Invited Special Review: Psychological Approaches for Managing Chronic Pain

Psychologists have had an important impact on the conceptualization, assessment, and treatment of chronic pain. Their contributions have been in the areas of emotional distress, behavioral limitations, cognitive mediating events, and psychosocial disruption of chronic pain. These foci have enabled them to clarify the multidimensional nature of chronic pain and to support the biopsychosocial framework as a conceptual guide for research and clinical purposes. Clinically, along with members of an interdisciplinary team, psychologists have a key role in the assessment and treatment of patients with chronic pain. Interdisciplinary collaboration allows the team to recognize important interactions between biomedical and psychosocial dimensions and to appreciate a broader conceptualization of patients' problems. The literature documents strong empirical support for operant-behavioral and cognitive-behavioral therapies for the treatment of chronic pain. On the other hand, although widely accepted from a clinical perspective, the use of motivational interviewing and motivational enhancement therapies is more recent and less well documented for use with patients with chronic pain.     

Normal Personality Correlates of Chronic Pain Subgroups

A heterogeneous sample of chronic pain patients was first classified into one of three previously identified subgroups (i.e., dysfunctional, interpersonally distressed, adaptive) using the Multidimensional Pain Inventory (R. D. Kerns, D. C. Turk, & T. E. Rudy, 1985). Multiple differences at the domain and facet levels of the Revised NEO PI-R Personality Inventory (P. T. Costa, Jr. & R. R. McCrae, 1992) were found among the three subgroups of patients. In particular, the interpersonally distressed patients showed a greater degree of Neuroticism and were more introverted. Further analyses revealed that this group had tendencies toward feeling more vulnerable, being less trustful, and experiencing less positive emotions than the other groups. The dysfunctional group of patients was notable in terms of their low activity level and lower Openness (to new experience). Adaptive copers reported being emotionally stable, having a moderate degree of Extraversion, and being open to a wider variety of experiences. These differences may act as mediating influences in differing patient responsiveness to pain management programs.     

Intrinsicalism and Conditionalism about Final Value

The paper distinguishes between two rival views about the nature of final value (i.e. the value something has for its own sake) — intrinsicalism and conditionalism. The former view (which is the one adopted by G.E. Moore and several later writers) holds that the final value of any F supervenes solely on features intrinsic to F, while the latter view allows that the final value of F may supervene on features non-intrinsic to F. Conditionalism thus allows the final value of F to vary according to the context in which F appears. Given the plausible assumption that there is an intimate tie between final values and appropriate attitudinal responses, it appears that conditionalism is the better approach for mainly the following three reasons: First, intrinsicalism is too indiscriminate, which makes it subject to what I call ‘location problems’ of final value. I illustrate this problem by discussing alleged examples of Moorean organic unities. Second, intrinsicalism evokes symptoms of ‘evaluative schizophrenia’. Third, considerations of theoretical economy tell in favour of conditionalism. Thereafter I respond to some recent challenges to conditionalism. An appendix surveys some meritorious implications that conditionalism offers for various substantial versions of such structurally different views about value as monism, pluralism, and particularism.     

How beliefs influence the relative magnitude of pleasure and pain

Loss aversion is an economic assumption about utility—people value giving up a good more than they value getting it. It also has hedonic meaning—the pain of a loss is greater in magnitude than the pleasure of a comparable gain. But value and pleasure are not necessarily identical. We test the hedonic interpretation of loss aversion in experimental markets. With hedonic forecasts, sellers imagine the pain of losing their endowment, and buyers imagine the pleasure of being endowed. With hedonic experiences, sellers rate the pleasure of having the endowment, and buyers rate the pain of being without it. Contrary to loss aversion, predicted pleasure is greater in magnitude than predicted pain, and experienced pleasure surpasses experienced pain. We show that the relative magnitude of pleasure and pain depends on beliefs about the likelihood of outcomes, as well as utilities. Surprise makes gains more pleasurable and losses more painful. With surprising gains and expected losses, pleasure can surpass pain. But when gains and losses are equally likely (or losses are surprising and gains are expected), the opposite pattern can occur. Finally, within‐group and between‐group prices are significantly correlated with hedonic experiences. Sellers who feel better with their endowments assign higher selling prices, and buyers who feel worse about the absence of endowment assign higher buying prices. Despite the fact that hedonic experiences deviate from loss aversion, these emotions predict the endowment effect. Copyright © 2009 John Wiley & Sons, Ltd.     

