Nerve Blocks and Cognitive Therapy: A Beneficial Failure

The trial by Gale et al (pages 185-189) is a valuable example of a negative result - the sort of finding that is published less often than a positive one. But, we can learn from the failure, both in understanding correct treatment and in planning future trials. Patients were recruited in a clinic where repeated treatment by nerve blocks is used as a palliative measure for chronic pain of all types. They were then offered the choice of entering a group with cognitive behavioural therapy or continuing with nerve blocks. For ethical reasons, patients could freely leave either branch of the trial without prejudice. At the onset, one of 34 patients in the nerve-block group left, while 12 departed from the cognitive therapy group. All 33 patients remaining in the nerve block group completed the eight-week trial, while only four of 34 patients completed it in the cognitive therapy group.

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A Randomized Treatment Study to Compare the Efficacy of Repeated Nerve Blocks with Cognitive Therapy for Control of Chronic Head and Neck Pain

Pain Research and Management ◽

10.1155/2002/509120 ◽

2002 ◽

Vol 7 (4) ◽

pp. 185-189 ◽

Cited By ~ 10

Author(s):

George Gale ◽

David Nussbaum ◽

Peter Rothbart ◽

Beverley Hann ◽

Van Leung ◽

...

Keyword(s):

Cognitive Therapy ◽

Nerve Block ◽

Therapy Group ◽

Depression Scale ◽

Consecutive Series ◽

Block Group ◽

Nerve Blocks ◽

Weekly Treatment ◽

Vas Scores ◽

World Organization

This prospective study compared the efficacy of two antinociceptive modalities: nerve blocks and cognitive therapy. A consecutive series of patients receiving nerve block therapy was invited to take part in a six-week randomized comparison of nerve blocks and cognitive therapy. Sixty-eight of 102 patients approached by telephone agreed to participate. Patients attended eight weekly treatment sessions. Baseline and seven weekly sets of values were recorded. The principal measure of outcome was the Pain on a Visual Analogue Scale (VAS). The secondary measures were the Hospital Anxiety and Depression Scale, and the Activities of Daily Living as measured on the Primary Care Cooperative Information Project/World Organization of National Colleges, Academies (COOP-WONCA) scale. Within the first week, one patient of 34 in the nerve block group withdrew and 12 of 34 in the cognitive therapy group withdrew from the study. After seven weeks, 33 patients in the nerve block group remained in the trial, but only 21 patients completed the questionnaires. Four of 22 patients in the cognitive therapy group completed the trial and their questionnaires. Mean VAS scores in the nerve block group dropped slightly during treatment. Mean VAS scores in the cognitive therapy group rose during the trial. However, the mean VAS score of the remaining four in the last week was below the initial group mean. Patients who had been receiving nerve blocks proved willing to remain in the study if allocated to the nerve block group and unwilling to remain in the cognitive therapy group while foregoing their accustomed treatment.

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An investigation into the efficacy of a cognitive behavioural therapy group for low self-esteem in a primary care setting

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x18000168 ◽

2018 ◽

Vol 11 ◽

Cited By ~ 1

Author(s):

Sarah Beattie ◽

David Beattie

Keyword(s):

Primary Care ◽

Cognitive Behavioural Therapy ◽

Care Setting ◽

Primary Care Setting ◽

Therapy Group ◽

Self Esteem ◽

Behavioural Therapy ◽

Cognitive Behavioural ◽

Mood Group ◽

Group Programme

AbstractSelf-esteem refers to how an individual appraises themselves and is associated with good mental health. A number of studies have identified the efficacy of cognitive behavioural therapy (CBT) in the treatment of low self-esteem based on the formulation and treatment trajectory developed by Fennell (1999). However, there has been little empirical enquiry into the efficacy of the programme delivered in primary care. The current study investigated the effectiveness of a CBT programme for low self-esteem delivered within primary care. Fifty-four participants attended a 9-week ‘Boost Your Mood’ group programme. Paired sample t-tests were conducted on pre- and post-group scores on measures of depression, anxiety and self-esteem. Results indicated that there were statistically significant improvements in levels of depression, anxiety and self-esteem post-treatment. Findings are consistent with the suggestion that group CBT may be effective at increasing levels of self-esteem and reducing levels of depression and anxiety when delivered in a primary care setting.

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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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