Behavioral remediation of chronic pain: a status report

The literature concerning the behavioral treatment of chronic pain other than headache was reviewed with particular emphasis on those studies being published since the most recent reviews from 1982. In general, the quality of these studies is much better than those included in the previous reviews. Several studies used broad outcome measures and many studies employed control conditions. The critical examination indicates that the operant program is effective in increasing activity levels and in decreasing medication consumption, and probably also in improving reported levels of pain and mood. Relaxation, in the form of biofeedback, showed mixed results. However, progressive relaxation and relaxation used as a coping strategy, proved to be useful especially in controlling pain ratings. No additional studies of pure 'cognitive' methods were found and the multimodal studies continued to be methodologically problematic. It was concluded that there is substantial evidence for the efficacy of some behavioral treatments for chronic pain. The comparative work suggests that relaxation may be a particularly valuable tool in remediating reported pain intensity. One question is which methods are most effective and economical and it remains for future research to find an answer. The data also suggest that treatment gains tend to be maintained and that patients continue to use assigned techniques although at a lower rate than recommended. Finally, it was pointed out that rehabilitation seldom leads to 100% improvement. Consequently, the need for prevention was stressed.