Behavioral interventions for managing chronic pain.

Behavioral interventions result in reliable improvements for patients with chronic LBP, RA, and OA. It should be emphasized, however, that these interventions rarely eliminate pain. Nevertheless, they often help patients reduce their suffering and health care costs. There also is evidence that preventive efforts may be especially beneficial to patients with recent back injuries (17, 18). There are two major differences between the outcomes produced by behavioral interventions for LBP and those produced by interventions for RA and OA. Interventions for LBP reduce pain and improve function, whereas treatments for RA and OA primarily reduce pain and psychological distress. Furthermore, in contrast to the effects of interventions for LBP, the beneficial outcomes achieved by patients with RA and OA tend to diminish after treatment termination. These differences probably are due to the fact that patients who have chronic LBP do not experience progressive changes in joint and bone tissues. Therefore, greater effort should be devoted to helping patients with RA and OA adapt to changes in disease progression following treatment termination. Keefe and Van Horn (36) have provided a model for improving patients' post-treatment adaptation that currently is being evaluated in a controlled study. Although physicians often wish to refer patients to pain treatment centers or behavioralists who treat chronic pain, they tend to have difficulty judging the quality of care offered by these centers and specialists. When you select a pain treatment center, first determine whether it meets the standards of the Commission on Accreditation of Rehabilitation Facilities (CARF, 101 North Wilmot Road, Suite 500, Tucson, AZ 85711).(ABSTRACT TRUNCATED AT 250 WORDS)