The literature on cognitive and cognitive-behavioral methods for pain control is selectively reviewed, with particular focus on controlled studies. Such methods include the provision of preparatory information, cognitive coping skills or strategies, the provision of preparatory information plus some form of coping skills instructions or training, prepared childbirth techniques, multifaceted cognitive-behavioral treatment regimens, and stress-inoculation training. Overall, the scientific evidence for the efficacy of cognitive and cognitive-behavioral methods for clinical pain attenuation is somewhat meager, although some encouraging but still tentative results have been obtained. There has been much work on the psychological elements involved in such strategies in the laboratory but there is still little sound information on their use for clinical pain. Several issues emerging from the literature review are discussed, with the need for further controlled evaluations being obvious.

Psychological factors in muscular pain.

Cognitive and cognitive-behavioral methods for pain control: a selective review.

• Empirical studies suggest the following main conclusions: functional somatic symptoms are extremely common; a large proportion appear to be caused by physiologic activity and tend to be aggravated by emotion. Hypochondriacal patients misunderstand the nature and significance of these symptoms and believe that they are evidence of serious disease. Hypochondriasis can be a part of another syndrome, usually an affective one, or it can be a primary disorder. The prevalence differs between cultures and social classes. Constitutional factors, disease in the family in childhood, and previous disease predispose to hypochondriasis. Various stressors can be precipitating events. Selective perception of symptoms, motivated by fear of disease, and subsequent increase in anxiety with more somatic symptoms appear to be links in the vicious cycle of the hypochondriacal reaction. Psychotherapy as well as psychotropic drugs are effective in the treatment of functional somatic symptoms. There are no adequate controlled studies of psychotherapy in hypochondriasis, and the recommended treatments are based on studies with similar disorders. The prognosis of treated hypochondriasis is good in a substantial proportion of patients.

Functional Somatic Symptoms and Hypochondriasis: A Survey of Empirical Studies

Between 60% and 80% of healthy individuals experience somatic symptoms in any one week. About 10% to 20% of a random sample of people worry intermittently about illness. A substantial proportion of patients present physicians with somatic complaints for which no organic cause can be found. Patients who are hypochondriacal do not understand the benign nature of functional somatic symptoms and interpret these as evidence of disease. Hypochondriacal concerns range from common short-lived worries to persistent and distressing fears or convictions of having a disease. Hypochondriasis can be secondary to other psychiatric disorders (eg, melancholia or panic disorder), and hypochondriacal attitudes remit when the primary disorder is successfully treated. Patients with primary hypochondriasis are also anxious or depressed, but the fear of disease, or the false belief of having a disease, persists and is the most important feature of their psychopathology. There are substantial differences among hypochondriacal patients in their personalities and psychopathologies. Psychotherapy as well as psychotropic drugs are effective in the treatment of functional somatic symptoms. There are no adequate controlled studies on the value of psychotherapy in hypochondriasis; the recommended guidelines are based on uncontrolled studies of hypochondriasis and on controlled studies of the psychotherapy in similar disorders. The prognosis of functional somatic symptoms as well as that of hypochondriasis is good in a substantial proportion of patients. ( JAMA 1987;258:2718-2722)

Hypochondriasis and Somatization

9 – Regulation of Pain: The Application of Cognitive and Behavioral Techniques for Prevention and Remediation

The purpose of the present chapter is to examine the utility of a variety of cognitive behavioral treatments designed to enhance tolerance for painful stimuli. The chapter is organized into three main sections. First, before describing the specific coping strategies employed, a brief overview of the phenomenon of pain will be provided. Such an overview underscores the complexity and intractability of this universal experience, and reveals the bases for the traditional therapeutic modalities employed to ameliorate pain.

Psychological factors in muscular pain.

Citations

Cognitive and cognitive-behavioral methods for pain control: a selective review.

Functional Somatic Symptoms and Hypochondriasis: A Survey of Empirical Studies

Hypochondriasis and Somatization

9 – Regulation of Pain: The Application of Cognitive and Behavioral Techniques for Prevention and Remediation

Cognitive Behavioral Techniques in the Management of Pain

Related Papers (5)

The psychological approach to pain.

Psychological control of pain

Association between pain drawing and psychological factors in musculoskeletal chronic pain: A systematic review.

Pain in adolescents with spinal muscular atrophy and Duchenne and Becker muscular dystrophy

Psychological and Physiological Bases of Chronic Pain