子宫内膜异位症引起的盆腔疼痛的诊断和治疗

子宫内膜异位症(endometriosis,EMT)是妇科最常见的疾病之一,且发病率呈逐年上升趋势,盆腔疼痛是它常见的症状之一,其发病机制尚未明确,易复发,成为妇科研究的热点和难点。随着对EMT引起盆腔疼痛的发病机理的不断认识,其诊治也相应得到完善和发展。本文从哲学的角度以认识和实践等观点对EMT引起盆腔疼痛的诊断和治疗进展进行综述,以助于临床诊治。     

急腹症疼痛管理新观念——早期止痛

从早期止痛的意义,早期止痛的依据以及传统止痛观念的成因等三个方面论述急腹症早期止痛的必要性和合理性,并探讨早期止痛的策略。提醒医务人员要更新观念,对急腹症患者应尽早实施止痛干预。     

疼痛条件下时间目标对时距估计的影响

本研究采用冷压任务引发疼痛,以健康大学生为被试,试图探讨在疼痛条件下时间目标对时距估计的影响。结果发现：疼痛条件下的时距估计值小于非疼痛条件下时距估计值,疼痛条件下具体时间目标的时距估计值显著大于无目标时距估计值。临床上给患者提供具体的时间目标或许有助于他们应对疼痛。     

基于神经生理学的疼痛测量

疼痛是一种受多重因素影响的复杂主观感受。临床上,疼痛测量主要依赖于患者的主观评价。然而,这种传统的疼痛测量方法具有多方面的局限。近年来,研究者借助生理记录、脑电和功能磁共振等技术,揭示疼痛的神经生理、心理机制,挖掘与疼痛相关的神经生理指标,进而构建有效、客观和精确的疼痛评价体系。在基础研究和临床实践中,这些技术有望弥补传统疼痛测量方法的不足,从而极大推动疼痛测量及其治疗等相关领域研究的发展。     

Automatic processing of pain: the change of implicit pain associations after psychotherapy

This study explores the utility of a pain IAT for the assessment of dysfunctional cognitive beliefs in chronic pain patients before and after a cognitive behaviour therapy. A patient group suffering from chronic pain (N=25) treated with a 4-week cognitive behavioural psychotherapy is compared with an untreated healthy control group (N=27) at two points in time. In addition, both groups completed a self-esteem questionnaire (Rosenberg-scale) and a self-esteem IAT. In the clinical group a questionnaire assessing self-reported pain cognitions was administered. The pain IAT was able to differentiate between chronic pain patients and healthy controls before the treatment. Most important, pain-related implicit associations could be shown to change over the course of treatment in the clinical group of chronic pain patients. Results provide first evidence for an application of the IAT in chronic pain research.     

Chronic Pain and Praying to a Higher Power: Useful or Useless?

In the present study a Swedish sample of 118 persons with chronic pain completed online tests on two occasions in association with treatment trials. A three item subscale measuring praying as a coping strategy was derived from the Coping Strategies Questionnaire (CSQ), but adapted to refer to “a higher power” instead of “God”. Measures of pain and anxiety/depression were also included. Results revealed significant associations between praying and pain interference and impairment. Praying was also associated with anxiety and depression scores. Results also showed that prayer predicted depression scores at follow-up, and that follow-up prayer was predicted by pain interference at first measurement occasion. Overall, if prayer had any relation with the other variables it was in the negative direction of more distress being associated with more praying both concurrently and prospectively.