Psychological treatments

Psychological treatments(4) are derived from different theoretical formulations of the aetiology of pain. These include behavioural, cognitive, and psychodynamic approaches that have been developed specifically for the treatment of chronic pain. Other approaches include various forms of 'stress management' including relaxation techniques, biofeedback, and hypnosis. Psychological treatments are rarely used in isolation, either from each other or from additional interventions.

A review of randomized controlled trials of behavioural and cognitive approaches (10> illustrates the problems in assessing outcome because of the different sampling methods, different types of control groups, non-standardized treatment components, and the different assessments and domains of assessment that are included. Despite these limitations, the best studies demonstrate the efficacy of these treatments, resulting in cognitive and behavioural improvements, including increased activity and return to work, as well as reduced pain, use of medication, and health services. These improvements can be sustained during prolonged follow-up periods. The value of relaxation techniques in pain relief is uncertain: although pain ratings tend to be reduced, this is not a consistent finding and in some studies there is similar improvement with control procedures/10'

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