Cognitive dimensions of chronic pain.

Behavioral interventions have now found widespread acceptance in the treatment of chronic benign pain. Among those with demonstrated therapeutic efficacy are operant conditioning, biofeedback and cognitive-behavior therapy. Since these interventions are based on different assumptions about the etiology of chronic pain, behavioral clinicians are often in the position of using different causal models to justify the use of different treatment procedures. In an effort to address this problem, the present paper proposes an explanatory framework based on the principles of cognitive psychology. Such a framework is parsimonious, empirically-based and offers an internally-consistent approach to understanding the development and maintenance of chronic pain symptoms. An important implication of this approach is that all behavioral interventions may exert an influence on chronic pain through a common mechanism, namely by changing the way clients think about their pain. Specific patterns of dysfunctional thinking are proposed to account for each of the major symptoms of chronic pain. These cognitive patterns include: awfulizing; low frustration tolerance; self-downing; and overgeneralizing. A conceptual analysis of biofeedback and operant conditioning found no evidence to suggest that either modality can effect changes in clients through noncognitive means. It was concluded that behavioral interventions are effective because they facilitate the development of new thinking skills that explicitly challenge the cognitive causes of chronic pain.