Chronic pain treatment: from psychological predictors to implementation.

Abstract

In this thesis, cognitive-behavioural factors were studied based on the Fear-avoidance model (catastrophizing, fear of pain and avoidance behaviour) and, based on recent literature, helplessness and acceptance. All were studied as predictors of chronic pain outcomes (pain intensity, functional disability and depression) and medical, paramedical and multidisciplinary chronic pain treatment effectivity. The results indicate that helplessness and acceptance are important coping factors as they appear to predict chronic pain outcomes and treatment effectivity beyond fear-avoidance factors. Also, the studies indicate that cognitive-behavioural factors predict the intensity of pain experience, functional disability and depression and the effectivity of medical, paramedical as well as multidisciplinary treatment. Based on these results, three recommendations may be formulated: 1. The fear-avoidance model may be extended by including helplessness and acceptance cognitions 2. pre-treatment screening procedures should include cognitive-behavioural factors of fear of pain, catastrophizing, avoidance behaviour, helplessness and acceptance. 3. Chronic pain treatment may benefit by including helplessness and acceptance oriented treatment modules.