Necessary components of psychological treatment in pain management programs: A Delphi study

There are various approaches to the psychological management of chronic pain and it is difficult to know which components of psychological therapies are necessary or desirable for the effective management of chronic pain.

We conducted a Delphi study to develop a consensus on the necessary and desirable psychological intervention strategies for chronic pain management. First, we identified 49 components of treatments that had been used in a treatment evaluated in a randomized controlled trial (RCT) through a systematic review. In the first round of the Delphi process, 23 (32% of 72) authors who had completed RCTs in chronic pain took part. In round 2, these experts plus clinicians working at pain management programs around Australia were invited to take part, and 44 experts completed the study.

The panel agreed that it was necessary to include psycho-education, particularly about pain mechanisms and the role of thoughts in maintaining pain. Cognitive approaches were deemed necessary, although the panel did not specify one particular strategy. Finally, approaches to increase activity were deemed necessary, including the strategies of pacing, goal setting and graded exposure. Relaxation training and relapse prevention were also deemed necessary.

There was a consensus that there were many desirable strategies to include in psychological chronic pain management approaches, but that treatments should include psycho-education, approaches to increase activity and cognitive approaches as a first line of intervention. Where patients fail to benefit from these approaches, experts identified other desirable strategies that could be utilized.

The expert consensus indicated that psycho-education, strategies to increase activity and cognitive therapy strategies were necessary for effective psychological treatment of patients with chronic pain. While other strategies were deemed desirable, psychological treatments should include at least those three components.