title: Does a combination of intensive cognitive-behavioral pain management and a spinal implantable device confer any advantage? A preliminary examination.
abstract: Research suggests that a combination of a somatic and a psychosocial intervention for chronic noncancer pain should be associated with a better outcome than either alone. This study presents data on a series of 31 patients who underwent sequential treatment with an implantable device targeting pain relief and a cognitive-behavioral pain management program that targeted improved function. A combination of treatments was used as there was a suboptimal response to the initial treatment. There were improvements in a range of outcomes at a long-term follow-up. Significant improvements were found in disability, affective distress, self-efficacy, and catastrophizing, but not in average pain severity. Further analyses failed to demonstrate an order effect. These results support the view that combined somatic and psychosocial interventions can achieve better outcomes than either alone in selected chronic pain patients. This approach requires that psychological assessment is essential before the use of an implantable device. This may not only improve patient selection, but also identify psychosocial factors that may be modified to enhance the effectiveness of invasive interventions. In addition, consideration for an implantable device following a suboptimal response to treatment in a cognitive-behavioral pain management program should include a re-evaluation of the patients' beliefs and use of self-management (coping) strategies before deciding on further treatment options.
authors.affiliation: The University of Sydney Pain Management and Research Center, Royal North Shore Hospital, Sydney, New South Wales, Australia. amolloy@med.usyd.edu.au
authors.forename: Allan R
authors.initials: AR
authors.lastname: Molloy
authors.forename: Michael K
authors.initials: MK
authors.lastname: Nicholas
authors.forename: Ali
authors.initials: A
authors.lastname: Asghari
authors.forename: Lee R
authors.initials: LR
authors.lastname: Beeston
authors.forename: Mohsen
authors.initials: M
authors.lastname: Dehghani
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cousins
authors.forename: Charles
authors.initials: C
authors.lastname: Brooker
authors.forename: Lois
authors.initials: L
authors.lastname: Tonkin
mesh_terms: D000328:Adult; D000344:Afferent Pathways / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001008:Anxiety Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000706:statistics & numerical data; D004599:Electric Stimulation Therapy / Q000379:methods* / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D010148:Intractable Pain / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D010865:Pilot Projects; D011584:Psychology; D013116:Spinal Cord / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine