Extending Physiotherapy Skills Using a Psychological Approach: Cognitive-behavioural management of chronic pain

A pastoral perspective on the threatening loss of employment The changing employment situation in South Africa is currently characterized by the various challenges it poses to individuals in the workplace, such as affirmative action, voluntary severance packages and discharges. Discharges are often associated with employment insecurity and the threatening loss of employment. A psychological approach to the threatening loss of employment is on its own inadequate. The aim of this article is to investigate the possibilities of a holistic approach as part of pastoral support to persons experiencing the threat of losing their employment. It aims to argue that pastoral care can benefit from a multi- disciplinary approach to the threatening loss of employment. However, pastoral care needs guidelines to facilitate its relationship with psychology and to assist in dealing with faith in the counselling process. This article makes use of Gerkin’s model for pastoral care in order to provide some guidelines for pastoral care for individuals who are experiencing a protracted threat of loss of employment. Gerkin’s model will be brought into dialogue with a cognitive behavioural therapeutic model.

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Pain Management in Context of Emotionally Unstable Personality Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1843 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S500-S500

Author(s):

E. Dobrzynska ◽

N. Clementi

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Personality Disorder ◽

English Language ◽

Opioid Analgesics ◽

Management Options ◽

Cognitive Behavioural ◽

Keywords Chronic Pain ◽

Competing Interest ◽

Emotionally Unstable Personality Disorder

IntroductionEmotionally unstable personality disorder (EUPD) is characterised by Pain Paradox. The response for acute, self-induced pain seems to be attenuated while chronic, endogenous pain is usually intolerable. Pain management of this group of patients poses many difficulties, including discrepancies between subjective and objective pain assessment, patients’ demands for strong analgesics and impact on relationship with other professionals.Objectives and aimsThe purpose of the study was to review pain management options for persons diagnosed with EUPD and complaining of chronic pain.MethodsMEDLINE and PsycINFO databases were searched for all English-language articles containing the keywords “chronic pain”, “pain management”, “borderline personality disorder”, and “emotionally unstable personality disorder”.ResultsSeventeen relevant papers were identified. Suggested first step in pain management was ongoing clarification with EUPD patients that analgesics are unlikely to fully treat their pain and support of non-pharmacological approaches to pain, including cognitive-behavioural strategies. Regarding pharmacology, liberal use of non-addicting analgesics was recommended with highly conservative use of opioid analgesics. Importance of evaluation and treatment of any underlying mood and/or anxiety syndromes was stressed as well as liaison with other professionals (e.g. psychologists, neurologists, orthopaedics, and physiotherapists).ConclusionsPatients with EUPD often report chronic pain, which can only be managed by close collaboration of professionals from different disciplines.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cognitive-behavioural therapy for chronic pain: determining what works for the person in front of you

British Journal of Pain ◽

10.1177/2049463718820054 ◽

2018 ◽

Vol 13 (1) ◽

pp. 4-5

Author(s):

Whitney Scott

Keyword(s):

Chronic Pain ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

What Works ◽

Cognitive Behavioural

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Is the psychological composition of the therapeutic group associated with individual outcomes in group cognitive behavioural therapy for chronic pain?

British Journal of Pain ◽

10.1177/2049463719895803 ◽

2019 ◽

pp. 204946371989580

Author(s):

Dianne Wilson ◽

Shylie Mackintosh ◽

Michael K Nicholas ◽

G Lorimer Moseley ◽

Daniel S J Costa ◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Fear Avoidance ◽

Therapeutic Group ◽

Individual Outcomes ◽

Psychological Attributes ◽

Group Cognitive Behavioural Therapy ◽

Cognitive Behavioural ◽

Mixed Modelling

This study explored whether the psychological composition of a group, with respect to mood, catastrophising, fear of movement and pain self-efficacy characteristics at baseline, is associated with individuals’ treatment outcomes following group cognitive behavioural therapy (CBT)-based programmes for chronic pain. Retrospective analyses of outcomes from two independently run CBT-based pain management programmes (Programme A: N = 317 and Programme B: N = 693) were conducted. Mixed modelling analyses did not consistently support the presence of associations between group median scores of depression, catastrophising or fear avoidance with outcomes for individuals in either programme. These results suggest that the psychological profiles of groups are not robust predictors of individual outcomes in CBT groups for chronic pain. By implication, efforts made to consider group composition with respect to psychological attributes may be unnecessary.

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Cognitive-behavioural interventions

Oxford Textbook of Paediatric Pain ◽

10.1093/med/9780199642656.003.0050 ◽

2013 ◽

pp. 519-530 ◽

Cited By ~ 1

Author(s):

Deirdre E. Logan ◽

Rachael M. Coakley ◽

Brittany N. Barber Garcia

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Practical Problem ◽

Psychological Treatment ◽

Behavioural Therapy ◽

Behavioural Interventions ◽

Empirically Supported ◽

Cognitive Behavioural ◽

Hands On ◽

Cognitive Behavioural Interventions

Cognitive-behavioural therapy (CBT) is the most commonly researched and empirically supported psychological treatment for the management of paediatric pain. CBT is a brief, goal-oriented psychotherapy treatment using a hands-on, practical problem-solving approach (Kendall, 2012). It is based on the concept that thoughts, feelings, and behaviours are causally interrelated. This chapter offers an overview of CBT and its application to pain management, describes specific cognitive-behavioural strategies commonly used for paediatric acute and chronic pain problems, presents the empirical evidence supporting these approaches, and highlights key considerations and emerging directions in the use of CBT and related treatments for paediatric pain.

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Online group pain management for chronic pain: Preliminary results of a novel treatment approach to teletherapy

Journal of Telemedicine and Telecare ◽

10.1177/1357633x19870369 ◽

2019 ◽

pp. 1357633X1987036

Author(s):

Timothy Y Mariano ◽

Limeng Wan ◽

Robert R Edwards ◽

Asimina Lazaridou ◽

Edgar L Ross ◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Group Discussion ◽

Preliminary Investigation ◽

Skills Training ◽

Chronic Pain Patient ◽

Behavioural Therapy ◽

Pain Patient ◽

Cognitive Behavioural ◽

Online Group

Objective This pilot study was designed to determine the feasibility, tolerability, safety, and efficacy of group teletherapy for persons with chronic pain. The aim was to present preliminary outcomes of an open trial of group cognitive behavioural therapy (CBT) teletherapy compared with an in-person chronic pain patient group. Methods We recruited 47 chronic pain patients to participate in an 8-session, 2-hour-per-week, online, structured, CBT-oriented pain management group using WebEx and compared them with 46 subjects who participated in a parallel, content-matched, in-person, weekly group. Both groups included goal setting, skills training, relaxation exercises, group discussion, and practice assignments. All subjects completed baseline measures, which were repeated post-treatment. Those in the online group participated in weekly telephone interviews and rated the perceived helpfulness of the remote group. Results The average age of the online group participants was 54.5 ( ± 14.3) years and 70.2% were female, compared with 59.7 ( ± 13.0) years of age and 57.8% females among the in-person group members. On follow-up, both CBT groups showed modest improvements on the outcome measures. Results of this preliminary investigation comparing online teletherapy with in-person CBT suggest similar benefit. Many participants in the online group rated their experience as very helpful (62.5%; 7–10/10) and most would recommend this programme to others (93.7%; 7–10/10). Discussion Preliminary findings suggest that online group CBT may be as effective in improving coping among persons with chronic pain as in-person groups. More rigorous controlled trials are needed to adequately assess the outcome benefit of online teletherapy for chronic pain.

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