Psychological treatment of chronic pain: a selective review

Chronic pain occurs commonly in patients who have either physical or mental disorders, or both. Almost any psychiatric diagnosis may be involved, but affective and somatoform disorders predominate, together with adjustment disorders and psychological factors affecting physical condition. Psychological treatments for chronic pain have developed rapidly within the last 15 years. Most treatment is provided in the form of multi-faceted 'packages' incorporating a range of methods which are derived from operant or cognitive-behavioural theories. A selective review of these approaches leads to the conclusion that in general there is good evidence for their efficacy, despite the limitations of many research reports. There is still considerable uncertainty about the most effective treatments for different patients with different disorders. The effects on treatment outcome of litigation and compensation and of family factors are briefly considered. Despite the considerable cost resulting from chronic pain there appears to be meagre treatment available in the United Kingdom, particularly for the most severely disabled.