Effectiveness of cognitive-behavioral treatment for chronic pain in patients with comorbidities
DOI:
https://doi.org/10.56294/hl2025649Keywords:
Effectiveness, Cognitive-Behavioral Therapy, Chronic PainAbstract
Introduction: although it is well-known that cognitive-behavioral therapy is efficacious for the treatment of chronic pain patients, studies that have evaluated its efficacy lose external validity because the scenario used in these investigations are highly different from natural settings.
Objective: to determine the effectiveness of a cognitive-behavioral treatment for patients with chronic pain in a natural ambulatory setting.
Method: a cuasi experimental design with no control group was implemented, in which a 14-session treatment program was used with 6 patients with chronic pain.
Results: after the treatment participants showed statistically significant reductions on the worst pain experienced and on pain average. Moreover, patients exhibited increments on health-related quality of life related to role limitations due to emotional problems, emotional wellbeing, loss of energy and fatigue and social functioning. Effect size measures revealed to be from moderate to big (d between 0,44 and 0,81).
Conclusion: these results suggest that the treatment program administered showed to be effective to diminish perceived pain and to improve health quality of life among chronic pain patients.
References
1. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):273–83.
2. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014;69(2):153–66.
3. Kröner-Herwig B. Chronischer Schmerz: Psychologische Behandlungsansätze und Stand der Evidenz Psychologische Behandlung des chronischen Schmerzes. Verhaltensther Verhaltensmed. 2014;35(1):57–74.
4. Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–59.
5. Moretti LS. Variables cognitivas implicadas en la experiencia de dolor crónico. Rev Argent Cienc Comport. 2010;2(3):21–9.
6. Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2013;109:5–12.
7. Moseley GL, Vlaeyen JWS. Beyond nociception: the imprecision hypothesis of chronic pain. Pain. 2015;156(1):35–8.
8. Weissenberg M. Cognitive aspects of pain. In: Wall PD, Melzack R, editors. Textbook of pain. New York: Churchill Livingstone; 1999. p. 345–58.
9. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1–9.
10. van Tulder MW, Ostelo R, Vlaeyen JWS, Linton SJ, Morley SJ, Assendelft WJJ. Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine. 2001;26(3):270–81.
11. Afrina R, Karimah A. Cognitive Behavioral Therapy for Chronic Pain. Biomol Health Sci J. 2019;2(2):129–34.
12. Salamanca-Sanabria A, Richards D, Timulak L, Castro-Camacho L, Mojica-Perilla M, Parra-Villa Y. Assessing the efficacy of a culturally adapted cognitive behavioural internet-delivered treatment for depression: protocol for a randomised controlled trial. BMC Psychiatry. 2018;18(53):1–11.
13. Taylor S, Asmundson GJG. Internal and external validity in clinical research. In: McKay D, editor. Handbook of research methods in abnormal and clinical psychology. Thousand Oaks: Sage Publications; 2008. p. 23–34.
14. Chambless DL, Hollon SD. Treatment validity for intervention studies. In: Cooper H, Camic PM, Long D, Panter AT, Rindskopf D, Sher KJ, editors. APA handbook of research methods in psychology. Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological. Washington (DC): American Psychological Association; 2012. p. 529–52.
15. Augustovski FA, Lewin G, García Elorrio E, Rubinstein A. The Argentine-Spanish SF-36 Health Survey was successfully validated for local outcome research. J Clin Epidemiol. 2008;61(12):1279–84.
16. Chapman CR, Syrjala KL. Measurement of pain. In: Loeser JD, editor. Bonica’s management of pain. Philadelphia: Lippincott Williams & Wilkins; 2001.
17. Torres M, Compañ V. La experiencia de dolor. Barcelona: UOC; 2006.
18. Thompson B. Exploratory and confirmatory factor analysis. Washington: American Psychological Association; 2004.
19. León OG, Montero I. Métodos de investigación en psicología y educación. Madrid: McGraw-Hill; 2003.
20. Linton SJ. A review of psychological risk factors in back and neck pain. Spine. 2000;25(9):1148–56
21. Eccleston C, Williams ACD, Morley S; Eccleston, Williams & Morley. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012;(11):CD007407
22. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain. 1999;80(1‑2):1‑13
23. Nicholas MK, Wilson PH, Goyen J. Comparison of cognitive‑behavioral group treatment and an alternative non‑psychological treatment for chronic low back pain. Pain. 1992 Mar;48(3):339‑47
24. Turner JA, Jensen MP. Efficacy of cognitive therapy for chronic low back pain. Pain. 1993 Feb;52(2):169‑78. doi:10.1016/0304‑3959(93)90128‑C
25. Williams A, Eccleston C, Morley S. Psychological therapies for the management of chronic pain in adults. Pain. 1999 Mar;80(1‑2):1‑13. (meta‑analysis included in Williams et al. 2012 discussion)
26. Lunde L, Nordhus IH, Pallesen S. The effectiveness of cognitive and behavioural treatment of chronic pain in the elderly: a quantitative review. J Clin Psychol Med Settings. 2009 Sep;16(3):254‑62. doi:10.1007/s10880‑009‑9162‑y
27. Sharpe L, Sensky T, Timberlake N, et al. A blinded, randomized, controlled trial of cognitive‑behavioural intervention for patients with recent onset seropositive rheumatoid arthritis. Pain. 2001 Jan;89(2‑3):275‑83. doi:10.1016/S0304‑3959(00)00379‑1
28. Moioli B, Merayo LA. Effects of psychological intervention on pain and emotional state of persons with fibromyalgia. Rev Soc Esp Dolor. 2005;12:476‑84.
29. Nicholas MK, Wilson PH, Goyen J. Operant‑behavioural and cognitive‑behavioural treatment for chronic low back pain. Behav Res Ther. 1991;29(1):79‑85.
30. Van‑der Hofstadt Román CJ, Narambuena L, et al. Effects of Mindfulness‑Based Cognitive Therapy for Chronic Pain: A multicenter study. Int J Environ Res Public Health. 2021;18(13):6951. doi:10.3390/ijerph18136951
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Copyright (c) 2025 Luciana Sofía Moretti, Leonardo Adrián Medrano, Zoilo Emilio Garcia-Batista, Morera Luis Pedro, Heinz-Dieter Basler (Author)

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