant change following an abbreviated interdisciplinary program of rehabilitation." The Journal of Pain 15(1): 101-113. Excerpt: "At the 3-month follow-up, 46.2% of patients achieved clinically significant change, and 58.9% achieved reliable change, in at least 1 key measure of functioning (depression, pain anxiety, and disability). Changes in measures of psychological flexibility significantly mediated changes in disability, depression, pain-related anxiety, number of medical visits, and the number of classes of prescribed analgesics. These results add to the growing body of evidence supporting interdisciplinary acceptance and commitment therapy for chronic pain, particularly with regard to the clinical significance of an abbreviated course of treatment."

Walz, et al. (2013). "Graded motor imagery and the impact on pain processing in a case of CRPS." The Clinical Journal of Pain 29(3): 276-279. Excerpt: "Pain intensity decreased over the course of GMI, and relief was maintained at follow-up. fMRI during movement execution revealed marked changes in S1 and S2 (areas of discriminative pain processing), which seemed to be associated with pain reduction, but none in the anterior insula and the anterior cingulate cortex (areas of affective pain processing). After mental rotation training, the activation intensity of the posterior parietal cortex was reduced to one third."

Weiss, et al. (2013). "Acceptance of pain: Associations with depression, catastrophizing, and functional disability among children and adolescents in an interdisciplinary chronic pain rehabilitation program." Journal of Pediatric Psychology 38(7): 756-765. Excerpt: "Significant and strong relations between acceptance, depression, catastrophizing, and functional disability were demonstrated. Participants demonstrated significant increases in acceptance and decreases in depression, catastrophizing, and functional disability. Finally, changes in acceptance significantly predicted changes in depressive symptoms, catastrophizing, and functional disability.... Pain acceptance is an important variable in the treatment of pediatric chronic pain."

Wetherell, J. L., et al. (2015). "Age moderates response to acceptance and commitment therapy vs. Cognitive behavioral therapy for chronic pain." International Journal of Geriatric Psychiatry (Published online in advance of print publication). Excerpt: "Older adults were more likely to respond to ACT, and younger adults to CBT, both immediately following treatment and at 6-month follow-up. There were no significant differences in credibility, expectations of positive outcome, attrition, or satisfaction, although there was a trend for the youngest adults (ages 18–45 years) to complete fewer sessions…. These data suggest that ACT may be an effective and acceptable treatment for chronic pain in older adults."

Wijk, et al. (2013). "Reliability and validity of a continuous pain registration procedure." European Journal of Pain 17(3): 394-401. Excerpt: "Conventional pain rating scales [i.e. visual analogue scales (VAS) or numerical rating scales (NRS)] only provide a summary for different levels of pain felt, while the duration of these levels is not accounted for. If pain can be rated continuously, the area under the curve (AUC) of varying pain intensity over time can be calculated, which integrates varying pain intensity with duration.... In general, participants produced reliable mean AUCs. In addition, the AUC of pain intensity over time could clearly discriminate between the four levels of pain used in the present study.... A continuous pain registration procedure, using an AUC approach, may be a promising direction to explore."

Wohlheiter & Dahlquist (2013). "Interactive versus passive distraction for acute pain management in young children: The role of selective attention and development." Journal of Pediatric Psychology, 2: 38. Excerpt: "Consistent with neurocognitive models of pain, children benefited more from interactive distraction than from passive distraction. Although older children demonstrated superior pain tolerance overall, age and selective attention skills did not moderate children's responses to the distraction intervention.... These findings suggest that younger preschoolers can benefit from interactive distraction to manage acute pain, provided that the distraction activity is developmentally appropriate."

Yoshino, A., et al. (2015). "Effectiveness of group cognitive behavioral therapy for somatoform pain disorder patients in Japan: A preliminary non-case-control study." Psychiatry and Clinical Neurosciences 69(12): 763-772. Excerpt: "We found that pain intensity, anxiety, depressive symptoms, and social functioning all significantly improved after treatment compared with the wait-list period, and the improvements in pain intensity, depressive symptoms, and social functioning were sustained at 12 months following the completion of CBT. There were strong positive correlations (P < 0.01) among pre- and post-treatment changes in the affective dimension of pain, depression, anxiety, and pain catastrophizing. …  These results show that the present CBT program was effective for Japanese patients with somatoform pain disorder and that gains were maintained over the long term."

 

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