OBJECTIVE: Current psychological and behavioral therapies for chronic musculoskeletal pain only modestly reduce pain, disability, and distress. These limited effects may be due to the failure of current therapies: a) to help patients learn that their pain is influenced primarily by central nervous system psychological processes; and b) to enhance awareness and expression of emotions related to psychological trauma or conflict. METHODS: We developed and conducted a preliminary, uncontrolled test of a novel psychological attribution and emotional awareness and expression therapy that involves an initial individual consultation followed by 4 group sessions. A series of 72 patients with chronic musculoskeletal pain had the intervention and were assessed at baseline, post-treatment, and 6-month follow-up. RESULTS: Participation and satisfaction were high and attrition was low. Intent-to-treat analyses found significant improvements in hypothesized change processes: psychological attributions for pain, emotional awareness, emotional approach coping, and alexithymia. Pain, interference, depression, and distress showed large effect size improvements at post-treatment, which were maintained or even enhanced at 6 months. Approximately two-thirds of the patients improved at least 30% in pain and other outcomes, and one-third of the patients improved 70%. Changes in attribution and emotional processes predicted outcomes. Higher baseline depressive symptoms predicted greater improvements, and outcomes were comparable for patients with widespread vs. localized pain. CONCLUSION: This novel intervention may lead to greater benefits than available psychological interventions for patients with chronic musculoskeletal pain, but needs controlled testing.
OBJECTIVE: Current psychological and behavioral therapies for chronic musculoskeletal pain only modestly reduce pain, disability, and distress. These limited effects may be due to the failure of current therapies: a) to help patients learn that their pain is influenced primarily by central nervous system psychological processes; and b) to enhance awareness and expression of emotions related to psychological trauma or conflict. METHODS: We developed and conducted a preliminary, uncontrolled test of a novel psychological attribution and emotional awareness and expression therapy that involves an initial individual consultation followed by 4 group sessions. A series of 72 patients with chronic musculoskeletal pain had the intervention and were assessed at baseline, post-treatment, and 6-month follow-up. RESULTS: Participation and satisfaction were high and attrition was low. Intent-to-treat analyses found significant improvements in hypothesized change processes: psychological attributions for pain, emotional awareness, emotional approach coping, and alexithymia. Pain, interference, depression, and distress showed large effect size improvements at post-treatment, which were maintained or even enhanced at 6 months. Approximately two-thirds of the patients improved at least 30% in pain and other outcomes, and one-third of the patients improved 70%. Changes in attribution and emotional processes predicted outcomes. Higher baseline depressive symptoms predicted greater improvements, and outcomes were comparable for patients with widespread vs. localized pain. CONCLUSION: This novel intervention may lead to greater benefits than available psychological interventions for patients with chronic musculoskeletal pain, but needs controlled testing.
Authors: Julie Loebach Wetherell; Niloofar Afari; Thomas Rutledge; John T Sorrell; Jill A Stoddard; Andrew J Petkus; Brittany C Solomon; David H Lehman; Lin Liu; Ariel J Lang; J Hampton Atkinson Journal: Pain Date: 2011-06-17 Impact factor: 6.961
Authors: Brook I Martin; Richard A Deyo; Sohail K Mirza; Judith A Turner; Bryan A Comstock; William Hollingworth; Sean D Sullivan Journal: JAMA Date: 2008-02-13 Impact factor: 56.272
Authors: Lindsey C McKernan; Benjamin N Johnson; Leslie J Crofford; Mark A Lumley; Stephen Bruehl; Jennifer S Cheavens Journal: Clin J Pain Date: 2019-05 Impact factor: 3.442
Authors: Hannah J Holmes; Elyse R Thakur; Jennifer N Carty; Maisa S Ziadni; Heather K Doherty; Nancy A Lockhart; Howard Schubiner; Mark A Lumley Journal: Gen Hosp Psychiatry Date: 2018-05-03 Impact factor: 3.238
Authors: Maisa S Ziadni; Jennifer N Carty; Heather K Doherty; John H Porcerelli; Lisa J Rapport; Howard Schubiner; Mark A Lumley Journal: Health Psychol Date: 2017-11-20 Impact factor: 4.267
Authors: Jennifer N Carty; Maisa S Ziadni; Hannah J Holmes; Janice Tomakowsky; Kenneth Peters; Howard Schubiner; Mark A Lumley Journal: Pain Med Date: 2019-07-01 Impact factor: 3.750