A critical review of behavioural treatments for chronic benign pain other than headache.

Studies of the effectiveness of operant, relaxation, cognitive, and multimodal behavioural approaches to the treatment of chronic benign pain other than headache were evaluated. In general, the quality of the studies was poor, and most investigations lacked appropriate and adequate control conditions, outcome measures, and/or follow-ups. While outcome reports for all four behavioural treatments have been mainly positive, few data were found which conclusively demonstrate that any of the approaches are effective or that they are the treatment of choice. The data do, however, imply that behavioural approaches may help patients lead more normal and productive lives. Specifically, the literature suggests that: (1) the operant method leads to increased activity levels and decreased pain and drug intake, (2) the relaxation approach results in decreased EMG levels and some pain reductions, (3) the cognitive techniques are speculative at this time, and (4) the multimodal method regularly produces a variety of improvements, but the diversity of the treatments makes general statements about utility impossible. It is concluded that behavioural treatments for pain are warranted in the clinic and that research dealing with effectiveness and subsequently with component analyses of treatments is badly needed.