Efficacy and cost-effectiveness: A study of different treatment approaches in a tertiary pain centre

Chronic pain is a pervasive problem that affects the patient, their significant others, and society in many ways. The past decade has seen advances in our understanding of the mechanisms underlying pain and in the availability of technically advanced diagnostic procedures; however, the most notable therapeutic changes have not been the development of novel evidenced-based methods, but rather changing trends in applications and practices within the available clinical armamentarium. We provide a general overview of empirical evidence for the most commonly used interventions in the management of chronic non-cancer pain, including pharmacological, interventional, physical, psychological, rehabilitative, and alternative modalities. Overall, currently available treatments provide modest improvements in pain and minimum improvements in physical and emotional functioning. The quality of evidence is mediocre and has not improved substantially during the past decade. There is a crucial need for assessment of combination treatments, identification of indicators of treatment response, and assessment of the benefit of matching of treatments to patient characteristics. Copyright © 2011 Elsevier Ltd. All rights reserved.

This article provides an overview of current research on psychological aspects of persistent pain. It is divided into 3 sections. In section 1, recent studies are reviewed that provide evidence that psychological factors are related to adjustment to persistent pain. This section addresses research on factors associated with increased pain and poorer adjustment to pain (ie, pain catastrophizing, pain-related anxiety and fear of pain, and helplessness) and factors associated with decreased pain and improved adjustment to pain (ie, self-efficacy, pain coping strategies, readiness to change, and acceptance). In section 2, we review recent research on behavioral and psychosocial interventions for patients with persistent pain. Topics addressed include early intervention, tailoring treatment, telephone/Internet-based treatment, caregiver-assisted treatment, and exposure-based protocols. In section 3, we conclude with a general discussion that highlights steps needed to advance this area of research including developing more comprehensive and integrative conceptual models, increasing attention to the social context of pain, examining the link of psychological factors to pain-related brain activation patterns, and investigating the mechanisms underlying the efficacy of psychological treatments for pain. This is one of several invited commentaries to appear in The Journal of Pain in recognition of The Decade of Pain Research. This article provides an overview of current research on psychological aspects of persistent pain, and highlights steps needed to advance this area of research. Copyright 2004 American Pain Society